Laparoscopic Robotic Diaphragmatic Plication

To assess the quality of life (QOL) and functional outcome of patients after pancreaticoduodenectomy. Pancreaticoduodenectomy is gaining acceptance and is being performed in increasing numbers for various malignant and benign diseases of the pancreas and periampullary region. There is a general impression that pancreaticoduodenectomy can severely impair QOL and alter normal activities. Only a few small studies have evaluated QOL after pancreaticoduodenectomy. A standard QOL questionnaire was sent to 323 patients surviving pancreaticoduodenectomy who had undergone surgery at The Johns Hopkins Hospital between 1981 and 1997. Thirty items on a visual analog scale were categorized into three domains: physical (15 items), psychological (10 items), and social (5 items). Scores are reported as a percentile, with 100% being the highest possible score. The same QOL questionnaire was also sent to laparoscopic cholecystectomy patients and healthy controls. A separate component of the questionnaire asked about functional outcomes and disabilities. Overall QOL scores for the 192 responding pancreaticoduodenectomy patients in the three domains (physical, psychological, social) were 78%, 79%, and 81%, respectively. These QOL scores were comparable to those of the 37 laparoscopic cholecystectomy patients and the 31 healthy controls. The pancreaticoduodenectomy patients were subgrouped into chronic pancreatitis, other benign disease, pancreatic adenocarcinoma, and other cancers. Patients who underwent resection for chronic pancreatitis and pancreatic adenocarcinoma had significantly lower QOL scores in the physical and psychological domains compared with the laparoscopic cholecystectomy patients and the healthy controls. Common problems after pancreaticoduodenectomy were weight loss, abdominal pain, fatigue, foul stools, and diabetes. This is the largest single-institution experience assessing QOL after pancreaticoduodenectomy. These data demonstrate that as a group, patients who survive pancreaticoduodenectomy have near-normal QOL scores. Many patients report weight loss and symptoms consistent with pancreatic exocrine and endocrine insufficiency. Most patients have QOL scores comparable to those of control patients and can function independently in daily activities.

BackgroundExpert opinion-derived disability weights are widely employed for estimating the global burden of diseases and injuries. For chronic diseases such as soil-transmitted helminthiasis and schistosomiasis, it has been suggested that a patient-based quality of life (QoL) approach should be considered for a more accurate appraisal of disability weights.Methods and ResultsWe carried out a cross-sectional survey and assessed the prevalence and intensity of soil-transmitted helminth infections as well as self-rated QoL indicators among 252 students attending grades 5-8 in two schools (Bulangshan and Pu'er) in Yunnan province, People's Republic of China. Each student provided a single stool sample, which was subjected to duplicate Kato-Katz thick smear readings and a single FLOTAC examination for parasitological diagnosis. Prevalence rates for hookworm, Trichuris trichiura and Ascaris lumbricoides were high in Bulangshan (75.9%, 70.0% and 68.2%), while the respective prevalence rates in Pu'er were 66.9%, 56.5% and 9.2%. Students were interviewed with two standardised questionnaires, the EuroQoL-5 Dimensions (EQ-5D) and ShortForm-12 (SF-12) Health Survey. Impairment in any of the five dimensions of the EQ-5D was reported by 87% of the students. However, no clear differences could be observed between individuals with and those without helminth infections, and there were discrepancies between the two schools. A multivariate logistic regression model revealed no differences between students with varying infection status in the domains of the SF-12 (odds ratio close to 1.0). Somewhat more pronounced, yet not statistically significant differences were observed when end-of-school-term marks were compared with students' helminth infection status: infected individuals had lower marks in Chinese, English and mathematics, but not in sports, compared to their helminth-free counterparts.ConclusionsOur results point to unresolved issues and challenges regarding the cultural appropriateness of the widely used standard QoL questionnaires. Hence, new research is needed to further develop these instruments and to validate them in connection with chronic parasitic diseases.

The grim prognosis that accompanies a diagnosis of a malignant glioma affects quality of life (QOL) as patients attempt to adapt to overwhelming losses. Caregivers also experience negative changes in QOL as responsibilities grow. This pilot study measured the QOL of patients with malignant gliomas prior to tumor progression and the QOL of their caregivers. It examined negative and positive factors that impacted the QOL while highlighting positive factors often overlooked in brain tumor QOL research. Standardized QOL questionnaires and focus groups were utilized. Patients experienced distress in the domains of physical, psychological, and social QOL but in all four of the QOL domains there were also positive outcomes. Caregiver data demonstrated mostly positive outcomes in the four QOL domains except for loved one's declining health and fear that the loved one would die.

With rising numbers of childhood cancer survivors, somatic and socioeconomic outcome as well as health-related quality of life (QoL) gain increasing relevance. Based on the first nationwide German Survey on Life Situation, State of Health, and Quality of Life of Childhood Cancer Survivors, the VIVE survey, we report the outcome of survivors of childhood brain tumors localized in the posterior fossa. Two hundred seventy participants with a median follow-up period of 21.9 years completed a questionnaire on socioeconomic and somatic late effects as well as a standardized QoL questionnaire (European Organisation for Research and Treatment of Cancer QLQ-C30). Comparisons were performed between World Health Organization (WHO) grades I-II, WHO grades III-IV brain tumor survivors (BTS), and the general population adjusting for potential confounders. The socioeconomic and QoL results of WHO grades I-II BTS were largely comparable to the general population, while grades III-IV BTS were at higher risk for significantly worse outcomes. Of WHO grades III-IV BTS, 36.8% were still living with their parents or in assisted living facilities compared with 16.1% of grades I-II BTS and 7.8% of the age-adjusted general population. Of grades III-IV BTS, 60.8% achieved at least an intermediate school degree in comparison to 80.5% of grades I-II BTS and 75.6% of the general population. Grades III-IV BTS developed up to 2 times more somatic late effects than survivors of grades I-II tumors. Derived from a large and homogeneous cohort, these results stress the importance of an appropriate follow-up period focusing not only on physical aspects but encompassing the entire living situation to allow patient-tailored support.

Correlation of Obesity With Patient-Reported Outcomes and Complications After Hip Arthroscopy

92 Background: Although DCF is a standard first line chemotherapy option for advanced GE adenocarcinoma, the regimen is associated with significant toxicity. Even so, time to detriment in quality of life (QoL) was significantly better with parent DCF than CF (Ajani, JCO 2007). Modified DCF (mDCF) has demonstrated less toxicity than parent DCF without compromising efficacy in two phase II studies (Shah, GI ASCO 2010; Kelsen, ASCO 2009). We report the quality of life (QoL) over time of patients receiving mDCF on these two clinical trials. Methods: Patients (pts) treated on two protocols utilizing the mDCF regimen, either alone or in combination with bevacizumab, were administered standard EORTC QoL questionnaires (QLC –C30 version 3), at baseline, 6 weeks, 3, 6, 9 and 12 months (m). Chemotherapy and QoL assessment continued until disease progression. Mean score change from baseline was assessed using Wilcoxon test. Results: 94 eligible pts have been enrolled on both studies; QoL questionnaires are available on 87 pts. 74% are male, median age 58 years (range 28-78), with baseline Karnofsky performance status of 80% (range 70-100). Patient compliance with QoL assessment was high at baseline but diminished with time; 89% of pts completed the questionnaire at baseline and 41% at 12m. There was no significant detriment in EORTC QOL scores (including global health, physical and social functioning and fatigue) during treatment with mDCF (Table). Conclusions: In patients with advanced GE cancer, we observed no detriment in QoL scores in patients receiving mDCF therapy. Specifically, physical and social functioning, fatigue, appetite, and global heath QoL scores were maintained at baseline levels during the first 6 months of therapy, and appear to improve in patients who remained on protocol therapy during the next 6 months of treatment. [Table: see text] No significant financial relationships to disclose.

The concept of quality of life (QOL) is understood as a multidimensional construct made up of physiological, psychological, and social aspects, but their particular weightings for the global QOL are rarely investigated. We examined 1) the general QOL of patients with diabetes, 2) the significance of the individual QOL aspects for the overall assessment of QOL, and 3) the modulating function of coping mechanism and particular personality traits. A total of 116 diabetes patients under intensified insulin therapy were studied, as were 107 patients with inflammatory bowel disease, 66 patients with chronic hepatitis C, and 229 students who served as control subjects. The examination was based on eight standardized QOL and personality questionnaires (354 items) and assessed by means of linear structural regression models (AMOS 3.6). The QOL of diabetes patients appears to be higher than the QOL of other chronically ill patients. Social, psychological, and physical aspects contribute to the overall QOL, although physical complaints receive a comparatively low weighting. Coping behavior and particular personality traits covary with all QOL aspects, giving these variables greater significance for the QOL than the existence of secondary illnesses. The hypothesis that the various factors involved in the multidimensional construct QOL receive different weightings was confirmed, making a simple summary score for the general QOL appear unjustifiable. In addition, all aspects that are commonly understood as parameters of QOL are influenced by external factors, such as coping behavior, based on individual personality characteristics.

Background — Obesity is a condition caused by the interaction of complex factors, which include genetics and behavioral components, such as physical activity and diet. Obesity has a negative impact on physical performance, quality of life (QoL), and health-promoting lifestyle (HPL). The purpose of our study was to investigate the relationship of QoL and HPL with body mass index (BMI) in medical students of Southern Iran. Methods — This cross-sectional study was conducted in 2021 on 536 students in Southern Iran. Data collection was completed using standardized QoL and HPL questionnaires and anthropometric measurements. Data were analyzed by chi-squared test and one-way ANOVA, assuming significance level of p<0.05, using the IBM SPSS Statistics 21 software package. Results — The mean age of study participants was 21.33±2.03 years. Over 88% of them were female; 347 (64.7%) students had normal BMI and 189 (35.3%) had abnormal BMI. Among the dimensions of QoL were physical health (p=0.03), mental health (p<0.001) and general health (p=0.01). We revealed statistically significant differences in students with different BMI levels. Among the dimensions of HPL, stress management (p<0.001), physical activity (p<0.001) and nutrition (p<0.05) exhibited statistically significant differences in groups based on BMI. Conclusion — Based on the results of this study, we concluded that it is necessary to plan multiple interventions, especially in the form of continuous and short-term training courses, and to encourage medical students to pursue a healthy lifestyle, especially in terms of nutrition, physical activity and stress management.

The aim of this study was to evaluate the mid-term outcomes of Oxford Phase 3 unicompartmental knee arthroplasty (UKA) in obese patients in terms of prosthesis survival, progression of lateral compartment arthrosis and functional outcomes. The study included 67 patients, with a body mass index over 30, treated with mobile bearing Oxford Phase 3 UKA for isolated medial osteoarthritis between January 2005 and December 2010. Preoperative and postoperative knee range of motion (ROM) and knee scores (Hospital for Special Surgery, HSS and Oxford knee scores) were compared. Additionally, prostheses were evaluated using Oxford radiographic evaluation criteria at the final follow-up. Mean age was 61 years and mean follow-up was 67.5 months. Insert dislocation occurred in 3 patients (4.5%). Postoperative knee ROM, HSS and Oxford knee scores were significantly improved (p<0.05). There was no sign of prosthesis failure or lateral compartment arthrosis in radiographic evaluation at the final follow-up. Oxford Phase 3 UKA with mobile bearing has good mid-term results in obese patients over 60 years of age.

BackgroundThe obesity epidemic continues to grow and coupled with an ageing population the number of obese patients undergoing transcatheter aortic valve replacement (TAVR) has increased significantly. Morbidly obese (MO) patients...

To evaluate the influence of obesity on outcomes after endovascular aneurysm repair (EVAR). A retrospective analysis was conducted of 80 patients (77 men; mean age 75.0+/-7.6 years) undergoing elective EVAR for abdominal aortic aneurysm (AAA) between 2001 and 2008. Patients were stratified on presence of obesity [body mass index (BMI) >or=30 kg/m(2)). Outcomes in-hospital and during follow-up were compared between obese and non-obese patients. In this cohort, 26 (33%) patients had a BMI >or=30 kg/m(2). Mean BMI in the non-obese group was 25.6 kg/m(2) versus 34.1 kg/m(2) in the obese group (p<0.001). In obese patients, EVAR operating time was longer compared to non-obese patients: 217 versus 177 minutes (p = 0.006). One obese patient died after EVAR (p = 0.325); the combined operative mortality and major complication rate was 8% (n = 2) in the obese group versus 7% (n = 4) in the non-obese group (p = NS). Endoleak occurred in 25% (n = 6) of the obese group versus 14% (n = 7) of the non-obese group (p = 0.261). Postoperative intensive care for >24 hours (65% versus 70%, p = 0.796) and overall length of stay (3.9 versus 3.8 days, p = 0.845) did not differ significantly; neither did all-cause mortality during 2 years of follow-up (p = 0.688). Obesity is associated with extended operation times during EVAR, but increasing BMI appears to have little influence on outcomes after EVAR. A preferential approach to offering EVAR for obese patients may be reasonable.

Background: Currently, compared to program hemodialysis and peritoneal dialysis, kidney transplantation is considered to be the preferred method of renal replacement therapy in patients with end-stage chronic kidney disease (CKD) in terms of patient survival and improvement in their quality of life (QOL). This study aimed to investigate the influence of the post-transplantation period and marital status on the health-related QOL of patients with CKD who underwent kidney transplantation.Methods and Results: A cross-sectional study was conducted among 78 patients who had received a kidney transplant from living related donors in the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation between January and April 2022. Kidney transplant recipients (KTRs) were divided into four groups depending on the time after kidney transplantation: 3, 6, 12 months, and 2 years or more after surgery. The study used 2 questionnaires. The first included questions about the sociodemographic data of patients; the second was the standardized health-related QOL questionnaire SF-36. This study of the QOL of KTRs, residents of the Republic of Uzbekistan, showed an improvement in most scales of physical and mental health components 12 months and 2 years or more after kidney transplantation. On the scales of physical and mental health components, unmarried KTRs had a higher self-assessment of QOL than married KTRs, and among married KTRs, those with children had higher QOL indicators.Conclusion: Clarifying how the time after kidney transplantation and individual sociodemographic and medical factors influence QOL indicators requires further research (including longitudinal studies) in a wider КTR population.

IntroductionCysteamine, a powerful endogenous antioxidant, is produced mostly by the vanin-1 with pantetheinase activity. With regard to glycemic, inflammatory, and redox factors, the current study sought to evaluate the association between the expression of the vanin-1 gene, oxidative stress, and inflammatory and iNOS signaling pathway in obese diabetic patients.MethodsWe enrolled 67 male subjects with an average age of 53.5 ± 5.0 years, divided into 4 groups according to the WHO guideline. We determined their plasma levels of glucose, insulin, IRI, HbA1c, TC, TG, HDL-C, TNF- α, MCP-1, TGF-β1, SOD, CAT, and TBARs, as well as expression of the iNOS and Vanin1 genes.ResultsOverweight and obese class I and II diabetics had significantly higher levels of plasma glucose, insulin, HbA1c, TNF-α, MCP-1, TGF-β1, CAT, and TBAR as well as iNOS and vanin-1 gene expression compared to healthy control individuals. In addition, as compared to healthy control individuals, overweight obese class I and II diabetics’ plasma HDL-C levels and blood SOD activity were significantly lower. In addition, ultrasound and computed tomography showed that the presence of a mild obscuring fatty liver with mild hepatic echogenicity appeared in overweight, class I and II obese diabetic patients.ConclusionThese findings provide important information for understanding the correlation between Vanin 1 and glycemic, inflammatory, and redox factors in obese patients. Furthermore, US and CT analysis were performed to visualize the observed images of fatty liver due to obesity.

Diaphragmatic eventration is an uncommon malady, underdiagnosed and often treated only in emergent situations. Eventration of the diaphragm is best treated by plication of diaphragm with or without meshplasty. Various studies have shown that thoracoscopic plication is as efficient as laparotomy or laparoscopic plication. We present here the report of thoracoscopic diaphragmatic plication for eventration performed in the third trimester of pregnancy in a 28-year-old woman who presented with acute respiratory distress. To our knowledge, we believe this to be the first published case in medical literature.

BackgroundThe prevalence of morbid obesity (MO) is increasing worldwide and consequently increasing numbers of morbidly obese (MO) patients are undergoing transcatheter (TAVR) and surgical (SAVR) aortic valve replacement for severe...