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The role of angioembolization (AE) in patients with benign liver diseases is an area of active research. This study aims to assess any difference in liver resection outcomes in patients with benign tumors dependent on utilization of preoperative AE. A retrospective cohort study of patients undergoing elective liver resections for benign liver tumors was performed using the National Surgical Quality Improvement Program database (2014-2019). Only tumors of 5 cm in size or more were included in the analysis. We categorized the patients based on preoperative AE (AE + versus AE -). The primary outcome measured included bleeding complications within 72 h. The secondary outcomes were to determine predictors of bleeding. After propensity score matching, there were 103 patients in both groups. There was no difference in intraoperative or postoperative blood transfusions within 72 h of surgery (14.6% versus 12.6%; P = 0.68), reoperation (1.9% versus 1.9%; P = 1), or mortality (1.0% versus 0.0%; P = 1) between the two groups. Multivariate regression analysis revealed an open surgical approach (odds ratio [OR]: 4.59 confidence interval [CI]: 2.94-7.16), use of Pringle maneuver (OR: 1.7, CI: 1.26-2.310), preoperative anemia (OR: 2.79, CI: 2.05-3.80), and preoperative hypoalbuminemia (OR: 1.53 [1.14-2.05]) were associated with the need for intraoperative or postoperative blood transfusions within 72 h of surgery. Preoperative AE was not associated with reducing intraoperative or postoperative bleeding complications or blood transfusions within 72 h after surgery. [ABSTRACT FROM AUTHOR]

The incorporation of a 1-y- or 2-y research period during general surgery residency is increasingly common in many academic programs, yet often, it is heterogeneously structured and ill-defined. This survey-based observational study aimed to characterize the perceptions of general surgery program directors (PDs) and residents regarding an in-training, dedicated research sabbatical. Two surveys were conducted using Qualtrics software. One survey was sent to general surgery residency PDs, and the other was sent to general surgery residents currently on a research sabbatical. The primary aim of the survey was to assess the PDs' and research residents' perceptions of the research sabbatical. Seven hundred and fifty-two surveys were analyzed, of which 120 were from PDs and 632 from research residents. Among the residents, 44.1% felt that the research time delayed their surgical training. Regarding research funding, 46.7% of the responding residents said that their residency program funded their research, 30.9% said they acquired funding independently, and 19.1% said that it came from a combination of residency program and independent funding. Finally, regarding how residents found their research opportunity, 42.7% said they found it independently and 53.3% said their program provided it. Research sabbaticals during residency may be considered essential to academic development. However, in this survey-based study, perceptions of research time and its structure varied greatly between PDs and residents. An intentional push toward developing guidelines for research sabbaticals may benefit residency program leadership and residents. [ABSTRACT FROM AUTHOR]

Background: Mucinous cystic neoplasms of the liver (MCN-L) including biliary cystadenomas (BCA) and biliary cystadenocarcinomas (BCAC) are rare cystic lesions that comprise less than 5% of all liver cysts and affect only a small subset of individuals. We herein review the current evidence regarding the clinical presentation, imaging characteristics, tumor markers, pathological findings, clinical management, and prognosis of MCN-L. Methods: A comprehensive review of the literature was performed using MEDLINE/Pubmed and Web of Science databases. In PubMed, the terms "biliary cystadenoma," "biliary cystadenocarcinoma," and "non parasitic hepatic cysts" were queried to identify the most recent data on MCN-L. Results: US imaging, CT, and MRI, as well as consideration of clinicopathological features, are required to appropriately characterize and diagnose hepatic cystic tumors. BCA are premalignant lesions and cannot be reliably differentiated from BCAC based on imaging alone. As such, both types of lesions should be treated with margin-negative surgical resection. Following surgical resection, recurrence is fairly low among patients with BCA and BCAC. Despite having worse long-term outcomes than BCA, the prognosis following surgical resection of BCAC still remains more favorable than other primary malignant liver tumors. Conclusion: MCN-L are rare cystic liver tumors that include BCA and BCAC, which can be difficult to differentiate based on imaging alone. Surgical resection remains the mainstay of management for MCN-L with recurrence being generally uncommon. Future multi-institutional studies are still required to better understand the biology behind BCA and BCAC to improve the care of patients with MCN-L. [ABSTRACT FROM AUTHOR]

Background: Radioembolization (RE) with 90Yttrium (Y90) has generally been used to treat patients with advanced disease. Recent data suggest, however, that RE is also safe and feasible to treat patients with early or intermediate stage disease. We herein review the current evidence regarding the use of RE with Y90 for patients with HCC. Methods: A comprehensive review of the literature was performed using MEDLINE/PubMed and Web of Science databases with a search end date of August 1, 2022. Results: Patients with HCC are often treated according to the BCLC staging system. Among patients with early-stage HCC (BCLC A), intermediate-stage HCC (BCLC B), and advanced-stage HCC (BCLC C), RE with Y90 has demonstrated promising results with comparable overall survival, time to disease progression, and radiological response compared with other standard of care treatment modalities. Moreover, Y90 RE can be used as a downstaging treatment modality for patients with advanced HCC who have a disease burden that is initially outside LT criteria. Radiation lobectomy (RL) has been described as a treatment modality with the intent of treating the ipsilateral liver that harbors the HCC, while also causing compensatory hypertrophy of the future liver remnant (FLR). Conclusion: While initially considered as a palliative option for HCC patients, Y90 RE has emerged as an important part of the multi-modality care of patients with HCC across a wide spectrum of clinical indications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fibrolamellar hepatocellular carcinoma (FLC) is a rare malignancy that primarily affects patients in late adolescence and young adulthood. FLC tumors are characterized by their unique histologic features and a recently discovered genomic alteration, a chimeric fusion protein found in nearly all tumors. This review article provides the latest advancements in diagnosing, imaging, and managing FLC. STUDY DESIGN: A comprehensive systematic review was performed using MEDLINE/PubMed and Web of Science databases, with the end of search date being July 1, 2022, regarding FLC diagnosis, imaging, and management. RESULTS: Surgical resection remains the mainstay of therapy offering a chance for cure; however, given the incidence of metastatic disease at diagnosis and high rates of distant relapse, systemic therapies remain a crucial component of disease control. Unfortunately, few systemic therapies have demonstrated proven benefits. Consequently, recent efforts have galvanized around single-institute or small consortia–based studies specifically focused on enrolling patients with FLC or using agents with a biologic rationale. CONCLUSIONS: FLC has unique demographic, radiologic, and pathologic features. The rarity of these tumors, coupled with the only recent acknowledgment of the genomic abnormality, has likely led to disease underrecognition and deprioritization of collaborative efforts to establish an evidence-based standard of care. Despite R0 resection, most patients experience recurrence. However, surgical resection is feasible for many recurrences and is associated with good survival. The role of chemotherapy is evolving, and further research is required to define its role in managing this disease. The rarity of fibrolamellar hepatocellular carcinoma of these tumors, coupled with the only recent acknowledgment of genomic abnormality, has likely led to disease underrecognition and deprioritization of collaborative efforts to establish an evidence-based standard of care. [ABSTRACT FROM AUTHOR]

Introduction: With the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes. Methods: We performed a retrospective review of the 2014–2019 NSQIP database of all patients undergoing liver resections. Propensity score matching was utilized to match the two groups (chronic steroids vs. no steroids) based on demographics, preoperative laboratory data, and operative findings. The primary outcome measure was mortality. Results: There were 712 patients in the chronic steroid group and 21,751 in the no steroid group. After propensity score matching; there were 420 patients in both groups. Post-match analysis again demonstrated that patients on chronic steroids were at higher risk of cardiac arrest than those not on steroids (OR 2.01, 95% CI 1.02–2.45, p = 0.04). In addition, rates of organ space wound infection (OR 2.66, CI 1.33–5.38, p = 0.03), superficial wound infection (OR 2.79, CI 1.08–5.41, p = 0.035), renal insufficiency (OR 1.25, CI 1.03–1.62, p = 0.02), postoperative sepsis (OR 1.28, CI 1.08–1.82, p = 0.04), DVT (OR 1.7, CI 1.01–2.82, p = 0.04), and bile leakage (OR 1.75, CI 1.24–3.36, p = 0.04) were also increased in patients on steroids. However, the matched cohorts were similar in postoperative mortality rates (OR 0.11, CI 0.6–1.17, p = 0.72). Conclusion: The study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality. [ABSTRACT FROM AUTHOR]

In particular, we observe the recommendations of the Liver Cancer Study Group of Japan and direct the regional lymph node dissection based on the location of the iCCA tumor in the liver and seek to evaluate a minimum of 6 nodes. Specifically, survival was worse among patients with gastrohepatic lymph node metastasis compared with patients who had lymph node metastasis located in the hepatoduodenal, peripancreatic or peri-duodenal area. To this point, the Liver Cancer Study Group of Japan recommends regional lymph node dissection of different lymph node basins depending on whether the iCCA tumor is located on the right or left side of the liver (Fig. [Extracted from the article]

Introduction: Most liver resections performed in the United States are open. With the ever-increasing role of robotic surgery, our study's role is to assess national outcomes based on the surgical approach.Methods: We performed a retrospective analysis of the 2015 National Readmission Database (NRD). We selected patients undergoing open, laparoscopic, and robotic hepatectomy. Propensity score matching was performed to match the three groups in terms of demographics, hospital characteristics, and resection type. Our primary outcome was 6-month readmission rates and associated costs.Results: 3,872 patients were included in the analysis (open = 3,420, laparoscopic = 343, and robotic = 109). Robotic liver resection has lower 6-month readmission rates (18.3%) than the laparoscopic (26.7%) and open (30%) counterparts. The robotic approach was more cost-effective ($127,716.56 ± 12,567.31) than the open ($157,880.82 ± 18,560.2) and laparoscopic approach ($152,060.78 ± 8,890.13) in terms of the total cost which includes cost per readmission.Conclusions: There is a financial benefit of using robotics in terms of cost, hospital length of stay, and readmission rates in patients undergoing liver resection, cost. [ABSTRACT FROM AUTHOR]

Background: Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs. Methods: A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management. Results: HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection. Conclusion: HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms. [ABSTRACT FROM AUTHOR]

Background: A national study analyzing the association between preoperative steroid use and outcomes after pancreatic resections is lacking. The purpose of this study is to evaluate the association between preoperative steroids and outcomes after pancreaticoduodenectomy using a national database. Materials and Methods: A retrospective analysis of patients undergoing pancreaticoduodenectomy was performed using the National Surgical Quality Improvement Program (NSQIP) database (2014–2019). In addition, we utilized propensity score matching to compare patients on preoperative steroids to those who were not. Outcomes measured included 30-day complications and mortality, need for readmission, a prolonged hospital length of stay, delayed gastric emptying, and pancreatic fistula. Results: After propensity score matching, there were 438 patients in the steroid group and 876 patients in the no steroid group. There was no difference in pancreatic fistula (23.8% vs. 21.7%; p-0.3), delayed gastric emptying (21.1% vs.20.1%; p-0.06), major complications (31.8% vs. 30.1%; p-0.1), and mortality (3.5% vs. 3.2%; p-0.6) between the two groups. Conclusion: Glucocorticoids did not reduce the incidence of overall complications, postoperative fistula, and delayed gastric emptying following pancreaticoduodenectomy. [ABSTRACT FROM AUTHOR]

Background: Radiological assessment is an important skill to develop in general surgery training. Therefore, we aimed to determine general surgery residents' points of view on receiving formal radiology didactics. Methods: We performed an anonymous survey of general surgery residents throughout the USA. The survey queried the residents' postgraduate year, training program type, diagnostic radiology education in their training program, as well as the residents' comfort level in interpreting various imaging modalities, followed by a series of images to assess the residents' ability to interpret images showing various surgical disease processes. Results: A total of 365 residents responded to the survey. In total, 76.6% of the respondent states that there is no structured didactic session in their program on radiological studies. However, 66.3% felt that interpretation of radiological images should be used to determine surgical competency and promotion to the next academic year. In terms of accurately reading images—68.7% of the residents were able to read an X-ray showing cecal volvulus correctly, 51.9% were able to read a cholangiogram correctly, and 95.3% were correctly read an X-ray showing free under the diaphragm. Conclusion: Most residents favored having radiological assessments as part of the competency evaluation. Furthermore, a curriculum and inbuilt training structure that aims to ensure residents develop competent clinical image interpretation abilities may enhance the development and retention of such skills, ultimately influencing patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Hepatic adenomas (HA), or hepatocellular adenomas, are benign, solid liver lesions that develop in otherwise normal livers, often in the setting of increased estrogen levels. While considered a benign tumor, there is a risk for substantial complications such as hemorrhage and malignant transformation. We review the diagnosis, classification, and potential therapeutic management options for patients with HA. Methods: A scoping narrative review was conducted based on recent literature regarding classification, diagnosis, and management of HA. Results: While HAs are typically considered benign, complications such as hemorrhage and malignant transformation may occur in approximately 25% and 5% of patients, respectively. Recent advances in imaging and molecular profiling have allowed for the classification of HAs into subtypes allowing for patient risk stratification that helps guide management. Surgical resection should be considered in asymptomatic patients who are male, have an adenoma ≥5 cm in diameter, or have the β-catenin-activated subtype due to an increased risk of hemorrhage and/or malignant transformation. Conclusion: Molecular profiling has aided in the stratification of patients relative to the risk of complications to predict better the potential behavior of HAs. [ABSTRACT FROM AUTHOR]

Background: Guidelines call for cholecystectomy during the index hospitalization for patients with gallstone pancreatitis. Therefore, the study sought to determine the trends for cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) for mild gallstone pancreatitis. Methods: A retrospective analysis of the 2010–2018 Nationwide Readmission Database (NRD) was performed to identify patients with mild gallstone pancreatitis. The primary aim was to identify the trends in the use of cholecystectomy in these patients, and the secondary aim was to assess if ERCP alone was protective against readmission. Results: A total of 510,470 patients with mild gallstone pancreatitis were identified. There has been an increasing trend in ERCP use (25% in 2018 vs. 22% in 2010; p-0.001) and a decline in cholecystectomy (37% in 2018 vs. 46% in 2010; p-0.001) prior to discharge. Multivariate analysis revealed higher 30-day readmission for patients who underwent ERCP without cholecystectomy (odds ratio1.3; 95% confidence interval, 1.1–3.5) during the index admission. Conclusions: There has been a decline in the use of cholecystectomy during index hospitalization for mild gallstone pancreatitis. In addition, ERCP was not protective against 30-day readmission from mild gallstone pancreatitis. [ABSTRACT FROM AUTHOR]

This paper examined how housing prices were determined by some macroeconomic factors in Saudi Arabia. Variables used are Gross Domestic Product Per capita (GDPP), Consumer Prices Index (CPI), and Unemployment Rate (UNEMP). Quarterly data for a period (2014q1 - 2019q4) were collected from publications of Saudi Arabian Monetary Authority (SAMA). The paper followed a descriptive analytical method in which Vector Auto-Regression Analysis (VAR) is employed to capture the dynamic effect of the variables on housing prices. Granger Causality, Variance Decomposition and Impulse response function were also used. The results showed that housing prices were insignificantly and positively related to GDPP, whereas it was negatively related to both (CPI & UNEMP). Only CPI had a significant relationship. The three variables, jointly, had Granger causality on HPI. Variance decompositions reflected that CPI was the variable with the highest explanatory power over the variation of housing prices, followed by GDPP and the UNEMP respectively indicating that CPI was the most influential determinants for housing prices. The findings suggested that Saudi authorities need to pay close attention to the effect of CPI on housing investment, and in view of the relatively large share of that sector, on overall growth. Finally, the paper expects that the results would provide awareness into the relation between housing investment and macroeconomic indicators in other developing countries. [ABSTRACT FROM AUTHOR]

Introduction: The United States Medical Licensing Examination (USMLE) was designed as a universal assessment tool for states to determine physician's medical licensure's candidacy. Recent changes in the USMLE exam have changed the way future surgical residency candidate applications will be reviewed. The survey aimed to assess the effect of changes in USMLE exams—USMLE Step 1 pass/fail, complete dissolution of USMLE clinical skills exam, and the role of holistic review in future surgical residency candidacy selection. Methods: An anonymous online survey was created and distributed to general surgery program directors and coordinators across the USA. The survey aimed to assess attitudes toward changes to USMLE exams and the potential changes with a holistic review of candidate applications. Results: The response rate was 63.7%. Most program directors and coordinators disagree with changing USMLE Step 1 to a pass/fail scoring system. The majority felt that contacts, the medical school's name, and performance in clinical electives and sub-internships would hold more significance. They also believe that a holistic review of application will decrease socioeconomic discrepancies and promote a more diverse and inclusive resident cohort. Conclusion: Step 2 clinical knowledge (CK) will gain more importance in future residency matches because of the change in the scoring system of Step 1. The medical school's name, personal contacts, and clinical performance in rotations will hold more significance. [ABSTRACT FROM AUTHOR]

As the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a viral pandemic, data on the clinical characteristics and outcomes of patients with SARS-CoV-2 infection undergoing solid organ transplant are emerging. The objective of this systematic review was to assess currently published literature relating to the management, clinical course, and outcome of SARS-CoV-2 infection in liver, kidney, and heart solid organ transplant recipients. We conducted a systematic review to assess currently published literature relating to the management, clinical course, and outcome of SARS-CoV-2 infection in liver, kidney, and heart solid organ transplant recipients. Articles published through June 2020 were searched in the MEDLINE, ClinicalTrials.gov , and PubMed databases. We identified 49 eligible studies comprising a total of 403 solid organ transplant recipients. Older age, male sex, and preexisting comorbidities, including hypertension and/or diabetes, were the most common prevailing characteristics among the solid organ transplant recipients. Clinical presentation ranged from mild to severe disease, including multiorgan failure and death. We found an overall mortality rate of 21%. Our analysis suggests no increase in overall mortality or worse outcome in solid organ transplant recipients receiving immunosuppressive therapy compared with mortality in the general surgical population with SARS-CoV-2. Our findings suggest that transplant surgery and its immunosuppressive effects should not be a deterrent to proper surgical care for patients in the SARS-CoV-2 era. [ABSTRACT FROM AUTHOR]

In this article, Forte Genescà and colleagues aimed to determine the relationship between sarcopenia based on several psoas computed tomography (CT)-derived measurements and the 5-year survival after AAA repair [[4]]. After elaborate statistical analysis, they were able to demonstrate that all CT-derived psoas muscle sarcopenia markers were associated with survival after AAA surgery and there was no benefit by combining them with anthropometric measurements rather than using simple quantification of TPA. Comparison between several CT-derived psoas muscle sarcopenia markers for predicting survival after abdominal aortic aneurysm repair. [Extracted from the article]

COVID-19 emerged as a viral pandemic in the year 2019. The practice and scope of surgery and medicine transformed radicially as the virus spread across the world. There is an urgent need to understand the outcomes of COVID-19 infected patients who undergo surgery. We present a comprehensive review of the current literature on the management of surgical patients who develop COVID-19.Findings: Poor outcomes were most frequent in general surgery or oncological surgery patients who were older with chronic comorbidities. In contrast, outcomes among transplant surgery and obstetric patients were not signficantly altered by COVID-19. Surgical societies have released specialty specific guidelines on the managment of patients who require surgical care during the pandemic.Conclusion: COVID-19 is associated with adverse outcomes and increased mortality in surgical patients. Data is currently limited, often restricted to single sites and smaller cohorts. As the sequelae of the virus is better understood, the revisions to the guidelines on managment of surgical patients may help improve outcomes. [ABSTRACT FROM AUTHOR]

Anonymous nondirected living liver donation (ANLLD), sometimes referred to as "altruistic" donation, occurs when a biologically unrelated person comes forward to donate a portion of his/her liver to a transplant candidate who is unknown to the donor. Here, we explore the current status of ANLLD with special consideration of published reports; US experience; impact on donor psychosocial outcomes; barriers to donation; and current global trends with respect to ethical considerations. Between 1998 and 2019, 105 anonymous nondirected living liver donor (ND‐LLD) transplants have been documented in the US Scientific Registry of Transplant Recipients. Sixteen donors (15%) were reported to experience a postoperative complication. Currently, 89 donors remain alive (85%), 16 (15%) have unknown status, and none are confirmed deceased. Although there are only a handful of case series, these data suggest that ANLLD is a feasible option. While there are no liver‐specific data, studies involving anonymous nondirected kidney donors suggest that anonymous donation does not adversely impact psychosocial outcomes in donors or recipients. There are substantial financial burdens and ethical considerations related to ANLLD. Further studies are required to assess donor demographics, psychosocial motivations, long‐term health‐related quality of life, and financial impact of ANLLD. [ABSTRACT FROM AUTHOR]

4‐Amino‐5‐mercapto‐4H‐1,2,4‐triazole derivative 1 was used as a key intermediate for the preparation of 1,2,4‐triazolo[3,4‐b][1,3,4]thiadiazepine derivatives 5a‐d, 12a‐g, and 16 via reactions with the appropriate chalcones 2a‐d, α,β‐unsaturated carbonitrile derivatives 9a‐g and 13, respectively. The identity of the synthesized compounds was elucidated via their spectral data and elemental analysis. Moreover, the sedative‐hypnotic activity of the newly synthesized compounds were evaluated and showed excellent activities especially compounds 12b, 12f, and 16. Also, their structure activity relationship (SAR) was clearly demonstrated and showed that the electron‐donating groups enhance activities while electron‐withdrawing groups decrease activities. The molecular docking of the most active derivative 16 against γ‐amino butyric acid (GABA) receptor was performed by the MOE 2014 0901program. The acquired outcomes demonstrated that the most active compounds could be a helpful model for future structure, adjustment, and examination to build more active analogs. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus infection (HCV) is known as a major public health challenge across the world. There is a positive association between iron accumulation in hepatocytes and increased concentration of serum markers, including ferritin and transferrin. The study has aimed to investigate the responsiveness of increased serum ferritin levels among patients suffering HCV infection. Materials and Methods: The study has recruited 195 patients from the Hamad General Hospital, who were suffering with HCV infection. The clinical characteristics included HCV viral load, biochemical data, and parameters of iron status were evaluated among all the patients. The obtained results were quantitatively analyzed using Microsoft excel 2013. Results: The results revealed that the correlation between HCV and iron accumulation in hepatocytes is significantly interfered by the anti-viral treatment. The mean value of iron for positive PCR was calculated to be 19.93 µmol/L; and for negative PCR, the value was estimated to be 24.61 µmol/L before administration of drug. The iron level was 62.77 µmol/L among the patients with positive PCR, which is within normal range. The decrease in level of ferritin represents negative results after the drug administration. Increased levels of ALT were observed among 37.62 percent of the patients. Conclusions: The patients, suffering from chronic HCV, possess significant association with serum iron levels. [ABSTRACT FROM AUTHOR]

Background: Pyridines have been reported to possess various pharmacological activities. Results: Sodium 3-oxo-3-(2-oxo-2H-chromen-3-yl)prop-1-en-1-olate (2) and sodium 3-oxo-3-(3-oxo-3H-benzo[f]chromen-2-yl)prop-1-en-1-olate (7) were prepared and reacted with 2-cyano-N'-(1-aryl(heteryl)ethylidene)acetohydrazides 3a–d to produce 2-oxo-1,2-dihydropyridine-3-carbonitrile derivatives 5a–d and 9a–d, respectively, in good yields. Also, 3a–d reacted with sodium (2-oxocyclopentylidene)methanolate (11a) or sodium (2-oxocyclohexylidene) methanolate (11b) to yield 2-oxo-tetrahydro-1H-cyclopenta[b]pyridine-3-carbonitriles 13a–d and 2-oxo-hexahydroquinoline-3-carbonitriles 13e–h, respectively. The mechanisms that account for the formation of the products are discussed. Additionally, the structures of all the newly synthesized products are confirmed, based on elemental analysis and spectral data. Several of the newly synthesized compounds are evaluated for their antitumor activity against HEPG2 and their structure activity relationship (SAR) was studied. Conclusions: The results revealed that the pyridine derivatives 5c and 5d (IC50 = 1.46, 7.08 µM, respectively) have promising antitumor activity against liver carcinoma cell line (HEPG2), compared to the reference drug, doxorubicin. [ABSTRACT FROM AUTHOR]

The use of neoadjuvant chemoradiation therapy in patients with pancreatic adenocarcinoma is emerging as an acceptable therapy option. The effects of neoadjuvant therapy on 30 days' outcomes in patients with pancreatic cancer are not well defined in the literature. NSQIP (2009-2012) was used. Only patients with a diagnosis of pancreatic cancer and those who underwent a Whipple were included in the analysis. Patient who underwent neoadjuvant chemoradiation therapy were compared with those who did not receive therapy. Main outcome measures were as follows: complications, ≥2 units of blood transfusions, length of stay, readmission rates, return to the operating room, and 30-day mortality. A total of 1445 patients (395: neoadjuvant chemoradiation and 1050: no neoadjuvant therapy) were identified. The mean age was 67 ± 12 years, and 51 per cent of the patients were male. Neoadjuvant chemoradiation therapy was associated with increase in readmission rates (18% vs 12.2%, P 0.02), unanticipated return to the operating room (2.3% vs 1.1%, P 0.03) with no difference in mortality rates. Neoadjuvant chemoradiation therapy is associated with increase in inhospital complications. These differences in outcomes may be explained by the more advance stage of pancreatic cancer in these subsets of patients. Resource utilization and preoperative rehabilitation are of utmost significance to overcome this rise in complications associated with neoadjuvant chemoradiation therapy. [ABSTRACT FROM AUTHOR]

Background: acne vulgaris is a common chronic inflammatory disease of the pilosebaceous unit, characterized by the formation of non-inflammatory comedones and inflammatory papules, pustules, nodules and cysts. Objective: the aim of this study was to evaluate serum levels of vitamin D in a group of Egyptian patients with acne vulgaris in comparison to controls, in order to shed more light on its possible role in the pathogenesis and detect any relation between vitamin D and acne severity. Patients and Methods: the study recruited 90 subjects, 60 acne vulgaris patients and 30 age and sex matched healthy controls. All patients were subjected to detailed history taking and examination to detect extent and severity of acne vulgaris. Blood samples were taken from all participants to assess serum 25 OH D level. Results: revealed lower serum vitamin D levels in acne patients in comparison to controls, with statistically significant p value (0.009). Serum 25 OH D level showed no significant difference in females than in males in both patients (p = 0.726) and controls in comparison to patients (p = 0.794). There was no significant difference in level of 25 OH D between participants reporting adequate sun exposure and those reporting inadequate sun exposure in patients (p = 0.804) but it was statistically significant p value in controls in comparison to patients (p < 0.001). Conclusion: the present study revealed lower, statistically significant, serum vitamin D levels in acne patients, suggesting a possible role for vitamin D supplementation in acne treatment. [ABSTRACT FROM AUTHOR]

Background: Warts, or verrucae, are benign epithelial proliferations of skin and mucosa caused by infection with human papilloma virus (HPV). They are common skin condition that can range in severity from a minor nuisance that resolves spontaneously to troublesome, chronic condition. Objective: The aim of the present study is to compare between intralesional injection of candida albicans antigen versus intradermal injection as an effective treatment of common warts. Patients and methods: This study included 60 (sixty) patients (adult males and females) were suffering from common warts. The patients were divided into two equal groups of 30 patients each: Group A treated by intradermal injection of candida albicans antigen. Group B treated by intralesional injection of candida albicans antigen in one of their warts (mother wart) which was chosen and marked. The patients were collected from the outpatient's clinics of Dermatology and Venereology Department of Al-Hossein University Hospital. Results: As we compared the response to candida albicans antigen injection, we found a highly significant cure response in intralesional injections over intradermal injections. After 6 months follow up in patients who responded by complete cure (29 patients), there was no recurrence in 26 patients (89.6%) and only 3 cases (10.4%) developed partially recurrence. As regard to side effects there were no side effects in 43 cases (71.7%). Conclusion: candida albicans antigen injection seems to be promising effective and safe remedy for cutaneous warts with good cure rates and excellent safety profile. [ABSTRACT FROM AUTHOR]

The current study in this article concerned with construction of five‐membered heterocycles with multiple heteroatoms as nitrogen and sulfur from readily available starting materials and reagents. Treatment of 1‐(2‐oxo‐2H‐chromene‐3‐carbonyl)‐3‐phenyl‐1H‐pyrazol‐5(4H)‐one with each of phenylisothiocyanate in alcoholic potassium hydroxide and carbon disulfide in basic medium gave rise to a thioanilide and methylthio derivatives, respectively. Treatment of the latter compounds with a variety of hydrazonoyl halides resulted in construction of thiadiazole moiety linked to pyrazole ring. Furthermore, triazole derivatives were synthesized from the thioanilide derivative through its reaction with methyl iodide followed by reaction with hydrazonoyl halides. 5α‐Reductase inhibition activity for the prepared compounds was investigated against the reference drug anastrozole, and the results showed that the inhibition activity of compounds 5g and 11g is more potent than anastrozole. Also compounds bearing triazole moiety is more potent than compounds bearing thiadiazole one. Moreover, the anti‐prostate cancer screening anti‐androgenic bioassay in human prostate cancer cells for the tested compounds was evaluated, and the results showed great inhibition growth and potential antiandrogens. [ABSTRACT FROM AUTHOR]

In the present study, 2‐(2‐oxo‐2H‐chromene‐3‐carbonyl)‐5‐phenyl‐2,4‐dihydro‐3H‐pyrazol‐3‐one was prepared and reacted with various hydrazonoyl halides to give a series of 2‐(2‐oxo‐2H‐chromene‐3‐carbonyl)‐5‐phenyl‐4‐((2‐phenylhydrazono)methyl)‐2,4‐dihydro‐3H‐pyrazol‐3‐one in good yield. Cyclization of the latter hydrazone with POCl3 yielded the respective 3‐(3‐phenyl‐ 4,6‐disubstituted‐1,6‐dihydropyrazolo[3,4‐c]pyrazole‐1‐carbonyl)‐2H‐chromen‐2‐ones. The structures of the newly synthesized compounds were established on the basis of spectroscopic evidences and their alternative syntheses. The newly synthesized compounds were evaluated for their antitumor activities against hepatocellular carcinoma (HepG2) cell line and the results revealed promising activities of compounds 4e, 4c, and 4d with IC50 equal 0.92 ± 0.22, 1.43 ± 0.19, and 2.17 ± 0.21 μM, respectively. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is an acquired pigmentary disorder of the skin, resulting from a loss of functioning epidermal melanocytes. Multiple pathogenetic factors have been proposed, including the neural theory, genetic predisposition and impaired anti-oxidative defense. Objective: To evaluate the role of interleukin-6 in pathogenesis of vitiligo and the effect Narrow band-UVB on IL-6 serum levels. Patients and Methods: The study included 30 patients with vitiligo and 30 healthy controls. Each was submitted to thorough history taking, complete general, dermatological examinations including VASI score, and assessment of serum interleukin-6 before and after 16 sessions of NB-UVB. Results: Results of this study showed no statistical significant difference between patients and control as regard age and gender. Our study revealed a statistically significant difference between levels of IL-6 in patients group before and after therapy. Conclusion: Knowing exactly the role of IL-6 is important not only to clarify the pathogenesis of this disease, but also to improve the clinical course of vitiligo (i.e., disease stabilization and/or repigmentation) and the quality-of-life of patients. [ABSTRACT FROM AUTHOR]

Ocular adnexal lymphoma and intraocular lymphoma, whether occurring simultaneously or sequentially, are often similar to associated systemic lymphoma. We describe 4 cases of ocular adnexal lymphoma or intraocular lymphoma with a dissimilar systemic lymphoma. Two of the cases represent Richter transformation of chronic lymphocytic leukemia/small-cell lymphoma into diffuse large B-cell lymphoma. In the third patient, conjunctival extranodal marginal zone lymphoma developed following treatment for Hodgkin lymphoma. The fourth patient had a remote history of systemic diffuse large B-cell lymphoma with a subsequent diagnosis of orbital extranodal marginal zone lymphoma. Clinical-pathological correlation is reported for all cases in addition to pertinent review of the literature. [ABSTRACT FROM AUTHOR]

The constant growth of medical knowledge and the increases in specialization in clinical practice have created a significant need to share and access patient information with speed and efficiency. However, current technology is centered on processing data, rather than gathering information. To realize the potential of modern technology in improving patient health, merely collecting and storing data are insufficient: one must convert these data into information and knowledge. In this article, I present an overview of 2 recent advances in technology and their assimilation into the practice of medicine, in the attempt to make clinical data meaningful and then to learn from aggregated clinical data. We address the emergence of clinical data warehouses (CDWs) and health information exchanges (HIEs), as features of the Health Information Technology for Economic and Clinical Health (HITECH) Act. This act, enacted in the United States as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology. [ABSTRACT FROM AUTHOR]

Palm fatty acid distillate (PFAD) is a by-product from the refining of crude palm oil. It comprises mainly of free fatty acids, having around 45% of palmitic and 33% oleic acid as the major components. It has been used as raw material in the making of soap, oleo chemicals and animal feed. This paper reports the synthesis of a urethane acrylate resin from PFAD. A hydroxyl terminated PFAD-based macromer was first prepared with molecular weight (Mw) around 6800 and acid value of 9.8 mgKOH/g and then copolymerized with 2-hydroxylethyl acrylate (2HEA) and toluene diisocynate (TDI). The urethane acrylate resin was produced from further reactions with TDI and characterized by Gel Permeation Chromatography (GPC) and % isocyanate (NCO) by titration. The urethane acrylate resin has Mw 12500 and less than 0.03% NCO. The resin could be cured by Ultra Violet (UV) irradiation using metal halide lamp at intensity of 225mW/cm². The reactions could be followed by Fourier transform infrared spectroscopy (FTIR) equipped with Attenuated Total Reflectance (ATR) by monitoring the peak at 810 cm-1 due to the unsaturation of the acrylate group. Glass transition temperature (Tg) of the cured film was measured by differential scanning calorimeter (DSC), and hardness of the film was determined by pendulum hardness tester according to ASTM4366. Crosslinking reactions initiated by UV irradiation have caused the decrease in unsaturation, while Tg has increased from 15° to 54°C and pendulum hardness of the film has increased from initial 15 to 105 s. The materials could potentially be applied as industrial wood coatings. [ABSTRACT FROM AUTHOR]

Cryptococcal intraocular infection is a rare disease and is usually associated with generalized systemic disease in immunocompromised patients. The diagnosis may be difficult because of the rarity of this disease and its similarities to other uveitic entities. We describe a case of culture-positive cryptococcal iridociliary granuloma diagnosed by anterior chamber tap and fine-needle aspiration biopsy in a 60-year-old immunocompetent woman with acute granulomatous uveitis. She was treated successfully with systemic amphotericin B and fluconazole and intravitreal amphotericin B, with improvement in the inflammation and visual acuity and regression of the iridociliary granuloma. We review previously reported cases of intraocular cryptococcal infection. Cryptococcal iridociliary granuloma should be considered in the differential diagnosis of an atypical iridociliary mass associated with acute uveitis. [ABSTRACT FROM AUTHOR]

A 72-year-old man presented after a single choroidal mass was incidentally detected on fundus examination of his right eye. The patient has a history of multiple myeloma and neuroendocrine thymoma diagnosed 6 and 10 years before presentation, respectively. Fine-needle aspiration biopsy revealed metastatic choroidal carcinoid tumor. The patient was subsequently treated with brachytherapy (iodine-125). [ABSTRACT FROM AUTHOR]

The usefulness of non-steroidal anti-inflammatory drugs (NSAIDs) is hampered by their gastrointestinal side effects. Non-selective cyclooxygenases inhibitors interfere with both COX-1 and COX-2 isozymes. Since COX-1 mediates cytoprotection of gastric mucosa, its inhibition leads to the undesirable side effects. On the other hand, COX-2 is undetectable in normal tissues and selectively induced by inflammatory stimuli. Therefore, it is strongly believed that the therapeutic benefits derive from inhibition of COX-2 only. The presence of a strong connection between reported COX-2 inhibitors and cardiac toxicity encourages medicinal chemists to explore new scaffolds. In the present study, we introduced imidazopyrazolopyridines as new potent and selective COX-2 inhibitors that lack the standard pharmacophoric binding features to hERG. Starting from our lead compound 5a, structure-based drug-design was conducted and more potent analogues were obtained with high COX-2 selectivity and almost full edema protection, in carrageenan-induced edema assay, in case of compound 5e. Increased bulkiness around imidazopyrazolopyridines by adding a substituted phenyl ring(s) afforded less active compounds. [ABSTRACT FROM AUTHOR]

Introduction: Iatrogenic bile duct injury is a serious complication of cholecystectomy. The aim of this study was to assess predictors of bile duct injury using a national database. Methods: The Nationwide Inpatient Sample (2010-2012) was queried for laparoscopic cholecystectomy. We used a) diagnoses for bile duct injury and b) bile duct injury repair procedure codes as a surrogate marker for bile duct injuries. Results: A total of 1,015 patients had bile duct injury. The mean age was 58.2 ± 19.7 years, 53.5 % were males, and median Charlson co-morbidity score was 2 [, ]. Multivariate analysis revealed morbid obesity [2.8 (2.1-4.3); p = 0.03] and age >65 [1.5 (1.05-2.1); p = 0.01] as the independent predictors for bile duct injury in patients undergoing cholecystectomy. Conclusion: Our study finds a new association between obesity, aging, and bile duct injuries which has never been reported in literature before. [ABSTRACT FROM AUTHOR]

The article discusses the improving healthcare and education in Qatar due to its economic advances. Topics covered include the Qataris' generosity and friendliness, the country's healthcare system which is pursuing advance medical equipment, highly qualified staff and a network model of hospitals and healthcare centers, and its efforts to institute educational reforms such as the launching of the Qatar Education City.

The article discusses the evidence based treatment for treating primary central nervous system (PCNSL-O) lymphoma, a rare type of non-Hodgkin's lymphoma. It states that ocular irradiation is considered a traditional therapy for PCNSL-O. It notes that the intravitreal methotrexate (MTX) has emerged as initial treatment option with excellent local tumor control. It mentions that intravitreal rituximab shows complete or partial remission.

The article focuses on radiation chorioretinopathy (RCR), a complication caused by retinal and choroidal exposure to radiation. It states that RCR is associated with treatment of intraocular tumors. It notes that the rate of RCR has increased since the establishment of brachytherapy as alternative to enucleation of melanoma. It mentions that the management of the complication continues to pose therapeutic challenge.

BACKGROUND: Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma. METHODS: We performed a retrospective analysis of a prospectively collected database of all trauma patients who received hypertonic saline during initial resuscitation. Medical records were reviewed for serum electrolytes and serum osmolarity, coagulation parameters, complications, and mortality. RESULTS: A total of 212 patients were included in the study, of which 170 patients received 5%NS and 42 patients received 3%NS. Both groups were similar in age (41.16 ± 19 vs 44.17 1 23.6; P = .45) and ISS score (26 [17 to 29] vs 25 [16 to 27]; P = .6). Mean serum osmolarity (316 ± 20.3 vs 294 ± 22.5; P = .02) and serum sodium levels (143 ± 8.6 vs 137 ± 10.9; P < .001) remained higher in the 5%NS group within 72 hours of admission. The pH was lower in the 5%NS group compared with the 3%NS group at 24 hours (7.29 ± .12 vs 7.33 ± .12; P = .01); however, at 48 and 72 hours (7.40 ± .07 vs 7.41 ± .07; P = .7), no difference was found. There was no difference in blood products requirement (1,734 vs 2,253 mL; P = .11) between the 2 groups. CONCLUSIONS: The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS. [ABSTRACT FROM AUTHOR]

Introduction: The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone. Methods: We performed a retrospective analysis of a prospectively maintained database of all coagulopathic (INR ≥ 1.5) trauma patients presenting to our level I trauma center during a 2-years period (2011-2012). Patients were stratified into two groups: patients who received PCC+FFP and patients who received FFP alone. Patients in the two groups were matched in a 1:3 (PCC+FFP:FFP) ratio using propensity score matching for demographics, injury severity, vital parameters, and initial INR. The two groups were then compared for: correction of INR, time to correction of INR, thromboembolic complications, mortality, and cost of therapy. Results: A total of 252 were included in the analysis [PCC+FFP:63; FFP:189]. The mean age was 44 ± 20 years; 70 % were male, with a median ISS score of 27 [16-38]. PCC use was associated with an accelerated correction of INR (394 vs. 1,050 min; p 0.001), reduction in requirement of pack red blood cell (6.6 vs. 10 units; p 0.001) and FFP (2.8 vs. 3.9 units; p 0.01), and decline in mortality (23 vs. 28 %; p 0.04). PCC+FFP use was associated with a higher cost of therapy ($1,470 ± 845 vs. 1,171 ± 949; p 0.01) but lower overall cost of transfusion ($7,110 ± 1,068 vs. 9,571 ± 1,524; p 0.01) compared with FFP therapy alone. Conclusions: PCC in conjunction with FFP rapidly corrects INR in a matched cohort of trauma patients not on warfarin therapy compared with FFP therapy alone. The use of PCC as an adjunct to FFP therapy is associated with reduction of blood product requirement and also lowers overall cost. [ABSTRACT FROM AUTHOR]

Background: A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy). Study Design: This was a 3-year prospective cohort analysis of patients aged 18 years and older, without antiplatelet or anticoagulation therapy, presenting to our level 1 trauma center with intracranial hemorrhage on initial head CT and a follow-up RHCT. Neurosurgical intervention was defined by craniotomy/craniectomy. Neurologic deterioration was defined as altered mental status, focal neurologic deficits, and/or pupillary changes. Results: A total of 1,129 patients were included. Routine RHCT was performed in 1,099 patients. The progression rate was 19.7% (216 of 1,099), with subsequent neurosurgical intervention in 4 patients. Four patients had an abnormal neurologic examination, with a Glasgow Coma Scale (GCS) of ≤8 requiring intubation. Thirty patients had an RHCT secondary to neurologic deterioration; 53% (16 of 30) had progression on RHCT, of which 75% (12 of 16) required neurosurgical intervention. There was an association between deterioration in neurologic examination and need for neurosurgical intervention (odds ratio 3.98; 95% CI 1.7 to 9.1). The negative predictive value of a deteriorating neurologic examination in predicting the need for neurosurgical intervention was 100% in patients with GCS > 8. Conclusions: Routine repeat head CT scan is not warranted in patients with normal neurologic examination. Routine repeat head CT scan does not supplement the need for neurologic examination for determining management in patients with traumatic brain injury. [Copyright &y& Elsevier]

Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain. The data were analyzed for demographics, change in international normalized ratio (INR), and subsequent organ donation. The primary end point was organ donation. Eighty-eight patients with lethal traumatic brain injury were identified from the trauma registry of whom 13 were coagulopathic at the time of admission (mean INR 2.2 ± 0.8). Of these 13 patients, 10 patients received PCC in an effort to reverse their coagulopathy. Mean INR before PCC administration was 2.01 ± 0.7 and 1.1 ± 0.7 after administration (P < 0.006). Correction of coagulopathy was attained in 70 per cent (seven of 10) patients. Of these seven patients, consent for donation was obtained in six patients and resulted in 19 solid organs being procured. The cost of PCC per patient was $1022 ± 544. PCC effectively reveres coagulopathy associated with lethal traumatic brain injury and enabled patients to proceed to organ donation. Although various methodologies exist for the treatment of coagulopathy to facilitate organ donation, PCC provides a rapid and cost-effective therapy for reversal of coagulopathy in patients with lethal traumatic brain injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head. METHODS: A 5-year review of all patients at a trauma center with GSWs to the head was performed. The primary outcome was organ donation after fatal GSW to the head. RESULTS: A total of 98 patients with fatal GSWs to the head were identified. The rate of potential organ donation was 70%, of whom 49% eventually donated 72 solid organs. Twenty-five percent of patients were not considered eligible for donation as a result of disseminated intravascular coagulopathy. The T4 protocol lead to significant organ procurement rates (odds ratio, 3.6; 95% confidence interval, 1.3 to 9.6; P = .01). Failures to organ donation in eligible patients were due to lack of family consent and cardiac arrest. CONCLUSIONS: Organ donation after fatal GSW to the head is a legitimate goal. Management goals should focus on early aggressive resuscitation and correction of coagulopathy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate the utility of repeat head computed tomography (RHCT) and outcomes in patients on low-dose aspirin (acetylsalicylic acid; ASA) therapy. Methods: Patients with traumatic brain injury with intracranial hemorrhage on initial head computed tomography (CT) were prospectively enrolled. Patients on prehospital low-dose (81 mg) aspirin therapy were matched with patients exclusive of antiplatelet and anticoagulation therapy using propensity score matching in a 1:1 ratio for age, Glasgow Coma Scale, head Abbreviated Injury Scale score, Injury Severity Score, and neurological examination. Outcome measures were progression on RHCT and subsequent neurosurgical intervention. Results: A total of 144 patients who had intracranial hemorrhage on initial CT scan (ASA group: 72; No-ASA group: 72) were enrolled. The mean age was 72.8 ± 11.7 years, 59.7% were male, and median head Abbreviated Injury Scale was 3 (2–3). There was no difference in progression on RHCT (25% in ASA versus 16.6% in no-ASA), change in management as a result of RHCT (1.4% versus 1.4%), RHCT as a result of neurological decline (0 versus 1.4%), discharge Glasgow Coma Scale (15 [14–15] versus 15 [14–15]), and mortality (0 versus 1.4%) between the two groups. Conclusions: Low-dose aspirin therapy is not associated with progression of initial insult on RHCT or clinical deterioration. Prehospital low-dose aspirin therapy as a sole criterion should not warrant a routine repeat head CT in traumatic brain injury. [Copyright &y& Elsevier]

Background: Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain. Study Design: We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation. Results: There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs. Conclusions: Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain. [ABSTRACT FROM AUTHOR]

An efficient synthesis of 19 2-(heteroaryl)-3H-benzo[f]chromen-3-ones is described via reaction of 2-(3-hydroxyacryloyl)-3H-benzo[f]chromen-3-one with various heterocyclic amines and active methylene compounds. The synthesised compounds, 18 of which are novel, were characterised on the basis of their elemental analysis and spectral data. Eight of the synthesised products were evaluated as antibacterial agents. [ABSTRACT FROM AUTHOR]