Analytical Methods in the Quality Control of Scientific Publications Part III: Publishers’ Ethics and Editors’ Complicity

In 2012, the first paper in the series Analytical Methods in Quality Control of Scientific Publications was published in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. This paper was mainly based on evidence presented in the 2011 in book Historical Overview of Chromatography and Related Techniques in Analysis of Antimalarial Drug Primaquine (editor Ilia Brondz, Nova Science Publishers, Inc., ISSN 978-1-61761-944-1). The first paper in this series di- scussed issues of obvious falsification and plagiarism contained in paper published by Dongre et al., Applications of GC-EI-MS for the Identification and Investigation of Positional Isomer in Primaquine, an Antimalarial Drug. Journal of Pharmaceutical and Biomedical Analysis, Vol. 39, No. 1-2, 2005, pp. 111-116. Dongre et al. copied their publication from an original research manuscript submitted for consideration by other authors. This paper was published in the Asian Journal of Chemistry, Vol. 17, No. 3, 2005, pp. 1678-1688. Conclusive arguments against the publication of Dongre et al. were presented in the American Journal of Analytical Chemistry, Vol. 3, No. 6, 2012, pp. 443-447. Further cases of general plagiarism and incompetence relating to authors, reviewers, editors, and publishers were presented in Part II in Analytical Methods in Quality Control of Scientific Publications Part II: The Authors’, Reviewers’, Editors’ Responsibility and the Publishers’ Authority in the International Journal of Analytical Mass Spectrometry and Chromatography, Vol. 1, No. 2, 2013, pp. 81-89. The present paper will discuss the following issues: the obvious neglect of the rights of authors by some publishers and editors;how original research manuscripts are exposed to mediocre researchers, and possibly sold, by editors to these “scientists” to boost the image of these particular “scientists”;how the order of authors’ names in published articles are changed to satisfy the commercial interests of companies;and how copyright is breached in an appalling way by well-established publishers. The documents presented here concern research publications in the fields of chromatography, chromatography-mass spectrometry, and mass spectrometry.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes:Cross-country comparison of cohort studies

Purpose:This study aimed to quantify the dose-response association and the minimal effective dose of leisure-time physical activity(PA)to prevent mortality and cardiovascular disease in adults with type 2 diabetes.Methods:Cross-country comparison of 2 prospective cohort studies including 14,913 and 17,457 population-based adults with type 2 diabetes from the UK and China.Baseline leisure-time PA was self-reported and categorized by metabolic equivalent hours per week(MET-h/week)according to World Health Organization recommendations:none,below recommendation(>0-7.49 MET-h/week);at recommended level(7.5-14.9 MET-h/week);above recommendation(>15 MET-h/week).Mortality and cardiovascular disease data were obtained from national registries.Results:During a median follow-up of 12.4 and 9.7 years,in the UK and China cohorts,repectively,higher levels of leisure-time PA were inversely associated with all-cause(1571 and 2351 events)and cardiovascular mortality(392 and 1060 events),mostly consistent with a linear dose-response relationship.PA below,at,and above recommendations,compared with no activity,yielded all-cause mortality hazard ratios of0.94(95%confidence interval(95%CI):0.79-1.12),0.90(95%CI:0.74-1.10),and 0.85(95%CI:0.70-1.02)in British adults and 0.87(95%CI:0.68-1.10),0.88(95%CI:0.74-1.03),and 0.77(95%CI:0.70-0.85)in Chinese adults.Associations with cardiovascular mortality were more pronounced in British adults(0.80(95%CI:0.58-1.11),0.75(95%CI:0.52-1.09),and 0.69(95%CI:0.48-0.97))but less pronounced in Chinese adults(1.06(95%CI:0.76-1.47),1.01(95%CI:0.80-1.28),and 0.79(95%CI:0.69-0.92)).PA at recommended levels was not associated with lower rates of major adverse cardiovascular events(2345 and 4458 events).Conclusion:Leisure-time PA at the recommended levels was not convincingly associated with lower mortality and had no association with risk of major adverse cardiovascular events in British or Chinese adults with type 2 diabetes.Leisure-time PA above current recommendations may be needed to prevent cardiovascular disease and premature mortality in adults with type 2 diabetes.

Trauma to the solid abdominal organs:The missed dark box of colonoscopy

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Prevention of complications in endourological management of stones:What are the basic measures needed before,during,and after interventions?

Objective:This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy(PCNL),ureteroscopy,and retrograde intrarenal surgery.Methods:A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years(January 2012 to December 2022).Search terms included“ureteroscopy”,“retrograde intrarenal surgery”,“PCNL”,“percutaneous nephrolithotomy”,“complications”,“sepsis”,“infection”,“bleed”,“haemorrhage”,and“hemorrhage”.Key papers were identified and included meta-analyses,systematic reviews,guidelines,and primary research.The references of these papers were searched to identify any further relevant papers not included above.Results:The evidence is assimilated with the opinions of the authors to provide recommendations.Best practice pathways for patient care in the pre-operative,intra-operative,and post-operative periods are described,including the identification and management of residual stones.Key complications(sepsis and stent issues)that are relevant for any endourological procedure are then be discussed.Operation-specific considerations are then explored.Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury.The role of endoscopic combined intrarenal surgery in this regard is discussed.Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury.The role of anaesthetic assessment is discussed.The importance of specific comorbidities on each step of the pathway is highlighted as examples.Conclusion:This review demonstrates that the principles of meticulous planning,interdisciplinary teamworking,and good operative technique can minimise the risk of complications in endourology.

Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?

Objective:Ureteral stents are customarily inserted to facilitate urinary drainage,but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences.The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade(Clavien-Dindo Grade 4A or above)complications.Methods:The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed.The parameters recorded included patient demographics,indwelling time,need for percutaneous nephrostomy,hemodialysis,urine culture,blood culture,total blood counts,serum creatinine,radiologic findings,management techniques,number of surgical interventions,modified Clavien-Dindo complications,follow-up,and mortality,if any.Results:Forty patients were included in the study.The median age was 52(range 6-85)years.Of the total,25(62.5%)patients had a“significant”stent load;31(77.5%)had renal failure or acute kidney injury on presentation;19(47.5%)patients had sepsis at presentation.Among the patients presented with sepsis,11(57.9%)patients demonstrated a positive urine culture;and 7/11(63.6%)patients exhibited pan-resistant organisms.Twelve out of 40(30.0%)patients in our series developed high-grade Clavien-Dindo complications.On univariate analysis,sepsis at presentation(p=0.007),stent load(p=0.031),diabetes(p=0.023),positive urine culture(p=0.007),and stent indwelling time of more than 1 year(p=0.031)were found to be significant.On multivariate logistic regression analysis,sepsis at presentation(p=0.017)and positive urine culture(p=0.016)were significant predictors for high-grade complications.Conclusion:It is prudent to identify specific risk factors,namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.

Time trends and outcomes of gastrostomy placement in a Swedish national cohort over two decades

BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children,respectively,requiring long-term enteral nutrition support.Procedure-related mortality is a rare event,often reported to be zero in smaller studies.National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term(<30 d)and long-term survival.METHODS In this retrospective,population-based cohort study,individuals that had received a gastrostomy between 1998-2019 in Sweden were included.Individuals were identified in the Swedish National Patient Register,and survival analysis was possible by cross-referencing the Swedish Death Register.The cohort was divided into three age groups:Children(0-18 years);adults(19-64 years);and elderly(≥65 years).Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.RESULTS In total 48682 individuals(52%males,average age 60.9±25.3 years)were identified.The cohort consisted of 12.0%children,29.5%adults,and 58.5%elderly.An increased use of gastrostomies was observed during the study period,from 13.7/100000 to 22.3/100000 individuals(P<0.001).The use of PEG more than doubled(about 800 to 1800/year),with a corresponding decrease in open gastrostomy(about 700 to 340/year).Laparoscopic gastrostomy increased more than ten-fold(about 20 to 240/year).Overall,PEG,open gastrostomy,and laparoscopic gastrostomy constituted 70.0%(n=34060),23.3%(n=11336),and 4.9%(n=2404),respectively.Procedure-related mortality was 0.1%(n=44)overall(PEG:0.05%,open:0.24%,laparoscopic:0.04%).The overall 30-d mortality rate was 10.0%(PEG:9.8%,open:12.4%,laparoscopic:1.7%)and decreased from 11.6%in 1998-2009 vs 8.5%in 2010-2019(P<0.001).One-year and ten-year survival rates for children,adults,and elderly were 93.7%,67.5%,and 42.1%and 79.9%,39.2%,and 6.8%,respectively.The most common causes of death were malignancies and cardiovascular and respiratory diseases.CONCLUSION The annual use of gastrostomies in Sweden increased during the study period,with a shift towards more minimally invasive procedures.Although procedure-related death was rare,the overall 30-d mortality rate was high(10%).To overcome this,we believe that patient selection should be improved.

Combinative approach of transzonular triamcinolonemoxifloxacin and perioperative drops to minimize postoperative complications of cataract surgery

AIM: To investigate the effectiveness of combinationtherapy with transzonular triamcinolone-moxifloxacin andconventional perioperative drops in reducing postoperativecomplications of cataract surgery. METHODS: Electronic medical records of cataractsurgery patients (single surgeon) were reviewed fromJanuary 2018 to September 2021. The rate of postoperativecomplications including prolonged and/or recurrentpostoperative inflammation, endophthalmitis, cystoid macularedema (CME), and intraocular pressure (IOP) was comparedbetween the patients receiving combinative therapy andpatients receiving drops only. RESULTS: Totally 596 patients and 1057 eyes(Combinative-Therapy group 493 and Drop-Only group 564)were included in this study. Using combination therapyreduced the relative risk of postoperative inflammationby 26.9% (16.6% Combinative-Therapy vs 22.7% Drop-Only, P=0.013). The incidence of endophthalmitis was 0in Combinative-Therapy group vs 0.5% in Drop-Only group(relative risk reduction 100%), although not statisticallysignificant (P=0.10). The incidence of severe IOP spikeswas not significantly different between Combinative-Therapy (2.4%) and Drop-Only (1.6%) groups (P=0.33).The relative risk of postoperative CME was 51.4% less inthree months follow up visit in Combinative-Therapy group,although not statistically significant (P=0.07). The visualoutcome 1-month postop. (best corrected visual acuity) wassignificantly better in Combinative-Therapy (logMAR 0.10)compared to Drop-Only (logMAR 0.14) groups (P=0.02) whilethe baseline visual acuity was not significantly different. CONCLUSION: The combinative approach oftranszonular triamcinolone-moxifloxacin plus perioperativeeyedrops is an effective method to minimize postoperativeinflammation, with better visual outcomes. It couldpotentially reduce the risk of postoperative endophthalmitisand CME (near-significant P-values;larger studies couldanalyze better considering low incidence).

Transepithelial photorefractive keratectomy without mitomycin-C for irregular astigmatism after femtosecond laser-assisted in situ keratomileusisflap complications

Dear Editor,W e write to present a case report of transepithelial photorefractive keratectomy(TPRK)without mitomycin-C(MMC)for irregular astigmatism after femtosecond laser-assisted in situ keratomileusis(FS-LASIK)flap complications.Written informed consent was obtained from the patient to allow the publication of this case and associated accompanying images.The study was conducted in accordance with the Helsinki Declaration.TPRK is a surgical procedure which uses an excimer laser to ablation of both the corneal epithelium and stroma,which is widely used in clinic[1-2].The procedure may be conducted in cases where there is notable topographic irregularity or scarring following complications with the LASIK flap.Corneal haze is a potential complication following TPRK,and the use of MMC as a prophylactic agent against postoperative corneal haze has been demonstrated to significantly reduce its formation after TPRK/photorefractive keratectomy(PRK).

Tenosynovitis of hand: Causes and complications

Tenosynovitis represents a common clinical condition characterized by inflam-mation of the synovium that encases the tendon sheath.Although tenosynovities may be noted in any tendon in the body,extremities such as hand,and foot remain the sites of high predilection to acquire this condition.The predominant cause of this predilection rests in the intricate tendon arrangements in these extremities that permit fine motor actions.This editorial explores the common causes and the complications associated with this condition to improve the understanding of the readers of this common condition encountered in our everyday clinical practice.

Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer

BACKGROUND Transanal endoscopic intersphincteric resection(ISR)surgery currently lacks sufficient clinical research and reporting.AIM To investigate the clinical effectiveness of transanal endoscopic ISR,in order to promote the clinical application and development of this technique.METHODS This study utilized a retrospective case series design.Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included.All patients underwent transanal endoscopic ISR as the surgical approach.We conducted this study to determine the perioperative recovery status,postoperative complications,and pathological specimen charac-teristics of this group of patients.RESULTS This study included 45 eligible patients,with no perioperative mortalities.The overall incidence of early complications was 22.22%,with a rate of 4.44%for Clavien-Dindo grade≥III events.Two patients(4.4%)developed anastomotic leakage after surgery,including one case of grade A and one case of grade B.Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients.The mean distance between the tumor lower margin and distal resection margin was found to be 2.30±0.62 cm.The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens.CONCLUSION Transanal endoscopic ISR is safe,feasible,and provides a clear anatomical view.It is associated with a low incidence of postoperative complications and favorable pathological outcomes,making it worth further research and application.

Discontinuity development patterns and the challenges for 3D discrete fracture network modeling on complicated exposed rock surfaces

Natural slopes usually display complicated exposed rock surfaces that are characterized by complex and substantial terrain undulation and ubiquitous undesirable phenomena such as vegetation cover and rockfalls.This study presents a systematic outcrop research of fracture pattern variations in a complicated rock slope,and the qualitative and quantitative study of the complex phenomena impact on threedimensional(3D)discrete fracture network(DFN)modeling.As the studies of the outcrop fracture pattern have been so far focused on local variations,thus,we put forward a statistical analysis of global variations.The entire outcrop is partitioned into several subzones,and the subzone-scale variability of fracture geometric properties is analyzed(including the orientation,the density,and the trace length).The results reveal significant variations in fracture characteristics(such as the concentrative degree,the average orientation,the density,and the trace length)among different subzones.Moreover,the density of fracture sets,which is approximately parallel to the slope surface,exhibits a notably higher value compared to other fracture sets across all subzones.To improve the accuracy of the DFN modeling,the effects of three common phenomena resulting from vegetation and rockfalls are qualitatively analyzed and the corresponding quantitative data processing solutions are proposed.Subsequently,the 3D fracture geometric parameters are determined for different areas of the high-steep rock slope in terms of the subzone dimensions.The results show significant variations in the same set of 3D fracture parameters across different regions with density differing by up to tenfold and mean trace length exhibiting differences of 3e4 times.The study results present precise geological structural information,improve modeling accuracy,and provide practical solutions for addressing complex outcrop issues.

Failure to Rescue as a Quality Metric in Congenital Heart Surgeries in a High-Complexity Service Provider Institution Located in a Middle-Income Country

Background:Failure to rescue has been an effective quality metric in congenital heart surgery.Conversely,mor-bidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance.We aim to measure the complications,mortality,and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a middle-income country and compare it with other institutions that have conducted a similar study.Methods:A retrospective observational study was conducted in a high-complexity service provider institution,in Cali,Colombia.All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included.The main outcomes evaluated in the study were complication,mortality,and failure to rescue rate.Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results:We evaluated 308 congenital heart sur-geries.Regarding the outcomes,201(65%)complications occurred,23(7.5%)patients died,and the FTR of the entire cohort was 11.4%.The presence of a postoperative complication(OR 14.88,CI 3.06–268.37,p=0.009),age(OR 0.79,CI 0.57–0.96,p=0.068),and urgent/emergent surgery(OR 8.14,CI 2.97–28.66,p<0.001)were the most significant variables in predicting mortality.Conclusions:Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries.Despite our higher mortality and complication rate,we obtained a comparable failure to rescue rate to high-income countries’health institutions.

Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

BACKGROUND Gastric cancer has a high incidence and fatality rate,and surgery is the preferred course of treatment.Nonetheless,patient survival rates are still low,and the incidence of major postoperative complications cannot be disregarded.The systemic inflammatory response,nutritional level,and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients.The systemic inflammatory response index(SIRI)and the albumin fibrinogen ratio(AFR)are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions.AIM To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery.METHODS We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019.We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications.We scored the patients and categorized them into three groups based on their SIRI and AFR levels.COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival(OS)and disease-free survival(DFS).RESULTS SIRI-AFR scores were an independent risk factor for prognosis[OS:P=0.004;hazards ratio(HR)=3.134;DFS:P<0.001;HR=3.543]and had the highest diagnostic power(area under the curve:0.779;95%confidence interval:0.737-0.820)for early serious complications in patients with gastric cancer.The tumor-node-metastasis stage(P=0.001),perioperative transfusion(P=0.044),positive carcinoembryonic antigen(P=0.014)findings,and major postoperative complications(P=0.011)were factors associated with prognosis.CONCLUSION Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.

Immediate secondary rhinoplasty using a folded dermofat graft for resolving complications related to silicone implants: A case report

BACKGROUND Various surgical techniques have been developed to enhance the nose shapes of Asian patients.Silicone implant augmentation rhinoplasty is widely used because it is relatively easy to perform and often yields satisfactory outcomes.However,this technique may lead to complications,including ischemia,necrosis,and over-augmentation.The most appropriate management of these complications,including infection,is immediate implant removal and revision surgery once the accompanying inflammation has healed.Occasionally,the patient may experience distress from nasal deformities during the intervention period.CASE SUMMARY Herein,we describe the case of a patient who underwent a secondary dorsal augmentation,with a folded dermofat graft harvested from the inguinal area and simultaneous implant removal,successfully preventing dimpling of the nasal deformity.CONCLUSION This surgical method can effectively manage implant-related complications following augmentation rhinoplasty using a silicone implant and provide satis-factory patient outcomes.

Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

Complicated calcified alloplastic implants in the nasal dorsum:A clinical analysis

BACKGROUND In rhinoplasty,calcification around silicone implants is frequently observed in the tip dorsum(TD)area.Additionally,based on a review of various literature,it is presumed that calcification in silicone implants occurs due to both inflammatory chemical reactions and physical friction against the tissue.The calcification of nasal silicone implants not only results in the functional loss of the implants,but also leads to material deformation.However,there is a lack of research on calcification of nasal silicone implants in the current literature.AIM To elucidate various clinical characteristics of calcification around nasal silicone implants,using histological and radiological analysis.METHODS This study analyzed data from 16 patients of calcified nasal implants,who underwent revision rhinoplasty for various reasons after undergoing augmentation rhinoplasty with silicone implants.The collected data included information on implant duration,implant types,location of calcification,presence of inflammatory reactions,and computed tomography(CT)scans.RESULTS The most common location of calcification,as visually analyzed,was in the TD area,accounting for 56%.Additionally,the analysis of CT scans revealed a trend of increasing Hounsfield Unit values for calcification with the duration of implantation,although this trend was not statistically significant(P=0.139).CONCLUSION Our study shows that reducing the frequency of calcification may be achievable by using softer silicone implants and by minimizing the damage to perioperative tissues.

Effects of vitamin family members on insulin resistance and diabetes complications

The following letter to the editor highlights the article“Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance”in World J Diabetes 2023 Oct 15;14(10):1514-1523.It is necessary to explore the role of vitamin family members in insulin resistance and diabetes complications.

Prognostic value of ultrasound in early arterial complications post liver transplant

Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the prognosis of hepatic artery complic-ations.The clinical manifestations of these complications are closely linked to factors such as timing,severity,and the specific type of onset.Insufficient hepatic arterial blood flow can lead to abnormal liver function,hepatic infarction,and the formation of hepatic abscesses.Additionally,since the hepatic artery is the sole blood supply to the biliary tract,hepatic artery-related ischemia may result in biliary stricture,obstruction,and the formation of bile ducts.Ultrasound examination remains the primary imaging modality for diagnosing complications post liver transplantation.This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and outlines abnormal sonographic findings for accurately diagnosing these conditions.NORMAL HEPATIC ARTERY During the intraoperative phase,an ultrasound examination is typically conducted to evaluate the hepatic artery anas-tomosis.The normal internal diameter of the hepatic artery typically ranges from 2 to 5 mm.Two strong echo points are typically identified near the anastomosis.To assess blood flow dynamics,peak systolic velocity,end-diastolic velocity,and resistance index are measured at the donor and recipient sides of the anastomosis following angle correction.Anastomotic stenosis presence and severity can be evaluated by comparing the velocity at the anastomotic site with that at the recipient side.Postoperatively,direct visualization of the anastomosis site through gray ultrasound scans is often challenging.The surgical approach has a significant impact on the proper hepatic artery’s position,resulting in a lower overall success rate of continuous visualization.Color Doppler ultrasound is primarily employed to trace the artery’s path,and spectral measurements are taken at the brightest position of the Color Doppler blood flow signal,primarily used to identify the presence of high-speed turbulence.Hepatic artery spectrum examination plays a crucial role,as a favorable arterial spectral waveform and appropriate hepatic artery flow velocity typically indicate a successful anastomosis,even in cases where the hepatic artery anastomosis cannot be directly visualized by ultrasound.The hepatic artery runs alongside the portal vein,often selected as a reference due to its larger inner diameter.A normal hepatic artery spectrum displays a regular pulsation pattern with a rapid rise in systole and a slow decline in diastole.Parameters for assessing hepatic artery resistance include a resistance index between 0.5 to 0.8 and an artery systolic acceleration of less than 80 ms.Instantaneous increases in the resistance index(RI>0.8)often occur within 2 d after surgery,followed by a subsequent return to normal hepatic arterial parameters.It has been established that the maximum blood flow velocity during systole in the hepatic artery should not exceed 200 cm/s[1].