A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

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Percutaneous transpapillary biliary stent placement for distal malignant biliary obstruction: Outcomes and survival analysis

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2019.18317 ◽

2019 ◽

Vol 30 (8) ◽

pp. 714-721

Author(s):

Qing-Quan Zu ◽

◽

Jin-Xing Zhang ◽

Bin Wang ◽

Wei Ye ◽

...

Keyword(s):

Survival Analysis ◽

Stent Placement ◽

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Biliary Stent ◽

Distal Malignant Biliary Obstruction

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The Cemented Custom Femoral Stem - a 10 Year Review

Hip International ◽

10.1177/112070000701700402 ◽

2007 ◽

Vol 17 (4) ◽

pp. 194-204 ◽

Cited By ~ 2

Author(s):

S. O'brien ◽

R.K. Wilson ◽

B.M. Hanratty ◽

N.W. Thompson ◽

M.E. Wallace ◽

...

Keyword(s):

Survival Analysis ◽

Median Survival ◽

Revision Surgery ◽

Hip Replacement ◽

Femoral Stem ◽

Kaplan Meier ◽

Custom Made ◽

Titanium Stem

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10 - 11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review - all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.

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Circular RNA circUBE2J2 acts as the sponge of microRNA-370-5P to suppress hepatocellular carcinoma progression

Cell Death and Disease ◽

10.1038/s41419-021-04269-4 ◽

2021 ◽

Vol 12 (11) ◽

Author(s):

Lu Zhang ◽

Yachong Liu ◽

Haisu Tao ◽

He Zhu ◽

Yonglong Pan ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Survival Analysis ◽

Circular Rna ◽

Luciferase Reporter ◽

Circular Rnas ◽

Tissue Samples ◽

Clinical Prognosis ◽

Kaplan Meier ◽

And Migration ◽

Hcc Cells

AbstractAccumulating evidences indicate that circular RNAs (circRNAs), a class of non-coding RNAs, play important roles in tumorigenesis. However, the function of circRNAs in hepatocellular carcinoma is largely unknown. CircRNA microarray was performed to identify abnormally expressed circRNAs in HCC tissue samples. We conducted Kaplan–Meier survival analysis to explore the significance of circUBE2J2 in clinical prognosis. Then, we examined the functions of circUBE2J2 in HCC by cell proliferation, migration, and mouse xenograft assay. We identified miR-370-5P as a circUBE2J2-related microRNA by using biotin-labeled circUBE2J2 probe to perform RNA antisense purification (RAP) assay in HCC cells. The dual luciferase reporter assay and RNA pulldown assays were employed to verify the relationships among circUBE2J2, miRNA-370-5P, and KLF7. Microarray analysis and qRT-PCR verified a circRNA termed circUBE2J2 that was downregulated in HCC. Kaplan–Meier survival analysis showed that downregulated circUBE2J2 was correlated with poorer survival. CircUBE2J2 expression in HCC cells was selectively regulated via luciferase reporter assays; circUBE2J2 and KLF7 were observed to directly bind to miR-370-5P. Furthermore, knockdown of circUBE2J2 in HCC could downregulate KLF7, the target of miR-370-5P, thus promoting the proliferation and migration of HCC cells. Then the related experiment suggested that circUBE2J2 could regulate the expression of KLF7 by sponging miR-370-5p. In summary, we infer that circUBE2J2 may act as a competing endogenous RNA (ceRNA) to regulate KLF7 expression through sponging miR-370-5P and play a regulatory functions in HCC. CircUBE2J2 may be a diagnostic biomarker and potential target for HCC therapy.

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BILIARY STENT A FRIEND TURNED FOE IF FORGOTTEN

10.36106/gjra/2703701 ◽

2020 ◽

pp. 1-3

Author(s):

Santosh kumar singh ◽

Jitendra Kumar Singh ◽

Devendra kumar shukla ◽

Ankur dutt tripathi

Keyword(s):

Biliary Tree ◽

Biliary Stent ◽

Left Behind ◽

Stent Removal ◽

Contact Information ◽

Registry System ◽

Long Duration ◽

Set Up

Introduction: The studies recommend replacement or removal of stent at least by 3-6 months after ERCP in order to avoid complications such as occlusion or migration of stent or cholangitis. While it cannot be denied that complications may occur following routine stenting too, presence of a stent in the biliary tree left behind for a long duration is especially fraught with danger since, the stent though crucial in patient management, is undoubtedly a foreign body. Method and material: Plastic stenting through ERCP for CBD obstruction was performed in 288 patients. Patients were divided into 3 groups on basis of duration of presentation from their respective date of ERCP Result: 50 out of 288 patients did not provide contact information at time of registration for ERCP. 28 out of 50 patients who did not provide contact details at time of registration presented >6 months after ERCP. 260 patients presented for stent removal within 6 months of stenting of which 05 patients (1.9%) developed stentolith. 28 patients presented > 6 months after stent placement of which 26 (92.8%) developed stentolith. Conclusion: All patients with biliary stent must be informed about the importance of its removal on time and complications of long term endoprosthesis in situ. ‘Stent Registry System’ should be set up under direct supervision of the surgeon is recommended. Stentolith referred to surgeon are usually impacted or too large to be removed endoscopically mandating open choledocholithotomy.

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Paleoweathered surfaces on granitoids of southern Nova Scotia: paleoenvironmental implications of saprolites

Canadian Journal of Earth Sciences ◽

10.1139/e03-016 ◽

2003 ◽

Vol 40 (6) ◽

pp. 805-817 ◽

Cited By ~ 12

Author(s):

Anne Marie O'Beirne-Ryan ◽

Marcos Zentilli

Keyword(s):

Nova Scotia ◽

Clay Minerals ◽

Silica Sand ◽

South Mountain Batholith ◽

History Of ◽

And Migration ◽

Clastic Sedimentary ◽

Weathering Effects ◽

In Situ Weathering

In addition to minor postglacial weathering effects, a complex history of three distinct weathering events has been identified within the granitoids of the South Mountain Batholith of southwestern Nova Scotia. Weathering prior to deposition of Carboniferous strata produced a well-developed saprolite, an in situ weathering profile. Feldspars and micas are altered to clay minerals, and only weak preservation of granitic texture is evident. Subsequent burial and relithification have masked the original weathering mineralogy in this horizon. Beneath Triassic clastic sedimentary rocks is a thick horizon (30 m) of weathered granitoid. This argillaceous saprolite with relict biotite exhibits an intensifying-upward weathering zonation typical of weathered horizons, with increased proportions of clay minerals at the upper levels. A younger arenaceous saprolite of pre-Pleistocene age can be found beneath glacial till at a number of locations throughout the batholith. These paleoweathered horizons attest to relatively warmer climates at several times in the geologic past. Their patterns of preservation imply some were much thicker and more widely distributed before partial erosion. The eroded materials may have formed the sediment for quartz sand in the Carboniferous sequence, clay and silica sand deposits of Cretaceous age, and a sandy till of Pleistocene age. The remnants preserved in situ today serve as significant conduits for water, and the geochemistry, mineralogy, and textures of these weathered profiles may enhance mobility and migration of U and Rn. These weathered horizons are mechanically weak, and the possibility of their presence should be considered when selecting construction and waste-disposal sites.

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Internal Migration and Fertility in Turkey: Kaplan-Meier Survival Analysis

International Journal of Population Research ◽

10.1155/2012/329050 ◽

2012 ◽

Vol 2012 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Mehmet Ali Eryurt ◽

İsmet KOÇ

Keyword(s):

Survival Analysis ◽

Internal Migration ◽

Family Formation ◽

Migrant Women ◽

Survival Curves ◽

Total Period ◽

Rural Migrant ◽

Kaplan Meier ◽

Analysis Technique ◽

And Migration

Starting from the mid-twentieth century, Turkey has experienced a remarkable fertility decline. Total period fertility declined from the level of 6 or 7 to the almost replacement level by 2003. Similarly, in the 1950s onwards internal migration gathered speed and transformed Turkey from a predominantly rural country to a mainly urban one in less than half a century. Fertility and migration were mutually reinforcing processes in Turkey. Considering this relationship, the study aims to compare fertility behaviours of migrants with those of nonmigrants at both origin and destination areas. The data source is the 2003 Turkey Demographic and Health Survey. A nonparametric descriptive survival analysis technique, Kaplan-Meier survival analysis, was employed. Kaplan-Meier survival curves of transition to first, second and subsequent births were compared by migration status. Survival curves of second and subsequent births for rural-to-urban and urban-to-rural migrant women are similar to the curves at the place of destination rather than place of origin. This result reveals that adaptation theory, rather than socialization theory, is more explanatory in the case of Turkey. Kaplan-Meier survival estimates showed that rural native and rural-to-rural migrant women experience all the events related with family formation earlier in their life cycle.

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Fate of the Antegrade Ureteric Stent

Journal of Endoluminal Endourology ◽

10.22374/jeleu.v1i2.15 ◽

2018 ◽

Vol 1 (2) ◽

pp. e27-e33

Author(s):

Jerry Abraham Raju ◽

Cherian George ◽

Prashant Patel ◽

Samson Liu

Keyword(s):

Stent Placement ◽

Strong Association ◽

Stone Disease ◽

University Hospital ◽

Stent Insertion ◽

Technical Success Rate ◽

Stent Removal ◽

Gynaecological Malignancy

Introduction Antegrade stents are commonly used to relieve malignant and benign ureteric obstruction. However, follow up of these patients often involves several specialties and the potential for delayed management and forgotten stents. This observational study reviews indications and outcomes of antegrade stent procedures at one university hospital to provide prognostic and quality improvement data. Patients and Methods A retrospective analysis of 152 antegrade stent procedures in 142 patients over a 27-month period was performed. Cohorts were studied according to underlying pathology, referring specialty and intended duration of stent placement. Measured outcomes were time to stent removal or stent exchange, death, forgotten stents and complications. Results The overall technical success rate of antegrade stent insertion was 98%. Follow-up data was available for 145 successful procedures in 138 patients. Malignancy (47%) and stone disease (35%) were the commonest indications. Overall, 43 patients (31%) died over a median follow up period of 2.2 years. 29 of 64 patients (45%) with malignancy died with stents in situ after a median interval of 3.5 months. Malignancy and unclear intended duration of stent placement were predictors of death with a stent in situ. Twelve patients (9%) had forgotten stents and a strong association with gynaecological malignancy was noted, which is felt to represent inadequate follow up of patients with non-urological pathology. Complications were reported in thirteen patients (9%), including ten cases of heavy stent encrustation and one malpositioned stent. Conclusions Prognostic factors should be considered in the management of patients stented for malignant obstruction, which is usually a marker of advanced disease. The hazards of inadequate follow up are highlighted, causing delays in stent removal and exchange, or the forgotten stent. Interventions are described to minimize these risks.

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EFNB1 Acts as a Novel Prognosis Marker in Glioblastoma through Bioinformatics Methods and Experimental Validation

Journal of Oncology ◽

10.1155/2021/4701680 ◽

2021 ◽

Vol 2021 ◽

pp. 1-15

Author(s):

Yaohong Shi ◽

Yuanyuan Sun ◽

Hongyan Cheng ◽

Chen Wang

Keyword(s):

Survival Analysis ◽

Protein Interactions ◽

Protein Protein Interactions ◽

Hub Genes ◽

Poor Overall Survival ◽

Online Tool ◽

Interactive Analysis ◽

Kaplan Meier ◽

Maximum Cluster ◽

And Migration

Purpose. Ephrin B1 (EFNB1), the Eph-associated receptor tyrosine kinase ligand, is suggested to have an important function in neurodevelopment. However, its contribution to glioblastoma multiforme (GBM) remains uncertain. This study aimed to determine the prognostic power and immune implication of EFNB1 in GBM. Methods. We first identified differentially coexpressed genes within GBM relative to noncarcinoma samples from GEO and TCGA databases by WGCNA. The STRING online database and the maximum cluster centrality (MCC) algorithm in Cytoscape software were used to design for predicting protein-protein interactions (PPI) and calculating pivot nodes, respectively. The expression of hub genes in cancer and noncancer tissues was verified by an online tool gene expression profile interactive analysis (GEPIA). Thereafter, the TISIDB online tool with Cox correlation regression method was employed to screen for immunomodulators associated with EFNB1 and to model the risk associated with immunomodulators. Results. Altogether 201 differentially expressed genes (DEGs) were discovered. After that, 10 hub genes (CALB2, EFNB1, ENO2, EPHB4, NES, OBSCN, RAB9B, RPL23A, STMN2, and THY1) were incorporated to construct the PPI network. As revealed by survival analysis, EFNB1 upregulation predicted poor overall survival (OS) for GBM cases. Furthermore, we developed a prognostic risk signature according to the EFNB1-associated immunomodulators. Kaplan–Meier survival analysis and receiver operating characteristic method were adopted for analysis, which revealed that our signature showed favorable accuracy of prognosis prediction. Finally, EFNB1 inhibition was found to block cell proliferation and migration in GBM cells. Conclusion. The above results indicate that EFNB1 participates in cancer immunity and progression, which is the candidate biomarker for GBM.

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