👤 Christopher D Whelan

This study aims to investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis. A systematic review was undertaken based upon articles published between January 1, 2000, and March 1, 2024. Databases Pubmed, Scopus, and Embase were used employing the key search terms "Diverticulitis" and "Peritoneal Lavage." Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, reoperation, and readmission rates were performed. An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomized controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group; however, there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity across all trials. There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up, there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomized studies are required to clarify whether LPL shows long-term benefit over PR. Show less

To date, the development of disease-modifying therapies for Alzheimer's disease (AD) has largely focused on the removal of amyloid beta Aβ fragments from the CNS. Proteomic profiling of patient fluids may help identify novel therapeutic targets and biomarkers associated with AD pathology. Here, we applied the Olink™ ProSeek immunoassay to measure 270 CSF and plasma proteins across 415 Aβ- negative cognitively normal individuals (Aβ- CN), 142 Aβ-positive CN (Aβ+ CN), 50 Aβ- mild cognitive impairment (MCI) patients, 75 Aβ+ MCI patients, and 161 Aβ+ AD patients from the Swedish BioFINDER study. A validation cohort included 59 Aβ- CN, 23 Aβ- + CN, 44 Aβ- MCI and 53 Aβ+ MCI. To compare protein concentrations in patients versus controls, we applied multiple linear regressions adjusting for age, gender, medications, smoking and mean subject-level protein concentration, and corrected findings for false discovery rate (FDR, q < 0.05). We identified, and replicated, altered levels of ten CSF proteins in Aβ+ individuals, including CHIT1, SMOC2, MMP-10, LDLR, CD200, EIF4EBP1, ALCAM, RGMB, tPA and STAMBP (- 0.14 < d < 1.16; q < 0.05). We also identified and replicated alterations of six plasma proteins in Aβ+ individuals OSM, MMP-9, HAGH, CD200, AXIN1, and uPA (- 0.77 < d < 1.28; q < 0.05). Multiple analytes associated with cognitive performance and cortical thickness (q < 0.05). Plasma biomarkers could distinguish AD dementia (AUC = 0.94, 95% CI = 0.87-0.98) and prodromal AD (AUC = 0.78, 95% CI = 0.68-0.87) from CN. These findings reemphasize the contributions of immune markers, phospholipids, angiogenic proteins and other biomarkers downstream of, and potentially orthogonal to, Aβ- and tau in AD, and identify candidate biomarkers for earlier detection of neurodegeneration. Show less