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<i>Adjuvant Chemotherapy using S-1 for Resected Biliary Tract Carcinoma</i>

Abstract Objective The benefit of adjuvant chemotherapy for resected biliary tract carcinoma (BTC) is unclear; however, the JCOG1202 trial indicated that S-1 may be effective. This retrospective study evaluated the effectiveness of S-1 adjuvant chemotherapy for resected BTC at a single institute. Methods Seventy-five patients who underwent resection for BTC between 2014 and 2021 were classified as surgery alone (N=29) or surgery plus S-1 (N=46). Outcomes, including relapse-free survival (RFS) and overall survival (OS), were compared between the groups. Results The cohort (mean age, 72.2 years) included 51 men and 24 women. No differences in patient characteristics (age, sex, tumor-node-metastasis classification, Union for International Cancer Control stage, and residual tumor (R) classification) were observed between the groups. Grade 3/4 adverse events were not observed, and relative dose intensity was 84.8%. No differences were observed between the groups regarding RFS and OS, nor in RFS when excluding those with R2 (p=0.599). However, a significant difference was observed in OS between the groups in the latter case (p=0.04), with median survival times of 22.2 months for surgery alone and 64.5 months for surgery plus S-1. Conclusion S-1 adjuvant chemotherapy prolonged OS in patients with BTC treated by curative resection (excluding R2).

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Effects of 60 degrees of flexion and perioperative use of tranexamic acid on recovery after knee replacement

Abstract OBJECTIVE To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. METHODS Knee replacement patients admitted to our hospital from October 2020 to September 2022 were selected as the study subjects, and randomly divided into two groups. Postoperative D-dimer, prothrombin time and partial thrombin time were recorded in the two groups, and the differences between the two groups were compared. Erythrocyte, hemoglobin and erythrocyte volume were recorded before, 1 day and 3 days after surgery and the affected limb circumference were also assessed. RESULTS On the 1st and 3rd day after surgery, the red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant(P&amp;lt;0.05). The difference in VAS score and circumference between the two groups on the 1st day and 3rd day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group(P&amp;lt;0.05). After surgical treatment, knee joint function recovered, knee joint mobility and HSS score improved, and the difference between the experimental groups was statistically significant (P&amp;lt;0.05). CONCLUSION Perioperative 60-degree flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

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Open Access
Robot-Assisted Resection of Exposed Colon With TaTME After Heavy Ion Radiotherapy for Locally Recurrent Rectal Cancer: A Case Report

Introduction Heavy ion radiotherapy has shown promising results in treating pelvic recurrence of rectal cancer. We report a case in which a patient underwent robot-assisted low anterior resection with transanal mesorectal excision (TaTME) following heavy ion radiotherapy, owing to challenges associated with spacer placement. Case presentation A 54-year-old man was diagnosed with upper rectal cancer. He underwent robot-assisted low anterior resection. Eight courses of CapeOX were administered as postoperative adjuvant chemotherapy. Immediately after completion of adjuvant chemotherapy (8 months postoperatively), computed tomography (CT) scan revealed a 30-mm large nodule on the dorsal surface of the oral anastomotic intestine, which was detected by positron emission tomography–CT. Given that the tumor had an indistinct border with the sacrum and its superior margin extended to the second sacrum, it was concluded that a combined sacral resection was not advisable, and heavy ion radiotherapy was indicated. Robot-assisted low anterior resection combined with TaTME was performed approximately 2 months after heavy particle radiotherapy [73.6 Gy (relative biological effectiveness)/16 sessions]. CT scan conducted 3 months after irradiation revealed substantial shrinkage of the recurrent tumor. Conclusion Robot-assisted resection of exposed colon with TaTME after heavy ion radiotherapy is regarded as an effective strategy for treating locally recurrent rectal cancer.

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Open Access
Risk Factors for Postoperative Pneumonia in Esophageal Cancer Patients

Purpose Patients undergoing surgery for esophageal cancer (EC) frequently experience postoperative pneumonia (POP). POP promotes poor prognosis as well as increased medical costs and longer hospital stays. Therefore, it is desirable to prevent and strictly control high-risk cases to reduce the incidence of pneumonia. The present study aimed to determine the risk factors for POP in EC. Patients and Methods The subjects of this retrospective study were 151 patients with EC who underwent subtotal esophagectomy in our department between January 2012 and December 2021. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of POP and clinical factors. Results Among 151 patients, 33 cases (21.8%) developed POP. Multivariate analysis identified preoperative C-reactive protein-to-albumin ratio (CAR) ≥0.03 [odds ratio (OR), 2.69; P = 0.0352], chronic obstructive lung disease (COPD) (OR, 7.32; P = 0.0001), and diabetes mellitus (DM) (OR, 3.35; P = 0.0252) as independent risk factors for POP. In accordance with the number of risk factors, the incidence rate of POP drastically increased, and its rate in patients with 3 risk factors was 80%. Conclusion High CAR, COPD, and DM are independent risk factors for the development of POP in patients undergoing subtotal esophagectomy for EC. Clinicians should be aware of the risk factors for POP and consider more intensive preventive measures and postoperative management in patients with EC.

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Open Access
Evaluating the Application of the SIR Model to a Localized Population

Objective Using data collected from the Johns Hopkins COVID-19 Repository, I investigated the reliability of the SIR (Susceptible-Infected-Removed) model. Summary of Background Data Modern pandemic responses have evolved into effective defenses when implemented correctly but present issues in epidemiological modeling efforts. Intervention strategies such as quarantining and masking limit population size (N), which affects the accuracy of modeling population-based rate systems especially in highly transmissible diseases. Methods I begin by reviewing the SIR model retroactively to the initial SARS-CoV-2 Wuhan strain. I compared the parameters available in the published literature (N = 2,717,000, β = 2, γ = 1/14) to the best-fitting SIR-yielded values by minimizing the root mean squared error function. Subsequently, I evaluated its predictive capabilities on the Delta variant using early surge data, which was later compared against a retroactive analysis. Results Using a least-squares error best-fit analysis allowed me to retroactively define remarkably accurate model parameters for the Wuhan waves. Parameters including N = 730, β = 0.46, γ = 0.043 in the first wave and N = 11,200, β = 0.198, γ = 0.07 in the second reflected effective intervention strategies. I show it is an effective predictive tool regarding the Delta variant, yielding parameters N = 50,900, β = 0.87, γ = 1/3.7 that proved accurate when compared with parameters from a full retroactive analysis (N = 60,000, β = 0.94, γ = 1/3.6). Conclusion The similarity of the yielded parameters in my results supports the SIR model’s utility in epidemiological monitoring of high-transmissibility, low-mortality outbreaks vis-à-vis various containment measures.

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Open Access
Comparison of the Patient Demographics, High-Resolution Computed Tomography Features of the Pulmonary Ground-Glass Opacity and Its Diagnostic Value Analysis

Introduction Pulmonary ground-glass opacity (GGO) observed on computed tomography (CT) is widely regarded as a diagnostic feature of lung adenocarcinoma; however, a significant radiological predictive sign remains controversial. In this retrospective study, we conducted a comprehensive analysis of 206 patients with GGO to establish a correlation analysis model between CT images and diagnosis of GGO nodules. Methods Histopathologic specimens were obtained from 206 patients (130 women, 76 men; age range 24–77). The clinical data, pathologic findings, and thin-section CT features of solid, pure GGO (pGGO), and mixed GGO (mGGO) nodules were compared using rigorous statistical methods, such as t-test, Fisher’s exact test, or univariate logistic regression analysis. Results Significant differences were observed among the 3 groups in terms of patient demographics, including gender (P = 0.016), smoking history (P = 0.002), and nodule size (P = 0.002). Morphologic CT characteristics, such as the presence of spiculated sign, lobulated sign, vascular sign, bubble-lucency sign, or pleural retraction, exhibited significant differences among the solid nodule, pGGO, and mGGO groups. However, no significant differences were observed in terms of air-bronchogram sign. Notably, the incidence of malignancy was significantly higher in pGGO nodules (76.52%) than in solid (48.48%) and mGGO (73.86%) nodules. Patients with mGGO had up to 2.988 times higher hazard of malignant lesions than those with solid nodules [P = 0.036, hazard ratio (HR) = 2.988]. Similarly, the hazard of malignant lesions was 2.941 times higher in patients with pGGO than in those with solid nodules (P = 0.007, HR = 2.941). Conclusion Clinical, pathological, and thin-section CT features of solid, pGGO and mGGO nodules were found to be significantly different. Based on our comprehensive analysis, patients presenting with a mGGO or pGGO on CT scans were more likely to be diagnosed with lung cancer.

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