Adjacent Vessels Research Articles

Angiogenesis Invasion Assay to Study Endothelial Cell Invasion and Sprouting Behavior.

Angiogenesis is the formation of new blood vessels from the existing vasculature. It is a fundamental process in developmental biology but also a pathological event that initiates or aggravates many diseases. In this complex multistep process, endothelial cells are activated by angiogenic stimuli; undergo specialization in response to VEGF/Notch signaling; degrade the basement membrane of the parent vessel; sprout, migrate, and proliferate to form capillary tubes that branch; and ultimately anastomose with adjacent vessels. Here we describe an assay that mimics the invasion step in vitro. Human microvascular endothelial cells are confronted by a VEGF-enriched basement membrane material in a three-dimensional environment that promotes endothelial cell sprouting, tube formation, and anastomosis. After a few hours, endothelial cells have become tip cells, and vascular sprouts can be observed by phase contrast, fluorescence, or time-lapse microscopy. Sprouting endothelial cells express tip cell markers, display podosomes and filopodia, and exhibit cell dynamics similar to those of angiogenic endothelial cells in vivo. This model provides a system that can be manipulated genetically to study physiological or pathological angiogenesis and that can be used to screen compounds for pro-/anti-angiogenic properties. In this chapter, we describe the key steps in setting up this assay.

Determination of the adequate vascular perfusion time of cross-leg free latissimus dorsi myocutaneous flaps in reconstruction of complex lower extremity defects.

Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or avulsion injuries. Management of lower leg defects is acomplex problem, especially when they are large with deep soft tissue loss. These wounds are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels. In such cases, the vascular pedicle of the free flap could be anastomosed to the recipient vessels of the contralateral healthy leg temporarily and then divided after adequate neo-vascularization of the flap from the wound bed. The ideal time to divide such pedicles should be investigated and accurately assessed to have the maximum success rate possible for these challenging conditions and procedures. Sixteen patients who did not have asuitable adjacent recipient vessel for free flap reconstruction had been operated with cross leg free latissimus dorsi flap between February 2017 and June 2021. The mean soft tissue defect dimension was 12 ×11 cm (the smallest 6 × 7 cm; the largest 20 × 14cm). Gustilo type 3B tibial fractures were present in 12 patients, while no fractures were present in the other 4 patients. Preoperatively, arterial angiography was performed on all patients. After the fourth week post-operatively, non-crushing clamp was applied around the pedicle for 15minutes. The clamping time was increased by 15 minutes on each consequent day (average 14 days). On the last 2 days, the pedicle was clamped for 2 hours, and bleeding was assessed by aneedle prick test. Clamping time was assessed in each case to reach ascientific calculation of the adequate vascular perfusion time needed for full flap nourishment. All flaps survived completely except two cases of distal flaps necrosis. Cross-leg free latissimus dorsi can provide asolution for large soft-tissue defects in lower extremities especially with absence of any suitable recipient vessels or when the use of vein grafts would not be feasible. However, ideal time before dividing the cross vascular pedicle should be identified to have the maximum success rate possible.

Segmentation and classification of specific pattern of Brain tumor using CNN

A Brain tumor is a growth of cells in the brain or near it. Brain tumors can happen in the brain tissue close by locations include nerves, the pituitary gland, central nervous system , meninges and the membranes that cover the surface of the brain[1]. A glioma is a tumor that forms in the brain or spinal cord A glioma is a tumor of the central nervous system that makes an appearance from glial stem or progenitor cells. Glial cells are a type of cell generally present in the nervous system. Gliomas predominantly occur in the brain and, rarely, in the spinal cord. They grow in approximately 6.6 per 100,000 individuals each year. They transpire at various ages, controlled by the subtype. Growing gliomas can compact areas of the brain where they occur and cause various symptoms including headaches, nausea, vomiting, cognitive impairment, seizures, gait imbalance, language impairment [2] A meningioma is a tumor that makes an appearance from the meninges — the membranes that surround the brain and spinal cord. In spite of the fact that not technically a brain tumor, it is included in this category because it may compress or squeeze the adjacent brain, nerves and vessels Meningiomas are tumors of the meninges, mostly benign and often managed by surgical resection, with radiation therapy and chemotherapy reserved for high-risk or refractory disease.[3]. Tumors can start nearly anywhere in the body. Tumors that start in the pituitary gland are called pituitary tumors. The anterior pituitary tumors start in the larger, front part of the pituitary gland known as the anterior pituitary. The posterior pituitary: The smaller, back part of the pituitary gland is an extension of brain tissue from the hypothalamus. The posterior pituitary stores and releases hormones made by the hypothalamus (vasopressin and oxytocin) into the bloodstream [4]. Machine learning applications in healthcare are already having a positive impact, and its potential is still in the early stages of being realized to deliver care[2]. In the future, machine learning in healthcare will become increasingly important as we strive to make sense of the ever-growing clinical data sets in healthcare. Heart disease cancer, and brain tumors are diagnosed using medical imaging procedures such as MRI scans, CT scans, and ECG. As a result, deep learning assists doctors in better analyzing diseases and providing the best treatment to patients. In this paper specific brain tumor segmentation and classification have been done using a Deep Convolutional Neural Network that incorporates a multiscale approach. . The proposed neural model can look over MRI images containing three types of tumors: glioma, meningioma, and pituitary tumor. Data has been collected from https://www.kaggle.com/datasets/masoudnickparvar/brain-tumor-mri-dataset?select=Training This dataset ecompasses 7023 images of human brain MRI images which are classified into 4 classes: glioma - meningioma - no tumor and pituitary. no tumor class images were taken from the Br35H dataset. The goal of this work was to aid clinical researchers in gaining a clear and intuitive understanding of the application of data-mining technology on clinical data to promote the production of research results that are beneficial to doctors and patients.

Neurovascular Interactions in the Development of the Vasculature.

Vertebrates have developed a network of blood vessels and nerves throughout the body that enables them to perform complex higher-order functions and maintain homeostasis. The 16th-century anatomical text 'De humani corporis fabrica' describes the networks of blood vessels and nerves as having a branching pattern in which they are closely aligned and run parallel one to another. This close interaction between adjacent blood vessels and nerves is essential not only for organogenesis during development and repair at the time of tissue damage but also for homeostasis and functional expression of blood vessels and nerves. Furthermore, it is now evident that disruptions in neurovascular interactions contribute to the progression of various diseases including cancer. Therefore, we highlight recent advances in vascular biology research, with a particular emphasis on neurovascular interactions.

Posttraumatic single-stage ear reconstruction with a contralateral temporoparietal free flap: a case report

In addition to the inherent difficulties of ear reconstruction, including its three-dimensional, symmetrical, and bilateral nature, posttraumatic ear reconstruction is even more challenging because of the destruction of the adjacent soft tissues and vessels following trauma. In severe cases, ipsilateral reconstruction becomes especially difficult. In the case herein, we present posttraumatic single-stage ear reconstruction with a contralateral temporoparietal fascial free flap using a branch of a facial artery as the recipient vessel. Posttraumatic ear reconstruction should be performed after considering the extent of tissue damage, the available treatment options, and the patient’s preferences. In challenging posttraumatic ear reconstruction cases that involve a lack of soft tissue and vessels on the ipsilateral side, a contralateral temporoparietal fascial free flap using a facial artery as the recipient vessel should be considered as a treatment option.

Intravascular Endothelial Hyperplasia of the Foot

Intravascular endothelial hyperplasia is a benign soft tissue mass rarely reported in the foot. Advanced imaging and confirming a benign diagnosis are critical for any soft tissue mass. This paper identifies 2 patients that developed intravascular endothelial hyperplasia tumors which required surgical excision. A 17-year-old male patient presented to clinic complaining of a painful bump to the arch of his right foot which he related to an injury 9 months prior. Magnetic resonance imaging of the right foot revealed a mass within the plantar subcutaneous fat that was serpiginous in nature similar to adjacent branching vessels favoring a low-flow vascular malformation. A 38-year-old female with Multiple Sclerosis presented with complaints of persistent symptoms of pain to the 1st interspace, difficult ambulation and neuritis. Ultrasound and MRI observed solid, multilobulated mass, with internal vascular malformation, MRI describing intrinsic involvement along the abductor musculature and flexor tendons. Both lesions were surgically excised and sent for pathology. Pathology report indicated a diagnosis of intravascular papillary endothelial hyperplasia or Masson's tumor in both cases. Pathology diagnosis of intravascular papillary endothelial hyperplasia is generally good with wide resection leading to low recurrence rates. Both patients in the current study have progressed postoperatively with resolution of symptoms and without recurrence.

Risk Factors for Lymphovascular Invasion in Invasive Ductal Carcinoma Based on Clinical and Preoperative Breast MRI Features: a Retrospective Study

Lymphovascular invasion (LVI) plays an important role in the prediction of metastasis and prognosis in breast cancer (BC) patients. The present study assessed correlations between preoperative breast MRI, clinical features, and LVI in patients with invasive ductal carcinoma (IDC) and identified risk factors based on these correlation factors. Patients confirmed with IDC between 01/2012 and 12/2021 were retrospectively reviewed at our hospital. A total of 5 clinical and 14 MRI features to characterize tumours were extracted. LVI evaluated in hematoxylin and eosin sections. T-test and chi-square tests were used to compare the differences in clinical and MRI features between the LVI positive and negative groups. The associations between individual features and LVI were analysed by univariable logistic regression analysis, and risk factors for LVI were identified by multivariable logistic regression analysis based on these correlation factors. This study included 353 patients with IDC, including 130 with positive LVI. Age, CEA, CA-153, amount of fibroglandular tissue (FGT), background parenchymal enhancement, tumour size, shape, skin thickening, nipple retraction, adjacent vessel sign, and axillary lymph node (ALN) size in the LVI positive group were significantly different from the LVI negative group (all p<0.05). Multivariate logistic regression analysis revealed that age (odds ratio OR=1.030), CA-153 (OR=1.018), heterogeneous FGT (OR=2.484), shape (OR=2.157), and ALN size (OR=1.051) were risk factors for LVI (all p<0.05). Preoperative breast MRI and clinical features correlated with LVI, age, CA-153, heterogeneous FGT, shape, and ALN size are risk factors for LVI in patients with IDC.

Thymic cyst: Is attenuation artifactually increased on contrast-enhanced CT?

Thymic cysts are often misinterpreted as thymomas or lymph nodes, then leading to unnecessary thymectomy. The purpose of this study was to investigate how the adjacent large vessels artifactually affected attenuation values of thymic cysts on contrast-enhanced CT (CE-CT). In this retrospective study, a total of 84 patients were included with pathological diagnosis of thymic cysts and preoperative CE-CT. Quantitative measurements of the size, CT attenuation of thymic cysts and CT attenuation of adjacent large vessels were performed on preoperative CE-CT. According to the absolute change in attenuation of the cysts between contrast-enhanced and nonenhanced CT, the patients were classified into the groups of artifactual hyper-density, unchanged density, and artifactual hypo-density. CT characteristics were compared between the three groups. Furthermore, multivariable logistic regression analysis was performed to determine the independent factors for artifactual hyper-density. The group of artifactual hyper-density had smaller short diameter of the cysts, higher postcontrast attenuation values and lower nonenhanced attenuation values of the adjacent large vessel. Furthermore, the multivariable logistic analysis showed that artifactual hyper-density of thymic cysts was negatively associated with nonenhanced attenuation of adjacent large vessel, and positively associated with postcontrast attenuation of adjacent large vessel and postcontrast attenuation of cysts. Most cases with >20 HU nonenhanced CT attenuation in surgically resected cases. Artifactual hyper-density─pseudo-enhancement phenomenon of thymic cysts was more apparent in higher increasing attenuation of adjacent large vessels on CE-CT. A well understanding of this phenomenon can help reduce preoperative misdiagnosis and unnecessary thymectomy.

The value of adjacent vessel sign in malignant breast tumors.

PURPOSE The aim of this study was to evaluate the prognostic quality of adjacent vessel sign (AVS) in malignant breast tumors by comparing it with classical prognostic pathological biomarkers and magnetic resonance imaging (MRI) findings. METHODS A total of 124 patients with 133 malignant lesions were included. All the imaging was performed on a 1.5T Avanto scanner and the images were interpreted according to BI-RADS-MR® (fifth ed.) atlas. Maximum intensity projection (MIP) images were constructed from subtracted post-contrast images and were used to investigate AVS. Histopathological results and MRI findings were compared with AVS. RESULTS Interobserver agreement about AVS status was substantial (κ=0.64). AVS positive lesions were significantly bigger in size (P < .001, AVS negative: median 12 mm, AVS positive: median 31 mm). AVS was significantly associated with increased Ki-67 index and axillary lymph node metastasis (P=.009 and P=.019, respectively). Between AVS and lymphovascular invasion (LVI), there was a trend toward positive relationship (P=.076). MRI findings of T2 hypointensity, peritumoral edema, irregular shape, non-homogeneous contrast enhancement, rapid early contrast enhancement, and skin infiltration showed significant positive relation with AVS (P < .001, P < .001, P < .001, P=.02, P=.021, and P=.021, respectively). AVS is found to be associated with increased Ki-67 index, axillary lymph node metastasis, and some MRI findings that point to malignancy or poor prognosis. CONCLUSION AVS indicates poor prognosis since it is related to axillary lymph node metastasis, increased Ki-67 index, LVI, peritumoral edema, rapid early contrast enhancement, increased background enhancement, skin extension, T2 hypointensity, non-homogeneous contrast enhancement, irregular lesion shape, and larger tumor size. AVS is an easy to use sign that shows substantial interobserver agreement.

The vascular response to ultrathin biodegradable polymer sirolimus-eluting stent at 2-weeks and 1-year follow up in patients with ST-elevation myocardial infarction

Abstract Background Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, the details of vascular response in very early and chronic phase have not been systematically addressed. Objective and method We exploratory investigate early and chronic vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT). Consecutive twenty-four patients with STEMI who underwent FD-OCT after primary PCI and were eligible for follow-up FD-OCT at 2 weeks and 1 year after implantation were enrolled between June 2018 and August 2020. OCT was performed immediately after PCI, at 2-weeks (2W) and 1-year (1Y) after the primary PCI. Struts were recorded as uncovered if any part was visibly exposed in the lumen or covered if a layer of tissue covered all reflecting surfaces. Struts of stents that are smaller than 3.0mm of diameter with more than 80μm between the center reflection and the adjacent vessel surface were recorded as malapposed. The reduction of atherothrombotic protrusion burden within the stent was also assessed. Results Twenty-four patients (age 64.9±11.4 years, male 83.3%) were enrolled. The percentage of uncovered struts significantly decreased from post-PCI to 2W follow-up and from 2W follow-up to 1Y follow-up (62±20% post-PCI versus 27±11% at 2W follow up, p&amp;lt;0.0001 and 2W follow-up versus 3.3±3.3% at 1Y follow up, p&amp;lt;0.0001). Malapposed struts also decreased from post-PCI to 2W follow-up (4.1±3.6% post-PCI versus 1.5±2.2% at 2W follow-up, p&amp;lt;0.0001), but no significant difference was shown between 2W follow-up and 1Y follow-up (2W follow-up versus 1.0±2.3 at 1Y follow up, p=0.12). The average protrusion area of athero-thrombotic burden decreased (0.57±0.32 at post-PCI versus 0.42±0.22 mm2 at 2W follow up, p&amp;lt;0.0001) and its volume showed similar tendency (16.6±10.7 at post-PCI versus 12.9±8.23 mm3 at 2W follow up, p=0.0011). Thrombus was shown in all patients at post-PCI, but two patients (8.0%) showed it at 1Y follow-up. Conclusion(s) This study elucidated very early and chronic vascular responses following ultrathin strut BP-SES implantation in STEMI patients by FD-OCT. It showed resolution of athero-thrombotic materials in very early phase and favorable progression of strut coverage in very early and chronic phase. Funding Acknowledgement Type of funding sources: None.

S2899 A Rare Case of Small Cell Lung Cancer in the Posterior Mediastinum Diagnosed With Endoscopic Ultrasound-Guided Fine Needle Biopsy

Introduction: Lung cancer is the leading cause of cancer mortality worldwide, accounting for 2 million diagnoses and 1.8 million deaths in 2020.1 10-15% of all lung cancers are small cell lung cancer (SCLC), an aggressive form that grows more rapidly and metastasizes more easily than NSCLC. Thus, in patients with suspected lung cancer, a tissue diagnosis is crucial. Here, we present a unique case of a man with a posterior mediastinal mass for whom obtaining a tissue diagnosis presented a diagnostic challenge. Case Description/Methods: A 49 y/o M, with a 30 pack-year smoking history, presented with worsening left-sided chest pain and a 10-pound unintentional weight loss over 2 months. Vital signs and physical exam were unremarkable. Labs demonstrated a mild anemia (Hb 11-12, MCV 82) and elevated inflammatory markers (ESR 54, CRP 70.9). CT scan demonstrated a 12.0x10.7x8.4 cm hypodense soft tissue density mass in the left posterior mediastinum, extending from the level of T1 to T7 vertebral bodies. The mass displaced the trachea, esophagus, and adjacent vessels. Several enlarged mediastinal lymph nodes were seen, the largest measuring up to 1.5 cm. However, there was no lymphadenopathy seen elsewhere and no convincing evidence of metastatic disease in the abdomen or pelvis. CT surgery recommended a CT-guided biopsy with IR vs. endoscopic bronchial US-guided biopsy. IR was unable to find a safe access point to go in for the biopsy as there was no window, as the lung was seen overlying the mass. The patient was discharged, and he returned the next week for outpatient EUS-FNB, which demonstrated a 72x39 mm mediastinal mass (Fig 1A). EUS-FNB was performed and EUS-guided transesophageal biopsies were performed. He was also found to have erosive gastritis, healing superficial sub-cm gastric ulcers, and multiple healing superficial duodenal ulcers. Pathology results demonstrated SCLC (Fig 1B-E) and H. pylori. He was treated with standard quadruple therapy, referred to his PCP to confirm eradication in 6 weeks, and referred to Oncology. For stage III-b SCLC treatment, he completed external beam RT and chemotherapy. Repeat PETCT demonstrated a decrease in the residual mass to 5.5x3.5x5.8 cm. Discussion: For patients presenting with a posterior mediastinal mass, for whom IR may not be able to perform a biopsy, obtaining a tissue diagnosis may be a diagnostic challenge. EUS-FNB provides a useful tool to assess the mediastinum and can provide timely diagnosis and staging of patients with rare forms of lung cancer.Figure 1.: A) A posterior mediastinal mass vs. esophageal mass measuring 72.1 mm by 39.2 mm was identified status-post EUS with FNB x 6. This mass appeared to arise from the muscularis propria of the esophagus; however, an extrinsic mediastinal mass could not be definitively ruled out due to the severe compressive effects of the mass on the esophagus. Mediastinal mass, needle biopsy: -Minute fragments of malignant neoplasm with necrosis. -Tumor cells are positive for AE1/3, CAM5.2, Chromogranin, Synaptophysin, CD56 and negative for p40, CD3, CD20, and CD45. Ki-67 demonstrats about 60% positivity. Combined with morphological features, this immunoprofile supports the diagnosis of small cell carcinoma. B) Hematoxylin and eosin (H&E) stain. C) CAM5.2. D) CD56. E) Chromogranin.

Bifurcation matching for consistent cerebral vessel labeling in CTA of stroke patients

PurposeVessel labeling is a prerequisite for comparing cerebral vasculature across patients, e.g., for straightened vessel examination or for localization. Extracting vessels from computed tomography angiography scans may come with a trade-off in segmentation accuracy. Vessels might be neglected or artificially created, increasing the difficulty of labeling. Related work mainly focuses on magnetic resonance angiography without stroke and uses trainable approaches requiring costly labels.MethodsWe present a robust method to identify major arteries and bifurcations in cerebrovascular models generated from existing segmentations. To localize bifurcations of the Circle of Willis, candidate paths for the adjacent vessels of interest are identified using registered landmarks. From those paths, the optimal ones are extracted by recursively maximizing an objective function for all adjacent vessels starting from a bifurcation to avoid erroneous paths and compensate for stroke.ResultsIn 100 CTA stroke data sets for evaluation, 6 bifurcation locations are placed correctly in 85% of cases; 92.5% when allowing a margin of 5 mm. On average, 14 vessels of interest are found in 90% of the cases and traced correctly end-to-end in 73.5%. The baseline achieves similar detection rates but only 35.5% of the arteries are traced in full.ConclusionFormulating the vessel labeling process as a maximization task for bifurcation matching can vastly improve accurate vessel tracing. The proposed algorithm only uses simple features and does not require expensive training data.

A three-dimensional visualization of the full-field surgical region based on thin-slice MRI: A helpful approach for simultaneously guiding tumor resection and perforator flap elevation.

The goal of the current study was to explore the application of preoperative three-dimensional reconstruction (3DR) based on thin-slice magnetic resonance imaging (MRI) in the simultaneous guidance of en bloc tumor resection and adjacent perforator flap elevation. The prospective cohort included 35 patients diagnosed with either soft tissue sarcoma or squamous cell skin cancer between 2019 and 2021. The preoperative 3DR based on thin-slice MRI illustrated the spatial anatomical relationship among the tumor, underlying muscle, adjacent perforator vessels, and bone around the surgical region. The accuracy of preoperative imaging data was verified by intraoperative vessel dissection and postoperative pathological measurements. Tumor size from 3DR data showed relatively high concordance rates with pathological measurements within the 95% limits of agreement. An average of three perforators (range: 1-7) with a mean diameter of 0.32 cm (range: 0.18-0.74 cm) from the 3DR were present in our study. The average distance between tumor boundary and perforator piercing sites on the 3DR was 2.2 cm (range: 1.2-7.7 cm). The average length of artery perforator coursing along the subcutaneous tissue was 5.8 cm (range: 3.3-25.1 cm). The mean flap harvest time was 55 mins (range: 36-97 min). The average flap size was 92.2 cm2 (range: 32-126 cm2). One perforator flap occurred distal partial necrosis. A thorough understanding of anatomical structures in the surgical region according to full-field 3DR based on thin-slice MRI can improve the performance of radical resection of the tumor and adjacent perforator flap transfer, especially for junior surgeons with a poor experience.

Initial Ultrasound Criteria for the Diagnosis of Cervical Lymph Node Metastases from Papillary Thyroid Cancer

Introduction: Cervical lymph node metastases from papillary thyroid cancer were classified into three categories according to ultrasound: 1) Metastases were not visible on ultrasound; 2) Metastases met initial criteria for the diagnosis; 3) Metastases met typical criteria for the diagnosis. Purpose: To develop initial ultrasound criteria for the diagnosis of cervical lymph node metastases from papillary thyroid cancer. Material and methods: We studied three groups of cervical lymph nodes in patients with papillary thyroid cancer. The first group consisted of 4307 lymph nodes that were not visible on ultrasound. However, in some of them histology revealed a metastasis. The second lymph node group consisted of 242 metastases, and the third one comprised 17 metastases causing first signs. Ultrasound imaging was performed by use of standard ultrasound machines that are widely used in clinical practice. The presence of metastases in the three groups was confirmed by histology and cytology. Results: According to histological data, metastases were present in 961 (22.3 %) of 4307 cervical lymph nodes of level VI located in the fatty tissue and removed for disease prevention. These lymph nodes were missed on ultrasound, so that metastases remained undetected. Typical criteria for the diagnosis of metastases were: an additional space-occupying lesion in the fatty tissue of the neck, local fat deformation, depth/width ratio over 0.5, no differentiation between the cortical and cerebral layers, predominance of the tissue nature, avascularity, calcifications. Cervical lymph nodes with extranodal extension showed some changes in the shape and outlines, metastatic spread to the adjacent fatty tissue, muscles and vessels. Initial sonographic features that helped to identify a metastasis included microcalcifications and an additional nodal space-occupying lesion occupying a part of the cortical and cerebral layers and being seen as the hyperechoic tissue or a cavity with fluid, or as a mixture of the hyperechoic tissue with fluid. The space-occupying lesion was round or ovoid in shape. There was no extranodal extension of early metastases. The space-occupying lesion was 0.5–0.7 cm in size. Conclusion: Ultrasound can detect metastases that cause first signs. Besides, it helps guide biopsies.

A Reverse Thymic Fat Pad Flap to Cover the Anastomosis of an Extended Tracheal Resection Following Induction Chemotherapy: A Challenging Case Report

Extended tracheal resection after neoadjuvant chemotherapy is rarely described in patients with tracheal cancer. Controversies still exist among surgeons about the length of tracheal resectability and possible harmful anastomotic complications. Different vascularized tissue flaps can be used to protect the anastomotic suture line. We reported a 67-year-old patient with middle tracheal squamous cell carcinoma treated by induction chemotherapy followed by a successful extended tracheal resection. The anastomosis was covered by a reversed thymic fat pad flap to prevent the erosion of adjacent brachiocephalic vessels. Postoperative concurrent chemoradiation did not threaten the integrity of the suture line. Careful tracheal dissection and accurate release manoeuvres are mandatory to achieve a tension-limited anastomosis. Extended tracheal resection may be safely performed after induction chemotherapy, with excellent long-term outcomes. A thymic fat flap seems to be beneficial to suture-line healing.

Proof of Principle of Combining Fluorescence-Guided Surgery with Photoimmunotherapy to Improve the Outcome of Pancreatic Cancer Therapy in an Orthotopic Mouse Model

BackgroundPancreatic cancer is a recalcitrant disease in which R0 resection is often not achieved owing to difficulty in visualization of the tumor margins and proximity of adjacent vessels. To improve outcomes, we have developed fluorescence-guided surgery (FGS) and photoimmunotherapy (PIT) using a fluorescent tumor-specific antibody.MethodsNude mice received surgical orthotopic implantation (SOI) of the human pancreatic cancer cell line BxPC-3 expressing green fluorescent protein. An anti-carcinoembryonic antigen-related cell adhesion molecule (CEACAM) monoclonal antibody (6G5j) was conjugated to the 700-nm fluorescent dye IR700DyeDX (6G5j-IR700DX). Three weeks after SOI, 16 mice received 50 μg 6G5j-IR700DX via the tail vein 24 h before surgery and were randomized to two groups: FGS-only (n = 8) and FGS + PIT (n = 8). All tumors were imaged with the Pearl Trilogy imaging system and resected under the guidance of the FLARE imaging system. The FGS + PIT group received PIT of the post-surgical bed at an intensity of 150 mW/cm2 for 30 min. Mice were sacrificed 4 weeks after initial surgery, and tumors were imaged with a Dino-Lite digital microscope, excised, and weighed.ResultsThe 6G5j-IR700DX dye illuminated the orthotopic pancreatic tumors for FGS and PIT. The metastatic recurrence rate was 100.0% for FGS-only and 25.0% for FGS + PIT (p = 0.007). The average total recurrent tumor weight was 2370.3 ± 1907.8 mg for FGS-only and 705.5 ± 1200.0 mg for FGS + PIT (p = 0.039).ConclusionsFGS and adjuvant PIT can be combined by using a single antibody–fluorophore conjugate to significantly reduce the frequency of pancreatic cancer recurrence.

EP07.03-004 Efficacy of Thoracic Radiotherapy for Local Progression in Advanced Thymic Carcinoma

Advanced thymic carcinoma is a rare epithelial tumor of the thymus with a poor prognosis. Local advance is crucial in many patients due to the anatomical adjacent large vessels, bronchus, and heart. Thoracic radiotherapy is the main modality for the treatment of local progression. We analyzed the efficacy of radiotherapy to anti-mediastinal region in patients with advanced and recurrent thymic carcinoma.

Characteristics of Computed Tomography for Identifying Patients at High Risk of Endogenous Endophthalmitis Due to Klebsiella pneumoniae-Related Pyogenic Liver Abscess.

Endogenous endophthalmitis (EE) associated with Klebsiella pneumoniae (K. pneumoniae)-related pyogenic liver abscess (PLA) is one of the fatal complications of PLA and leads to loss of vision. Early diagnosis and treatment are important to save the patient’s vision. We investigated the characteristics of computed tomography (CT) in EE associated with K. pneumoniae-related PLA for the identification of the predictors of EE, in order to facilitate early diagnosis. A total of 274 patients diagnosed with K. pneumoniae-related PLA, including 15 patients with EE, were identified between January 2005 and December 2019. The clinical (age, gender, and underlying disease) and radiologic (the location, size, and number of abscesses) features were reviewed. In addition, the involvement of the adjacent vessels, such as the hepatic vein and portal vein, was carefully reviewed. A comparative analysis was performed between the EE and non-EE groups. Uni- and multivariate logistic regression analyses were used to identify the predictors of EE. Diabetes mellitus (DM), the involvement of the left or both hepatic lobes, and the adjacent vessels on the CT were significantly more frequent than those in the non-EE group (p < 0.05 in all), and they were the significant predictors of EE in the logistic regression analyses. In patients with K. pneumoniae-related PLA, the CT findings, such as the locations of the abscess (i.e., left or both lobes) and the involvement of the adjacent vessels, should be considered in addition to the ocular symptoms for an early diagnosis of EE.

Multi-scale modelling of nanoparticle delivery and heat transport in vascularised tumours.

We focus on modelling of cancer hyperthermia driven by the application of the magnetic field to iron oxide nanoparticles. We assume that the particles are interacting with the tumour environment by extravasating from the vessels into the interstitial space. We start from Darcy's and Stokes' problems in the interstitial and fluid vessels compartments. Advection-diffusion of nanoparticles takes place in both compartments (as well as uptake in the tumour interstitium), and a heat source proportional to the concentration of nanoparticles drives heat diffusion and convection in the system. The system under consideration is intrinsically multi-scale. The distance between adjacent vessels (the micro-scale) is much smaller than the average tumour size (the macro-scale). We then apply the asymptotic homogenisation technique to retain the influence of the micro-structure on the tissue scale distribution of heat and particles. We derive a new system of homogenised partial differential equations (PDEs) describing blood transport, delivery of nanoparticles and heat transport. The new model comprises a double Darcy's law, coupled with two double advection-diffusion-reaction systems of PDEs describing fluid, particles and heat transport and mass, drug and heat exchange. The role of the micro-structure is encoded in the coefficients of the model, which are to be computed solving appropriate periodic problems. We show that the heat distribution is impaired by increasing vessels' tortuosity and that regularization of the micro-vessels can produce a significant increase (1-2 degrees) in the maximum temperature. We quantify the impact of modifying the properties of the magnetic field depending on the vessels' tortuosity.

A thermally-driven seawater desalination system: Proof of concept and vision for future sustainability

Since the 1970s, commercial-scale thermally-driven seawater desalination plants have been powered by low-grade energy sources, drawn either with low-pressure bled-steam from steam turbines or the solar renewable energy harvested that are supplied at relatively low temperatures. Despite the increasing trend of seawater reverse osmosis plants, the role of thermal desalination methods (such as multi-stage flashing and multi-effect distillation) in GCC countries is still relevant in the Arabian Gulf, arising from higher salinity, the frequent algae blooms of seawater and their ability to utilize low temperature heat sources. Given the urgent need for lowering both the capital and operating costs of all processes within the desalination industry and better thermodynamic adaptation of low-grade heat input from renewable sources, the present paper addresses the abovementioned issues by investigating the direct contact spray evaporation and condensation (DCSEC) method. A DCSEC system comprises only hollow chambers (devoid of membranes or tubes, minimal use of chemical and maintenance) where vapor generation (flashing) utilizes the enthalpy difference between the sprayed feed seawater and the saturated vapor enthalpy of the vessels. Concomitantly, vapor is condensed with spray droplets of cooler water (potable) in adjacent condenser vessels, employing a simple design concept. We present detailed design and real seawater experiments data of a DCSEC system for the first time. The water production cost is calculated as $0.52/m 3 , which is one of the lowest figures reported compared to commercial processes presented by Global Water Intelligence.