Circumferential Extent Research Articles

Effects of transducer’s Parameters on the Amplitude Response of Spirally Propagating Circumferential Lamb Wave and Their Application in Defect Detection

Abstract The commonly used traditional cylindroid guided wave modes are not sensitive to a crack with limited circumferential extent within a pipe. The circumferential guide wave will not be affected by the limited circumferential extent of a crack, which can be make up the limitation of the commonly used traditional cylindroid guided wave modes in crack detecting within a pipe. This article studied the spirally propagating circumferential Lamb wave within a pipe, which can determine the axial position of a crack only if the axial extent of the crack is large enough regardless the limited circumferential extent of the crack. To efficiently trigger the spirally propagating circumferential Lamb wave, the effect of the frequency, the circumferential coverage and the axial length of the transducer on the spirally propagating circumferential Lamb wave signals were investigated based on the theoretical model and experiments. Then, the comparison experiments presented the superiority of the proposed spirally propagating circumferential Lamb wave in detecting a crack with limited circumferential extent over the commonly used cylindroid guided wave mode. Finally, the angular interval of two cracks that in the same axial position can be determined through the angular interval of the triggering positions of the spirally propagating circumferential guided wave, which cannot be evaluated through the commonly used traditional cylindroid guided wave modes.

Prevalence and clinical implications of calcification in internal carotid artery stenosis: a retrospective study

BackgroundCalcification is common in advanced atheromatous plaque, but its clinical significance remains unclear. This study aimed to assess the prevalence of plaque calcification in the moderate-to-severe internal carotid artery stenosis and investigate its relationship with ipsilateral ischemia.MethodsThe retrospective study included 178 patients detected with proximal internal carotid artery (pICA) stenosis of ≥ 50% on multidetector computed tomography at Zhejiang Hospital from January 2019 to March 2023. Association between plaque calcification characteristics (calcification thickness, position, type, circumferential extent, calcium volume and calcium score) and ipsilateral cerebrovascular events was analyzed.ResultsThe 178 patients (mean age 71.24 ± 10.02 years, 79.78% males) had 224 stenosed pICAs overall. Plaque calcification was noted in 200/224 (89.29%) arteries. Calcification rates were higher in older age-groups. Calcification volume (r = 0.219, p < 0.001) and calcification score (r = 0.230, p < 0.001) were correlated with age. Ipsilateral ischemic events were significantly more common in the noncalcification group than in the calcification group (χ2 = 4.160, p = 0.041). The most common calcification type was positive rim sign calcification (87/200, 43.50%), followed by bulky calcification (66/200, 33.00%); both were significantly associated with ischemic events (χ2 = 10.448, p = 0.001 and χ2 = 4.552, p = 0.033, respectively). Calcification position, thickness, and circumferential extent, and calcification volume and score, were not associated with ischemic events. In multivariate analysis, positive rim signs (OR = 2.795, 95%CI 1.182–6.608, p = 0.019) was an independent predictor of ischemic events.ConclusionsPlaque calcification in proximal internal carotid artery is common, and prevalence increases with age. Calcification characteristics could be predictive of ipsilateral ischemic events. The positive rim sign within plaque is a high-risk factor for a future ischemic event.

Intracranial artery calcification: Frequency, determinants, and modification of outcomes from endovascular thrombectomy

IntroductionIntracranial artery calcification (ICAC) is a common finding on computed tomography (CT) in patients presenting with large vessel occlusion acute ischemic stroke (LVO-AIS) and could serve as a useful biomarker of intracranial atherosclerosis and altered intracranial vessel pliability in patients undergoing endovascular thrombectomy (EVT). MethodsThis was a retrospective cohort study analyzing consecutive patients undergoing CT head prior to EVT between 2016 and 2020. Extent of ICAC proximal to the target vessel was scored using a validated grading scale examining thickness and circumferential extent of calcifications. The relationship between 3 levels of ICAC burden and procedural, clinical, and safety outcomes was analyzed. ResultsAmong 86 patients meeting inclusion criteria, ICAC of any degree was present in 72.1 %. Median ICAC score was 3 [IQR 0-4]. There was a U-shaped association between ICAC score and successful reperfusion: 90.9 %, 65.7 %, and 94.4 % in the low, intermediate, and high ICAC score groups, respectively (p = 0.008). Use of rescue intervention, most often angioplasty and stenting, was greatest in the high ICAC score group: 3.0 % vs. 5.7 % vs. 22.2 % (p = 0.05). Functional independence at 90 days did not differ significantly among groups (41.7 % vs. 31.0 % vs. 15.4 %, p = 0.26), nor did rates of symptomatic intracranial hemorrhage (15.2 % vs. 14.3 % vs. 16.7 %, p = 0.97). ConclusionsICAC is seen on CT in nearly three-quarters of patients with LVO-AIS. Extent of ICAC has a U-shaped association with successful reperfusion, in part due to more frequent use of rescue interventions in patients with extensive ICAC.

Local triamcinolone injection and selective add-on oral steroids to prevent esophageal post-endoscopic submucosal dissection stricture: a retrospective analysis in a Western center.

Extensive esophageal endoscopic submucosal dissections (ESDs) without preventive measures carry a high risk of stricture. Oral steroids and local injection of triamcinolone acetonide have proven to be effective in Asia for the prevention of esophageal stricture. This study aimed to assess the efficacy of a systematic steroid administration protocol for stricture prevention in a Western center. A retrospective review was conducted of all esophageal ESDs performed at H.U.B. Erasme Hospital, Brussels between 2016 and 2022. Injection of triamcinolone was performed for mucosal defects between 50% and 89% of the circumference. We added oral corticosteroids for patients with resections of ≥90% of the circumference. The primary outcome was the incidence of symptomatic stenosis at 3 months. Secondary outcomes included the cumulative stricture rate assessed by endoscopy within 6 months of ESD. Potential risk factors of stricture were evaluated with univariate and multivariate analysis. 111 patients underwent 130 esophageal ESDs, with 59 patients receiving triamcinolone acetonide local injection and eight receiving local and oral corticosteroids. The primary outcome demonstrated a stricture incidence of 8.4%. The cumulative stricture rate assessed by endoscopy within 6 months of ESD was 10.4%. A mucosal defect of ≥60 mm in length was associated with a 15-fold increased risk of stricture, with circumferential extent also identified as being an independent prognostic factor for stricture. Our protocol led to a low stricture rate, even after extensive resection. As a single session treatment without systemic side effects, triamcinolone injection could provide benefits as a preventive method after large esophageal resections.

Multicenter retrospective analysis of complications and risk factors in endoscopic resection for esophageal cancer across Japan.

Endoscopic resection (ER) is a minimally invasive treatment for esophageal cancer that sometimes causes complications. To understand the real-world incidence and risk factors for these complications, a nationwide survey was conducted across Japan. This retrospective multicenter study included patients who underwent ER for esophageal cancer from April 2017 to March 2018 (2017 complication analysis) and April 2021 to March 2022 (2021 complication analysis). The study assessed the complication rates and conducted risk factor analyses for endoscopic submucosal dissection (ESD) using data for these patients, with exclusions based on specific criteria to ensure data accuracy. In the 2021 complication analysis, there were two mortalities highly likely attributable (0.03%) to ER and one mortality possibly attributable (0.01%) to ER. Intraoperative perforation, delayed bleeding, and pneumonia occurred in 137 cases (1.8%), 44 cases (0.6%), and 130 cases (1.7%), respectively. In the multivariate analysis for complications after ESD, low ER volume of the facility was an independent risk factor for perforation, while lesion location in the cervical or upper thoracic esophagus was an independent factor for reduced risk of perforation. Age ≥ 80years was a risk factor for pneumonia, while use of traction techniques was a factor for reduced risk of pneumonia. Lesions located in the middle thoracic esophagus had a lower risk of stricture, and the risk of stricture increased as the circumferential extent of the lesion increased. This large-scale study provided detailed insights into the complications associated with esophageal ER and identified significant risk factors.

Development and Validation of a User Friendly Morphology Grading System (PATENT) Predicting Aortic Remodelling After Thoracic Endovascular Aortic Repair in High Risk Uncomplicated Type B Aortic Dissection

This study aimed to create a morphology grading system, solely based on 2D images from computed tomography angiography, to predict negative aortic remodelling (NAR) for patients with high risk uncomplicated type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). This single centre retrospective cohort study extracted and analysed consecutive patients diagnosed with high risk uncomplicated TBAD. Negative aortic remodelling was defined as an increase in the diameter of a false lumen or total aorta, or decrease in the diameter of a true lumen. The multivariate Cox regression model identified risk factors and a prediction model was created for two year freedom from NAR. A three category grading system, in which patients were classified into low, medium, and high risk groups, was further developed and internally validated. Of 351 patients included, 99 (28%) of them developed NAR. The median age was 52 years (interquartile range 45, 62 years) and 56 of them (16%) were female. The rate of two year freedom from NAR was 71% (95% CI 65 - 77%). After the multivariate Cox regression analysis, Patent false lumen, Aberrant right subclavian artery, Taper ratio, abdominal circumferential Extent, coeliac artery or reNal artery involved, and four channelled dissection (Three false lumens) remained independent predictors and were included in the PATENT grading system. The risk score was significantly associated with NAR (HR 1.21; 95% CI 1.14 - 1.29; p < .001). The medium and high risk groups demonstrated a higher rate of NAR (medium risk, HR 2.82; 95% CI 1.57 - 5.01; p = .001; high risk, HR 4.39; 95% CI 2.58 - 7.48; p < .001). The grading system was characterised by robust discrimination with Harrell's C index of 0.68 (95% CI 0.63 - 0.75). The PATENT grading system was characterised with good discrimination and calibration, which may serve as a clinician friendly tool to aid in risk stratification for TBAD patients after TEVAR.

Risk of stricture after endoscopic submucosal dissection in the cervical esophagus and efficacy of local steroid injection for stricture prevention (with video)

There is a high incidence of stricture after endoscopic submucosal dissection (ESD) for cervical esophageal cancer. We aimed to elucidate the risk factors for stricture and to evaluate the efficacy of steroid injection for stricture prevention in the cervical esophagus. We retrospectively analyzed 100 patients who underwent ESD for cervical esophageal cancer to (1) identify the factors associated with stricture among patients who did not receive steroid injection, and (2) compare the incidence of stricture between patients with and without steroid injection. Among 48 patients who did not receive steroid injection, there were significant differences in tumor size (P= .026), resection time (P= .028), and circumferential extent of the mucosal defect (P= .005) between patients with stricture (n= 5) and without stricture (n= 43). Compared with patients without steroid injection, patients with steroid injection had a significantly lower incidence of stricture when the post-ESD mucosal defect was<3/4 and≥1/2 (40% versus 8%; P= .039). For the patients with a post-ESD mucosal defect of≥3/4 (n= 13), local steroid injection was performed for all of them, and 6 (46%) developed stricture. Patients who underwent≥1/2 circumferential resection were at high risk of cervical esophageal stricture. Steroid injection had a stricture prevention effect in patients with<3/4 and≥1/2 circumferential resection, but seemed to be insufficient in preventing stricture in patients with≥3/4 circumferential resection.

Investigating the determinants of iridolenticular contact area: a novel parameter for angle closure

Background/aimsTo identify ocular determinants of iridolenticular contact area (ILCA), a recently introduced swept-source optical coherence tomography (SSOCT) derived parameter, and assess the association between ILCA and angle closure.MethodsIn this population-based...

Temporal evolution of primary angiitis of the central nervous system (PACNS) on MRI following immunosuppressant treatment

PurposeTo systematically analyse the time course of vessel wall enhancement and associated stenosis in patients with primary angiitis of the central nervous system (PACNS) following immunosuppressive therapy.Material and methodsTwo neuroradiologists retrospectively analysed MRIs of patients with PACNS seen at the Bern University Hospital and the St. Gallen Cantonal Hospital between 2015 and 2020. MRIs were examined for the presence of vessel wall enhancement, length of vessel wall enhancement (mm), circumferential extent of enhancement (degree) and degree of stenosis (%). Descriptive statistics and measurements of interobserver reliability were obtained. To investigate the temporal profiles of the variables following the commencement of immunosuppressant treatment, four series of Bayesian generalised multi-level models were generated.ResultsA total of 23 patients with 43 affected vessels identified from 209 MRI exams were evaluated (mean follow-up: 715 days, standard deviation ± 487 days), leading to a complete dataset of 402 entries. Vessel wall enhancement and circumferential extent of enhancement decreased for approximately 1 year after the initiation of immunosuppressant therapy. Changes were more pronounced in younger patients. Disappearance of vessel wall enhancement (in at least one vessel) was seen in about half of patients after a median of 172 days interquartile range 113–244, minimum 54 days, maximum 627 days.ConclusionsThis study evaluated the typical time course of vessel wall enhancement in patients with PACNS. Our results could be a useful reference for radiologists and clinicians interpreting follow-up imaging in patients with PACNS.Critical relevance statementRoutine clinical exams can be interpreted with more confidence when radiologists are aware of the typical temporal evolution of vessel wall enhancement in patients with primary angiitis of the central nervous system after initiation of immunosuppressive therapy.Key PointsFew data exist for vessel wall imaging of primary angiitis of the central nervous system.Following immunosuppressant therapy, vessel wall enhancement decreases for approximately one year.These results may serve as a reference for radiologists performing follow-up imaging.Graphical

The contribution of pulmonary veins to the mechanism of persistent AF is dependent on their extent of electrical connection

Abstract Introduction Success rate of pulmonary vein isolation (PVI) is lower in patients with persistent AF (peAF) compared to paroxysmal AF. The indiscriminate use of adjunctive catheter ablation (CA) strategies beyond PVI involve potential risks and new areas of iatrogenic arrhythmogenesis. Thus, distinguishing patients with peAF who may be cured with PVI-only from those who need CA beyond PVI would allow a more efficient patient-tailored CA strategy. Purpose We aimed to evaluate whether the circumferential extent of PV electrical connection assessed during pre-ablation mapping predicts the success rate of a PVI-only CA strategy. Methods Consecutive patients with peAF undergoing first CA consisting of a PVI-only CA were included. The extent of PV electrical connection was assessed using a circular mapping catheter placed within the PVs prior to ablation. Based on their follow-up (FU), patients were considered: a) PVI-responders, in the absence of AF or atrial flutter recurrence ≥ 12 months off-anti-arrhythmic drugs, b) PVI-non responders, in case of AF recurrence despite absence of any PV reconnection at reintervention, or despite one reintervention consisting of stand-alone residual PV connection ablation, c) PVI response was considered as indeterminate for all other instances (eg. Sinus rhythm maintenance on-AAD, shorter FU, etc). Results 148 patients were included (mean age 64 ± 9.7 years, mean peAF duration 7.3 ± 7 months). After a mean FU of 18 months after last PVI, we identified 60 PVI-responders and 25 PVI- non responders. In the remaining 63 patients, PVI response was indeterminate. In PVI-responders, the median percentage of the PV circumference displaying PVs potentials was significantly higher compared to PVI-non responders (68% vs. 60%, respectively; p=0.035). Conclusions The circumferential extent of PVs connection is correlated to the success rate of a stand-alone PVI CA strategy in patients with peAF. It may be a marker of the contribution of PVs to AF. Patients with poorly connected PVs during index CA ablation may warrant additional ablation strategies beyond PVI.

Radial Field Detector to Improve Sensitivity of Localized Defects in Remote Field Eddy Current Technique

ABSTRACT This paper presents the development of a cone-shaped radial magnetic-field-detector–based remote field eddy current (RFEC) probe for enhanced detection of localized defects in ferritic steel tubes. The performance of the radial coil detector has been evaluated for the detection of different types of defects such as through holes, flat bottom holes and notches of different sizes and orientations. The RFEC signals are observed to be corrupted by heavy noise due to spatial variations in material permeability. To remove the random noise from the nonstationary time series RFEC signals, empirical mode decomposition (EMD) processing has been adopted and has been found to significantly improve the signal-to-noise (SNR) ratio. Furthermore, the effect of the circumferential extent of defects on the signal amplitude is analyzed through experimental and finite-element-model–based studies. The linear resolution of the designed radial coil detector and its repeatability behavior are also scrutinized. Studies demonstrate that the developed radial field detector is a promising configuration in remote field eddy current technique for enhanced defect detection and also in designing an array probe.

P460 The POCER index: application of a novel endoscopic score in a real-life cohort of patients with Crohn's disease after surgery

Abstract Background The Rutgeerts score (Rs) is the most widely used score that offers essential prognostic information in the field of postoperative management of patients (pts) with Crohn's disease (CD). A recent study has introduced the POCER postoperative index (Pi), which includes the circumferential extent and depth of anastomotic ulcers, which can be an additional tool to better define the prognosis of this category of pts Methods Our study aims to evaluate the Pi in a real-life cohort, its correlation with Rs, and its prognostic value. We conducted a single center retrospective study, evaluating different outcomes of pts with CD who underwent ileocolonic resection. All pts underwent the first endoscopic evaluation within 6-12 months to assess postoperative recurrence (POR). We applied both the Rs and the Pi. POR was defined as Rs≥2 or Pi≥2. A clinical and objective assessment was performed at 18-24 months. Clinical Recurrence (CR), evaluated in all pts, was defined with a Harvey-Bradshaw Index (HBI)≥5. Objective Recurrence (OR), evaluated in a subgroup, was defined by the presence of endoscopic activity and/or radiological activity (assessed by ultrasound (US) when a wall thickness≥4 mm was present) Results We included 103 pts who underwent ileocolonic resection, with a median age at surgery of 38 years old. The main indication for surgery was a stenotic disease. 63% of pts had ≥1 risk factor for POR. All pts underwent prophylactic biologic therapy. At 6 month, POR was observed in 50 (48.3%) and 17 (16.5%) pts, according to Rs and Pi, respectively. Mean Rs and Pi were 1.39 (± 1.31) and 0.70 (± 1.08); a moderate correlation (r=0.523) between the two was observed. We assessed the ability of Rs and Pi at 6-12 months to predict CR and OR at 18-24 months. A Rs≥2 predicted CR with an AUROC of 0.8345 (sensitivity 93.3% and specificity 59.3%). A Pi≥2 predicted CR with an AUROC of 0.693 (sensitivity 33.33% and specificity 84.88%). When evaluating the performance of the mean of the two scores, we observed that a mean score≥1.75 could predict CR with an AUROC of 0.807 (sensitivity 80.00% and specificity 68.6%). A mean score≥1.75 could also predict OR with an AUROC of 0.662 (sensitivity 45.45% and specificity 74.29%). We also evaluated the subgroup of pts with Rs 1-2 at 6 months and the significance of the addition of the Pi: although no statistical significance was observed, a Pi&amp;lt;1 had a specificity of 100% in predicting the absence of CR Conclusion Rs and Pi can be used to assess POR and predict CR and OR. The combination of the two might outperform each of them with a good compromise between sensitivity and specificity. The addition of the Pi in pts with Rs 1-2, might be helpful in clarifying the prognostic significance of this result

A large post-stenting intramural hematoma in the left anterior descending artery caused by a small intimal calcium spur; should we respect the calcium shape?

Coronary heavy calcification (HC) poses a sturdy challenge to percutaneous coronary intervention (PCI). Scores considering calcification length, thickness, or circumferential extent, are widely accepted to dictate upfront calcium modification to improve PCI outcomes. Although often marginalized, calcification shape (morphology) may require consideration during procedure planning in selected cases. This case demonstrates how a focal but spur-shaped calcification led to a massive proximal left anterior descending (LAD) dissecting intramural hematoma.

Stall and stability enhancement mechanisms of transonic compressor with inlet total temperature distortion

Inlet total temperature distortion refers to the nonuniform distribution of the total temperature at the inlet of the aero-engine, which is one of the external destabilizing factors that have the most remarkable impact on the stability of an aero-engine. In this study, the stalling process of the Darmstadt transonic compressor is investigated under the total temperature distortion of 180 deg circumferential extent and 500 K intensity by full-annulus unsteady numerical simulation. The analysis shows the addition of inlet total temperature distortion deteriorates the compressor stall margin from 22.7% to 17.0% with a considerable decrease in the pressure ratio. The type of compressor stall inception under temperature distortion conditions remains spike. Pressure perturbations and radial vortex formation are first clearly detected when the rotor rotates into the high temperature distortion region. The circumferential propagation of the stall cells under the total temperature distortion is 66% of the rotor speed, which is faster than that under uniform condition whose value is 44% of the rotor speed. The optimized casing treatment (CT) has extended the stall margin of the rotor without producing efficiency loss under uniform condition. The anti-distortion ability of CT is first verified despite its negative impact on efficiency under total temperature distortion. The adoption of CT could obviously push the shock wave into the blade passage under total temperature distortion condition. In addition, it can reduce the tip blade loading, thus removing the low Mach number area in the tip region, while increasing the blade loading below 80% span.

The feasibility of endoscopic resection for colorectal laterally spreading tumors.

The present study aimed to investigate the feasibility and safety of endoscopic resection for colorectal laterally spreading tumors (LSTs) in different size groups. This retrospective study included 2699 patients with LSTs who underwent endoscopic treatment at the Second Xiangya Hospital of Central South University from May 2012 to February 2022. The patient baseline and procedure outcomes were compared between the < 5cm group, 5-10cm group, and ≥ 10cm group. Meanwhile, lesions larger than 5cm in diameter were longitudinally compared for endoscopic safety using ESD with surgical operation outcomes. There were 2105 patients in the < 5cm group, 547 patients in the 5-10cm group, and 47 patients in the ≥ 10cm group. En bloc resection and R0 resection rates, the incidence of adverse events, length of stay (LOS), and medical costs significantly differed between the groups (P < 0.01). Comorbidity of diabetes or hypertension, history of antithrombotic drug use, lesion size, location, gross type, endoscopic procedures selection, and circumferential extent of the mucosal defect were independent risk factors for delayed bleeding (P < 0.05). En bloc resection, R0 resection, and lesion canceration were associated with local recurrence. For lesions larger than 5cm in diameter, ESD had similar R0 resection and local recurrence rates compared with a surgical operation but a lower en bloc rate, LOS, and medical costs. Expert endoscopists can significantly increase en bloc and R0 resection rates and reduce the incidence of adverse events. Endoscopic resection results distinguish in different size groups of colorectal LSTs, yet its safety and feasibility are not inferior to a surgical operation.

Laparoscopic Double Discoid Colorectal Resection for the Treatment of Two Distinct Deep Endometriotic Nodules

To show the surgical steps used to perform a laparoscopic double discoid colorectal resection for the excision of 2 distinct deep endometriotic nodules (DENs). Stepwise demonstration of the technique with narrated video footage. To date there is agreement that discoid resection should be the first choice procedure in patients eligible for surgical treatment with rectal, unifocal DENs measuring ≤ 3 cm [1-3]. For surgical management of lesions of the sigmoid colon, current international guidelines suggest to perform segmental resections [3]. Data on surgical treatment of multiple colorectal DENs separated by a great distance from each other are very limited, mostly owing to the rarity of such a diagnosis. In particular, there is paucity of data concerning the efficacy and safety of a double discoid resection for surgical management of distinct DENs found in the sigmoid colon and rectum [4]. In a context of multiple colorectal DENs, the decision-making process with respect to a double discoid excision must take into consideration both the distance between the 2 nodules and the nodules' distance from anal verge. When technically feasible, such organ-sparing surgery allows preserving the healthy bowel interposed between the endometriotic lesions, seeming to offer advantages in terms of quicker return of bowel function and better rectal functional outcomes than segmental colorectal resection. The patient was a 36-year-old woman experiencing drug treatment failure and presenting with refractory constipation, dyschezia, dysmenorrhea, dyspareunia, cyclical abdominal bloating, and chronic pelvic pain. Preoperative ultrasonography revealed the presence of an endometriotic nodule of 19×6×16 mm deeply infiltrating the tunica muscularis of the sigmoid colon. A second DEN was found at the level of the rectum, the latter measuring 19×5×12 mm and having a distance of 9 cm from the anal verge. Both the intestinal lesions resulted to have a circumferential extent of 30%. The distance between the 2 nodules was 15 cm. A 3-dimensional laparoscopy was performed. Sigmoid colon and rectal mobilization were performed according to our standardized technique [5-7]. A 31-mm circular stapler was used to excise first the nodule of the sigmoid colon. The stapler, in its closed position, was gently introduced into the rectum via the anus and then progressively advanced inside the large bowel up to the level of the sigmoid nodule. After correct positioning, the stapler was completely opened and the nodule was imbricate between the anvil and staple housing of the stapler. Then, the stapler was closed and fired. The procedure was repeated using a second 31 mm circular stapler to resect the rectal endometriotic nodule. The overall operative time was 90 minutes. The estimated blood loss was 5 mL. Neither intra- nor postoperative complications occurred. The patient was discharged 3 days after surgery. The sigmoid colon and rectal endometriotic nodules measured, respectively, 20×6×15 mm and 20×5×12 mm on fresh unfixed specimens. Both nodules were found to have endometriosis-free surgical margins on definitive pathology. The operative technique displayed in this video may contribute to the standardization of a procedure, which could be included among the options available in the surgical armamentarium, to be used in selected cases of multiple colorectal DENs each having 3 cm or less in diameter. Surgeon experience and an adequate preoperative evaluation are of utmost importance to plan the operative strategy and have the best chance of surgical success.

Interdisciplinary aspects of abdominal and plastic surgery- what does the (abdominal) surgeon need to know?

The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. - Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or"tensor-fascia-lata"(TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber).-Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps.-Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight.-Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty.-Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension.-Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty.-Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time-plastic surgery expertise has to be included into interdisciplinary tumor concepts.-Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose.-Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer).-Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e.,surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve.-Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed byplastic surgery coveragecan prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. An interdisciplinary approach of abdominal and plastic surgery is characterized bya highly developed cooperationin common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

Consistency of transesophageal echocardiography and angiography in grading paravalvular regurgitation during transcatheter aortic valve replacement.

The Valve Academic Research Consortium 3 (VARC-3) standardizes the classification criteria and Doppler parameters for paravalvular regurgitation (PVR) by echocardiography. However, the consistency between transesophageal echocardiography (TEE) and angiography in grading (using the VARC-3 criteria) of PVR during transcatheter aortic valve replacement (TAVR) is unclear. Forty-six patients who underwent TEE and angiography during TAVR were retrospectively included. All patients had complete baseline information, TEE and angiography data. The Doppler parameters measured by TEE included the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area. PVR was classified into four grades: absent, mild, moderate and severe. The weighted kappa coefficient was used to analyze the consistency between the two techniques. Kendall's W coefficient was used to evaluate the consistency of parameters measured by TEE. Among all patients, there were 43 cases (93.5%) with consistent assessments between TEE and angiography. PVR was observed in 19 cases. TEE assessed mild PVR in 17 cases and moderate PVR in two cases; Angiography assessed mild PVR in 14 cases and moderate PVR in two cases. The weighted kappa coefficient between angiography and the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area respectively was .84, .79, .74, .85 (P < .001). Kendall's W coefficient was .83 (P < .001). TEE and angiography had strong consistency in the grading (using the VARC-3 criteria) of PVR during TAVR. TEE was a convenient diagnostic tool to quantify and grade PVR during TAVR.

Utility of Machine Learning Algorithms in Predicting Preoperative Lymph Node Metastasis in Patients With Rectal Cancer Based on Three-Dimensional Endorectal Ultrasound and Clinical and Laboratory Data.

We aimed to investigate the value of a machine learning (ML) algorithm in the preoperative prediction of lymph node metastasis in patients with rectal cancer. Based on the histopathological results, 126 rectal cancer patients were divided into two groups: lymph node metastasis-positive and metastasis-negative groups. We collected clinical and laboratory data, three-dimensional endorectal ultrasound (3D-ERUS) findings, and parameters of the tumor for between-group comparisons. We constructed a clinical prediction model based on the ML algorithm, which demonstrated the best diagnostic performance. Finally, we analyzed the diagnostic results and processes of the ML model. Between the two groups, there were significant differences in serum carcinoembryonic antigen (CEA) levels, tumor length, tumor breadth, circumferential extent of the tumor, resistance index (RI), and ultrasound T-stage (P < 0.05). The extreme gradient boosting (XGBoost) model had the best comprehensive diagnostic performance for predicting lymph node metastasis in patients with rectal cancer. Compared with experienced radiologists, the XGBoost model showed significantly higher diagnostic value in predicting lymph node metastasis; the area under curve (AUC) value of the receiver operating characteristic (ROC) curveof the XGBoost model and experienced radiologists was 0.82 and 0.60, respectively. Preoperative predictive utility in lymph node metastasis was demonstrated by the XGBoost model based on the 3D-ERUS finding and related clinical information. This could be useful in guiding clinical decisions on the selection of different treatment strategies.

Watchful Waiting after Definitive Radiochemotherapy in Patients with Esophageal Cancer: Independent Predictors for Recurrence

Abstract Background Treatment of Esophageal Cancer (EC) consists of neoadjuvant radiochemotherapy (RCT) followed by resection. However, esophagectomy is associated with considerable morbidity in patients already burdened with comorbidities, malnutrition, and unhealthy lifestyle. In this context, a watch and wait (WW) strategy has gained importance in patients with complete response to RCT and has been adopted by our center a decade ago. Aims To investigate independent predictors for recurrence in patients with EC undergoing WW. Methods We retrospectively analyzed data of all patients with potentially curable EC and complete response to RCT from 01/2014–12/2020 at a tertiary university hospital. Patients underwent staging (computed tomography (CT), upper endoscopy with ultrasound and biopsies (EUS), and positron-emission tomography (PET)), followed by RCT with restaging six weeks after completion. Routine follow-up consisted of EUS every three and CT every six months. Clinical data were extracted from electronic medical records. Factors associated with recurrence were adjusted for patient- and tumor-characteristics in multivariate regression analysis. Results A total of 40 patients were included. Of these, 22 (55%) had cancer recurrence. Tumor type was squamous cell carcinoma in 24 (60%) and adenocarcinoma in 16 (40%), respectively. T3-stage was most frequent (n=26, 65%), 35 (88%) patients were nodal-positive. Mean age was 67 years (SD 8.8), 30 (75%) patients were male. Recurrence occurred after a mean of 413 days (SD 171). Multivariate analysis revealed a circumferential tumor extent &amp;gt;50% in staging (OR 15.229, p=0.017) and dysphagia at restaging (OR 6.336, p=0.023) as independent risk factors for recurrence. Conclusions The current study revealed tumor extent and dysphagia as independent risk factors for recurrence. These predictors may help in the early identification of patients with EC recurrence, thus contributing to a personalized follow-up.