Clinical Recurrence Rate Research Articles

Endoscopic resection of upper gastrointestinal lymphangioma: A single-center experience.

Lymphagioma, which in most cases as benign tumors, occurs in head, neck, axilla, and mediastinum. Lymphangioma is exceedingly rare in the upper gastrointestinal tract including esophagus, stomach, and duodenum. However, the clinical characteristics, natural history, and recurrence rate after endoscopic resection remain unclear. This study aims to evaluate the characteristic findings and assess the efficacy of endoscopic techniques in the management of this disease. In this systematic retrospective analysis, we evaluated all 24 cases of upper gastrointestinal lymphangioma resected by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and diagnosed by histopathology at our hospital from January 2012 to May 2021. We analyzed the results of endoscopy, endoscopic ultrasonography (EUS), CT, histologic examination, and follow-up assessments. 9 male and 15 female patients with esophageal lymphangioma were enrolled in this study, with a mean age of 54.17 ± 11.60 years (range 30-71 years). The lesions' size varied from 2.20 to 40.10 mm, with the median size of 7.83 mm. All patients were evaluated preoperatively, whose endoscopic appearance typically appears as dilated lymphatic channels beneath the surface epithelium of the protrude mucosal or sub-mucosal lesion. Endoscopic ultrasonography revealed the presence of a honeycomb-like or grid-like mass with a heterogeneous echo pattern, and a clear boundary between the lesion and the muscularis propria layer may be helpful for the primary diagnosis of this disease. 22 patients underwent EMR and 2 patient were treated with ESD. Histologic examination revealed that the lesions contained many dilated lymphatic vessels, which confirmed the initial diagnosis of lymphangioma in all patients. No major adverse events were found during the operation or a median follow-up of 43 months (range 13-92). Endoscopic ultrasonography has important clinical value for the primary diagnosis of lymphangioma in the upper gastrointestinal tract. This study also suggests that endoscopic resection should be considered as a more minimally invasive, safe, feasible, and effective therapeutic option comparing to laparoscopic surgery.

Abstract 11177: Pulmonary Vein Reconnections Predict Good Clinical Outcomes After a Second Catheter Ablation of Persistent Atrial Fibrillation: Insight From the EARNEST-PVI Trial

Introduction: The effect of an extensive ablation strategy in addition to pulmonary vein (PV) isolation is still controversial in persistent atrial fibrillation (AF) ablation. Electrical PV reconnection is an important confounder affecting the trial results. Objectives: To evaluate the PV reconnection rate and association between the reconnection and AF recurrence after a re-do AF ablation in the EARNEST-PVI trial (NCT03514693). Methods: The analysis was performed using the extended data of the EARNEST-PVI trial (N=512), a randomized controlled trial to evaluate ablation strategies for persistent AF, which was conducted in the Osaka region of Japan. During a median follow-up of 47 months, a total of 126 (25%) patients underwent a re-do AF ablation. Among them, 120 (median age, 68 years; 36% female; 31% long-standing persistent AF, 95% contact force-sensing catheter use) whose follow-up data were available after the 2 nd AF ablation were enrolled in this study. Results: PV reconnections were observed in 75 (63%) patients. Although there was no difference in age, gender, long-standing persistent AF, and CA strategy during the index procedure, AF recurrence within 1 year was more frequent in patients with PV reconnections (81.3% vs. 64.4%, p = 0.039). During a median follow-up of 31 months after the re-do AF ablation, patients with PV reconnections had a lower clinical recurrence rate than those without (38.7 vs. 44.4%, log-rank p = 0.047). However, additional linear ablation did not affect the recurrence rate. Even after adjustment for age, gender, long-standing persistent AF, and presence of non-PV triggers, Cox regression analysis revealed that a number of reconnected PVs of ≥2 was independently associated with a lower recurrence of AF after the 2 nd AF ablation (hazard ratio, 0.36; 95% confidence interval, 0.19-0.67; p = 0.001). Conclusions: Among patients who underwent a redo-AF ablation in the EARNEST-PVI trial, about two-thirds exhibited PV reconnections. Patients with ≥2 PV reconnections had better clinical outcomes than those with ≤1 PV reconnections. A durable PV isolation is an important pre-requisite before exploring any additional ablation strategies for persistent AF.

LBMON236 Investigating The Effect Of Social Vulnerability Index On Fibroid Recurrence And Metabolic Dysfunction

Abstract Fibroids and metabolic dysfunction disproportionately affect women of color. We have previously shown that recurrent fibroids and metabolic dysfunction lead to increased healthcare utilization. The impact of socioeconomic factors on access to care for these women is poorly understood. Our objective was to evaluate the social vulnerability indices of women with fibroids with and without metabolic dysfunction, and determine the association of social vulnerability with fibroid recurrence. We conducted a retrospective cohort study of 918 geocoded patients who underwent myomectomy at a tertiary health care system. The primary exposure was the Social Vulnerability Index (SVI), a measure of socioeconomic disadvantage developed by the CDC with four thematic subgroups (socioeconomic status, household composition, Race/Ethnicity/Language, and Housing/Transportation). The primary outcome was clinically significant fibroid recurrence after initial myomectomy, defined as symptomatic fibroids requiring re-imaging or surgery. SVI was analyzed as an overall score and by quartiles. Models were adjusted for age, race, and insurance status, with metabolic dysfunction analyzed separately as a covariate. Patients were classified as having metabolic dysfunction (MD) if they met any 2 of 5 WHO or NCEP ATP III criteria for metabolic syndrome with BMI as proxy for waist circumference. Appropriate parametric and non-parametric tests and logistic regression were used to determine the association of SVI with fibroid recurrence. The mean SVI score for the cohort was 0.58 (SD 0.31). Mean SVI scores for patients with and without clinically significant fibroid recurrence were similar at 0.56 (SD 0.30) and 0.57 (SD 0.30), respectively. There remained no association between mean SVI score and odds of fibroid recurrence in adjusted models (OR 0.35, CI 0.10-1.24, p 0.11). Notably, there was a decreased rate of radiologic fibroid recurrence in the highest quartile of SVI (p=0. 011) and an increased rate in the third quartile (p=0. 015). When isolating the individual themes of the SVI index, there was a significant decrease in surgical and radiologic fibroid recurrence in individuals with the highest quartile of minority and language vulnerability (p=0. 03). The odds of metabolic dysfunction increased by 2.9 with each unit increase in SVI (OR 2.85, CI 1.34-6. 07, p 0. 006) after adjusting for age, race, and insurance status. We report that while patients with a higher SVI have increased risk of metabolic dysfunction, this does not translate to higher rates of clinical significant fibroid recurrence. Higher SVI is associated with lower resourced settings and reduced access to care and can therefore be used as a starting point for public health policy. SVI should be considered when studying fibroids, and may illuminate potential barriers in access to care for fibroid recurrence in patients with a history of myomectomy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study.

To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. All patients were followed up for 21 to 110months, with an average of 63.79months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. IV: case series.

Short and medium term results of the surgical management of ileocecal Crohn's disease

The treatment of Crohn's disease (CD) is based on medical therapy and surgery is reserved for failure of medical management or complications. To evaluate endoscopic, clinical, and surgical recurrence of CD after surgery. In a prospectively maintained database, consecutive patients older than 15 years subjected to an ileocecal resection for ileocolic disease from January 2011 to April 2021, were identified. The diagnosis of CD was confirmed with the pathologic report. Patients with less than one year of follow-up were excluded. Information was obtained retrospectively from the database and clinical records. Fourteen patients were identified. The mean age at the time of surgery was 38 years. Surgery was performed at a median of 41.5 months (0-300) after the diagnosis of CD, nine elective and five emergency procedures. In five patients there were four major and two minor postoperative complications, with no anastomotic leakage. Six patients had endoscopic recurrence and seven had clinical recurrence (50%) at a mean of 15 months, one of whom required a second operation. There was no mortality. After the surgical treatment of CD, the clinical and endoscopic recurrence rate continues to be high.

Long-Term Efficacy and Recurrence Prediction of Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

To explore the efficacy of prostatic artery embolization (PAE) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) during long-term follow-up and analyze predictors related to LUTS recurrence. This was a single-center retrospective study involving 125 BPH patients with LUTS who underwent PAE from February 2014 to February 2020. The median follow-up was 36months. Clinical success was defined as reductions in the International Prostate Symptom Score (IPSS) and quality of life (QoL) score and no need for any other treatment for LUTS; otherwise, it was regarded as a clinical failure. Recurrence was defined as a clinical failure that occurred after an initial success. Cumulative clinical success rates, recurrence rates and re-intervention rates were evaluated. Friedman test was performed to compare differences in IPSS, QoL and prostatic volume (PV) among baseline and follow-up times. Predictors for LUTS recurrence were analyzed with the univariate and multivariate Cox regression model. Technical success (bilateral PAE) rate was 92.8% (116/125). Significant differences in IPSS, QoL and PV were observed between baseline and follow-up time points (P < 0.001). The cumulative clinical success rates at 2, 3, 4 and 5years were 82.4%, 65.5%, 52.4% and 37.4%. The cumulative recurrence rates and re-intervention rates at 1, 2 and 5years were 6.8%, 12.7%, 60.4% and 5.9%, 10.2%, 50.8%, respectively. Unilateral PAE was an significant predictor of recurrence (P < 0.05). PAE is an effective treatment option for LUTS. Unilateral PAE is a significant independent predictor of LUTS recurrence.

Role of percutaneous CT-guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system.

We investigated procedural safety, technical and clinical outcomes of the percutaneous image-guided radiofrequency ablation (PRFA) of intra-articular (IA), intra-articular close to cartilage (IACC), and extra-articular (EA) osteoid osteomas (OO). We proposed a new radiologic classification for osteoid osteoma depending on the degree and location of sclerosis which may correlate with technical failure and/or difficulties. According to the inclusion criteria, we enrolled consecutive patients who were referred to the investigation center from June 2018 to January 2022. After clinical and CT imaging features were suggestive for the diagnosis of OO, all the patients were treated by percutaneous CT-guided RFA with a standardized technique. Biopsy of the lesion was not performed in all patients. A retrospective analysis was conducted to assess the procedure's technical, primary clinical, and secondary clinical successes, recurrence rate, and complications. We classified all the OOs according to a new proposed classification of the site and the amount of sclerosis. A total number of 55 patients were enrolled in our study according to the inclusion criteria. The mean age of the enrolled patients was 24.07 ± 14.71years (ranges from 7 to 57years). The M/F ratio was roughly 2:1. The mean follow-up was 20.18 ± 12.60months (ranges from 2 to 44months). EA group included 36 patients, IA included 5 and IACC included 14 patients. Technical success was achieved in all cases of IA and IACC groups. Technical success in the EA group was 97.22% (1 technical failure). Primary clinical success was 100%, 92.85%, and 91.66% for IA, IACC, and EA groups, respectively. Accordingly, the recurrence rate was 5.88% in EA, and 7.14% in IACC, while no recurrence occurred in the IA group. No complications occurred. The secondary success rate of the 3 cases of recurrence was 100%. PRFA proved to be a safe procedure with a high rate of success for OO treatment even in intra-articular lesions in close contact with cartilage. This study showed that the results in terms of technical and clinical success are comparable for IA OO, IACC OO, and EA OO, even if the recurrence rate was higher in EA OO. Our proposed new classification of the degree and location of sclerosis may correlate to technical failure, but further studies with a larger number of patients are needed for validation.

Treatment and Outcomes of Unifocal and Multifocal Osseous Pelvic Langerhans Cell Histiocytosis Lesions in a Pediatric Population.

IntroductionLangerhans cell histiocytosis (LCH) is a rare, clonal disorder characterized by proliferation and tissue infiltration by myeloid dendritic cells, most commonly occurring in pediatric populations. It often manifests as skeletal lesions with possible pelvic involvement. Few studies have characterized and reviewed outcomes after treatment of isolated pelvic LCH lesions.MethodsA retrospective single-institution review was conducted on diagnoses of patients younger than 18 with a diagnosis of unifocal or multifocal skeletal LCH lesions involving the pelvis. Clinical presentations, lesion sites, focal classification, radiographic findings, treatments, complications, and recurrence rates were reviewed.ResultsTwenty patients had unifocal or multifocal LCH pelvic lesions (11 males, nine females). The median age at diagnosis was 3.5 years (0.8-21.6). Eight cases (40%) involved unifocal lesions, and twelve (60%) involved multifocal lesions, with the most common associated skeletal disease occurring at the ilium. 100% of cases had a lytic bone lesion with no pathologic fractures. All cases were treated nonoperatively with chemotherapy medications, corticosteroids, or observation alone. 75% of cases were treated with chemotherapy with a 100% resolution rate. The median length of follow-up was 4.5 years (0.4-16.7). ConclusionOur study found that chemotherapy alone or chemotherapy with corticosteroid supplementation are appropriate options for unifocal pelvic LCH lesions. In contrast, pelvic lesions that are part of a multifocal presentation may be managed adequately with varied chemotherapy regimens. Corticosteroid therapy and observation alone may also be reasonable for a single organ system, multifocal, skeletal lesions that are anatomically accessible for biopsy and small in number or size.

Investigation of the clinical features and recurrence patterns of acute right-sided colonic diverticulitis: A retrospective cohort study

BackgroundRight-sided colonic diverticulitis (RCD) and left-sided colonic diverticulitis (LCD) are considered distinct diseases. However, separate guidelines for RCD do not exist. Since the establishment of RCD management would first require evaluation of disease characteristics and recurrence patterns, this study has aimed to investigate the differences in the clinical characteristics between RCD and LCD and the recurrence patterns of RCD. MethodsPatients admitted for colonic diverticulitis between January 2012 and August 2020 were retrospectively reviewed. Clinical characteristics and recurrence rates in RCD and LCD patients, and predictors for recurrence and the recurrence patterns of RCD were analyzed. ResultsIn total, 446 colonic diverticulitis patients (343 RCD, 103 LCD) were included in this study. RCD patients were more likely to be male, younger, taller, heavier, smoke, drink alcohol, have better physical performance scores, lower modified Hinchey stages and better initial laboratory findings. LCD patients were more likely to receive invasive treatments, have longer fasting and hospital days, higher mortality and cumulative recurrence rates (20.5% vs. 30.4%, P = 0.007). Recurrences in most RCD patients were of similar disease severity and received the same treatments for initial attacks, with rates of recurrence increasing after each recurrence. Predictors of the recurrence of RCD were complicated diverticulitis (hazard ratio[HR] 2.512, 95% confidence interval[CI] 0.127–5.599, p = 0.024) and percutaneous drainage (HR 6.549, 95% CI 1.535–27.930, p = 0.011). ConclusionRCD is less severe and has a lower recurrence rate than LCD, suggesting that RCD should be treated conservatively. Patients with complicated diseases and those requiring percutaneous drainage are more likely to experience a disease recurrence, suggesting nonsurgical management may be insufficient.

Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study.

BACKGROUNDThe incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIMTo evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.METHODSWe retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTSA total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.CONCLUSIONThe incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Exploring the role of antibiotics and steroids in managing respiratory diseases

Respiratory diseases (RDs), such as chronic obstructive pulmonary disease, cystic fibrosis, asthma, and pneumonia, are associated with significant morbidity and mortality. Treatment usually consists of antibiotics and steroids. Relevant published literature reviews, studies, and clinical trials were accessed from institutional and electronic databases. The keywords used were respiratory diseases, steroids, antibiotics, and combination of steroids and antibiotics. Selected articles and literature were carefully reviewed. Antibiotics are often prescribed as the standard therapy to manage RDs. Types of causative respiratory pathogens, spectrum of antibiotics activity, route of administration, and course of therapy determine the type of antibiotics that are prescribed. Despite being associated with good clinical outcome, treatment failure and recurrence rate are still high. In addition, antibiotic resistance has been widely reported due to bacterial mutations in response to the use of antibiotics, which render them ineffective. Nevertheless, there has been a growing demand for corticosteroids (CS) and antibiotics to treat a wide variety of diseases, including various airway diseases, due to their immunosuppressive and anti-inflammatory properties. The use of CS is well established and there are different formulations based on the diseases, such as topical administration, tablets, intravenous injections, and inhaled preparations. Both antibiotics and CS possess similar properties in terms of their anti-inflammatory effects, especiallyregulating cytokine release. Thus, the current review examines and discusses the different applications of antibiotics, CS, and their combination in managing various RDs. Drawbacks of these interventions are also discussed.

Evidence construction of Chinese herbal formulae for the treatment of H. pylori positive peptic ulcer: A Bayesian network Meta-analysis

PurposeHelicobacter pylori (H. pylori) positive peptic ulcer disease (PUD) is a highly prevalent digestive disease with serious consequences of poor prognosis without rational medical intervention. Apparent advantages of Chinese herbal formulae application in PUDs have been appreciated by clinical practitioners recently in China. However, there is no enough viewpoint of evidence-based medicine for them to reach a broad consensus at the more favorable formulae. Therefore, we adopted the method of Bayesian network Meta-analysis (BNMA) in order to get a solution. MethodLiterature retrieval of clinical randomized controlled trials (RCTs) was conducted with eight databases of PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, the VIP medicine information system, the Wanfang Data Knowledge Service Platform and Chinese Biomedical Literature Service System. Review Manager 5.4 software, R project 4.1.1 software and STATA16.0 software were used to carry out this BNMA. The primary outcome indicator is H. pylori eradicated rate. The secondary outcome indicator is clinical effectiveness rate, recurrence rate and adverse reaction report. ResultA total of fifty-one RCTs involving 5172 patients and ten therapeutic strategies were included in this BNMA. The results showed that supplementation with Chinese herbal formulae significantly improved the eradication rate, clinical efficiency and reduced recurrence rate of H. pylori compared with the single conventional triple therapy (CON) group in a relatively safe manner. Comprehensive therapeutic efficacy analysis of H. pylori eradicated rate and clinical effectiveness rate showed that CON combined with Xiangsha Liujunzi decoction (XSD) manifests at the first grade among these ten therapeutic strategies. ConclusionThe efficacy and safety of Chinese herbal formulae and conventional triple therapy were validated by this BNMA. CON+XSD appears to be the most satisfactory therapeutic strategy for H. pylori-positive PUD, reminding clinicians of the potential value of the combination of Chinese herbal formulae and conventional chemotherapy. Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021268574.

Surgically managed symptomatic intraspinal lumbar facet synovial cyst outcome of surgical treatment with resection and instrumented posterolateral fusion, a case series

BackgroundThere is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature.MethodsRetrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score.ResultsSixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4–L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level.ConclusionIn symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.

Phototherapy-Based Treatment for Sexually Transmitted Infections—Shining Light into Unexplored Territory

New therapeutic strategies are urgently needed to overcome drawbacks in the treatment of some infections, particularly sexually transmitted infections (STI). STIs are easily spread by the transmission of various bacteria, viruses, and parasites with some of the infections being incurable or even lethal, leading to a serious impact on reproductive health worldwide. Phototherapy (PT) is a major therapeutic approach based on the controlled administration of light in the visible, near infrared, or UV spectrum, with or without the application of an external photosensitizer. Despite the fact that PT has not been explored to its full potential in the control of STIs, it has already demonstrated good clinical response rates and lower recurrence rates in genital infections. For instance, increasing evidence has demonstrated that 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) is effective in the treatment of condyloma acuminatum (CA), by eliminating the causative latent human papillomavirus (HPV) infection, and also in the antiviral treatment of recurrent genital herpes simplex virus (HSV) infections. The clinical application of PDT is a new treatment for oral fungal infection caused by Candida albicans in adult acquired immune deficiency syndrome (AIDS) patients, with human immunodeficiency virus (HIV), and could also be used for genital fungal infections. Another antimicrobial PT strategy, water-filtered infrared A combined with visible light irradiation, has been shown to be effective against genital Chlamydia trachomatis bacterial infection, and an optical nano-genosensor has been designed for the diagnosis of trichomoniasis, a parasitic Trichomonas vaginalis infection. This review aims to summarize the published evidence for the effectiveness of PT in the treatment of STIs, and for the suppression of STI-related pathogens of various types.

Treatment of cryptoglandular fistulas with the fistula tract laser closure (FiLaC™) method in comparison with standard methods: first results of a multicenter retrospective comparative study in the Netherlands.

Current surgical closure techniques for sphincter-sparing treatment of high cryptoglandular fistulas in the Netherlands include the mucosal advancement flap procedure (MAF) and ligation of the intersphincteric fistula tract (LIFT). A relatively novel treatment is the fistula tract laser closure (FiLaC™) method. The aim of this study was to investigate the differences in healing and recurrence rates between FiLaC™ and current standard practices. This multicenter retrospective cohort study included both primary and recurrent high cryptoglandular anorectal fistulas, treated with either FiLaC™ or standard methods (MAF or LIFT) between September 2015 and July 2020. Patients with extrasphincteric fistulas, Crohn's disease, multiple fistulas, age < 18years or missing data regarding healing time or recurrence were excluded. The primary outcomes were the clinical primary and secondary healing and recurrence rates. Primary healing was defined as a closed external opening without fluid discharge within 6months of treatment on examination, while secondary healing was the same endpoint after secondary treatment. Secondary outcomes included healing time and complaints. A total of 162 high fistulas from 3 Dutch hospitals were included. Ninety-nine high fistulas were treated with FiLaC™ and 63 with either MAF or LIFT. There were no significant differences between FiLaC™ and MAF/LIFT in terms of clinical healing (55.6% versus 58.7%, p = .601), secondary healing (70.0% versus 69.2%, p = .950) or recurrence rates (49.5% versus 54%, p = .420), respectively. Median follow-up duration was 7.1months in the FiLaC™ group (interquartile range [IQR] 4.1-14.4months) versus 6months in the control group (IQR 3.5-8.1months). FiLaC™ treatment of high anorectal fistulas does not appear to be inferior to MAF or LIFT. Based on these preliminary results, FiLaC™ can be considered as a worthwhile treatment option for high cryptoglandular fistulas. Prospective studies with a longer follow-up period and well-determined postoperative parameters such as complication rates, magnetic resonance imaging for confirmation of fistula healing, incontinence and quality of life are warranted.

Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis.

ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.

P.119 Clinical outcome and recurrence rate of chronic subdural hematoma after surgical drainage: a retrospective study

Background: Chronic subdural hematoma (CSDH) is of the most encountered neurosurgical cases, predominantly in older individuals. Surgical drainage remains the mainstay, yet is challenged by variable recurrence rates. Less invasive methods of embolization of the middle meningeal artery (EMMA) could reduce the recurrence rates. Before adopting a newer treatment (EMMA), it is prudent to establish the outcomes from surgical drainage. The purpose of this study is to assess the clinical outcome and recurrence risk in surgically treated CSDH patients. Methods: A retrospective search of our surgical database was done to identify CSDH patients undergoing surgical drainage in 2019-2020. Demographic and clinical details were collected through chart review and a qualitative statistical analysis was performed. Results: A total of 136 patients (mean age-68 years; range-21-100 years; Male-105) with CSDH underwent surgical drainage with repeat surgery in 11.8%(n=16). Periprocedural mortality and morbidity were 8.8%(n=12) and 20.6%(n=28), respectively. No radiological follow-up was seen in 30(22%) of patients. Of those with follow-up, recurrence was seen in 21.7%(n=23). Mean hospital stay was 9.64 days. Conclusions: Our retrospective study showed periprocedural morbidity (20.6%) and mortality (8.8%) with a 21.7% risk of recurrence. This is likely due to older patients but is in keeping with what is reported in the literature.

A Retrospective Study from a Single Center of 208 Patients with Unilateral Chronic Subdural Hematoma to Compare Outcomes Following Burr Hole Craniotomy and Hematoma Drainage Within 48 Hours and Between 48 Hours and 5 Days

BackgroundThis retrospective study from a single center aimed to compare patient outcomes following burr hole craniotomy (BHC) and hematoma drainage within 48 hours and between 48 hours and 5 days in 208 patients with unilateral chronic subdural hematoma (CSDH).Material/MethodsPatients were divided into 2 groups according to the duration of drainage: early (1 or 2 days, n=100) and late (3–5 days, n=108) drain removal. We compared the clinical outcomes, recurrence rate, time to recurrence, and complications between the groups. Quantitative analysis of computed tomography parameters at various time points (postoperative, day of drain removal, and postoperative day 7) was also performed to compare radiologic outcomes.ResultsClinical outcomes and recurrence rate were similar in both groups. We found no significant differences in radiologic outcomes of both groups through all chronologies, although the total drainage volume was significantly greater in the late removal group (P<0.001). The incidence of surgical complications was significantly higher in the late drain removal group (8% vs 22.2%, P=0.007). Specifically, contralateral subdural effusion (CSE) tended to occur more frequently in the late removal group (2% vs 8.3%, P=0.038).ConclusionsFollowing BHC and hematoma drainage for unilateral CSDH, maintaining the subdural drain for more than 48 hours did not improve patient outcomes or reduce the recurrence of hematoma, but increased the surgical complications, including CSE.

Incisional hernia repair with a slowly absorbable P4HB mesh: what happens after the mesh disappears? A retrospective longitudinal clinical study.

To analyze the incisional hernia recurrence rate at a long-term follow-up using a biosynthetic long-term absorbable mesh in patients with a higher risk of surgical infection in a contaminated surgical field. This was a retrospective multicentric study. All patients undergoing incisional hernia repair between 2016 and 2018 at 6 participating university centers were included. Patients were classified according to the Ventral Hernia Working Group (VHWG). All consecutive patients who underwent abdominal wall repair using biosynthetic long-term absorbable mesh (Phasix®) in contaminated fields (grade 3 and 4 of the VHWG classification) were included. Patients were followed-up until September 2021. Preoperative, operative, and postoperative data were collected. All patients' surgical site infections (SSIs) and surgical site occurrences (SSOs) were recorded. The primary outcome of interest was the clinical incisional hernia recurrence rate. One hundred and eight patients were included: 77 with VHWG grade 3 (71.3%) and 31 with VHWG grade 4 (28.7%). Median time follow-up was 41months [24; 63]. Twenty-four patients had clinical recurrence during the follow-up (22.2%). The SSI and SSO rates were 24.1% and 36.1%, respectively. On multivariate analysis, risk factors for incisional hernia recurrence were previous recurrence, mesh location, and postoperative enterocutaneous fistula. At the 3year follow-up, the recurrence rate with a biosynthetic absorbable mesh (Phasix®) for incisional hernia repair in high-risk patients (VHWG grade 3 and 4) seemed to be suitable (22.2%). Most complications occurred in the first year, and SSI and SSO rates were low despite high-risk VHWG grading.

Lower prevalence of stump reflux after endovenous laser flush ablation of the great saphenous vein.

Background: This single center prospective randomized study was performed to compare the effect of endovenous laser flush ablation (EVLAf) of the great saphenous vein (GSV) close to the sapheno-femoral junction (SFJ) with a standard ablation (EVLAs) up to two cm distally of the SFJ on reflux in the GSV stump. Patients and methods: Between April 2013 and January 2016, 146 legs in 146 consecutive patients, meeting the inclusion/exclusion criteria, were treated by EVLA. All patients were randomized into 2 groups. In group 1 EVLAf started from the SFJ level, and in group 2 EVLAs started two cm below the SFJ. The primary endpoint was reflux in the GSV stump after 900 days. Secondary endpoints were reflux in the anterior accessory saphenous vein (AASV), proximal clinically recurrent varicose veins related to reflux in the stump and/or the AASV. Results: At day 900, 27 patients were lost to follow-up. Reflux in the stump was detected in 3.6% in group 1 and in 22.2% in group 2 (p<0.05). Reflux in the AASV was present in 7.1% in group 1 and in 17.46% in group 2 (p=0.09). Proximal clinically recurrent varicose veins were observed in 8.9% in group 1 and in 19.1% in group 2 (p=0.12). The greatest diameter of the stump was significantly larger in group 2 (group 1: 0.41 cm, group 2: 0.6 cm, p<0.001). Conclusions: EVLAf is associated with a significantly lower incidence of reflux in the GSV stump, with a trend to a lower incidence of reflux in the AASV and with a lower incidence of proximal recurrent varicose veins after 900 days follow-up compared to EVLAs. EVLAf may improve the clinical recurrence rate after EVLA of the GSV.