Cut Margin Research Articles

A prospective 10-year follow-up study after sublobar resection for ground-glass opacity-dominant lung cancer

This single-arm multi-institutional prospective study aimed to evaluate the 10-year outcomes of sublobar resection for small-sized ground-glass opacity-dominant lung cancer. Among 73 patients prospectively enrolled from 13 institutions between November 2006 and April 2012, 53 ground-glass opacity-dominant lung cancer patients underwent sublobar resection with wedge resection as the first choice. The inclusion criteria were maximum tumor size of 8–20 mm; ≥ 80% ground-glass opacity ratio on high-resolution computed tomography; lower 18F-fluorodeoxyglucose accumulation than the mediastinum; intraoperative pathological diagnosis of adenocarcinoma in situ; and no cancer cells on intraoperative cut margins. The primary endpoint was a 10-year disease-specific survival. The 53 eligible patients had a mean tumor size of 14 ± 3.4 mm and a mean ground-glass opacity ratio of 95.9 ± 7.2%. Wedge resection and segmentectomy were performed in 39 and 14 patients, respectively. The final pathological diagnoses were adenocarcinoma in situ in 47 patients (88.7%) and adenocarcinoma with mixed subtype in 6 patients (11.3%). The 10-year disease-specific survival and overall survival were 100% and 96.2%, respectively, during a median follow-up period of 120 months (range, 37–162 months). Ground-glass opacity-dominant small lung cancer is cured by sublobar resection when patients are strictly selected by the inclusion criteria of this study.

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery.

Fluorescence-guided surgery (FGS) is a cutting-edge technology that uses near-infrared (NIR) fluorescence imaging to guide surgeons in surgery. Indocyanine green (ICG) is a fluorescent dye, which can be used for in vivo imaging of tumor cells. We aimed to explore the use of ICG fluorescence-guided technology as a rapid intraoperative margin assessment method for breast cancer surgery. In addition, we also compared the dose selection of ICG. This was a non-randomized prospective cohort study. Data were collected between August 2021 and October 2022 in the Division of Breast Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University. Upon specimen removal, tumor margins were immediately analyzed by ICG fluorescence detection and then sent to the pathology department for intraoperative frozen section analysis and subsequent routine pathological examination. Abnormal margin rates were calculated and compared using intraoperative frozen section analysis and under the guidance of ICG fluorescence. The study included 69 cases of breast cancer patients who underwent tumor resection assisted by ICG fluorescence-guided technology, including 18 patients with a 0.5 mg/kg dose and 51 patients with a 1.0 mg/kg dose. According to the study findings, the ICG test achieved a sensitivity of 81.82% and a specificity of 75.82%. At a dose of 0.5 mg/kg, the sensitivity was 66.67% whereas the specificity was 93.33%. At the dose of 1 mg/kg, the sensitivity was 87.5%, and the specificity was 74.42%. Similarly, for intraoperative frozen section analysis, the sensitivity was 81.82%, but the specificity was enhanced to 94.83%. Positive surgical cut margin was not identified in 2/69 by ICG fluorescence and frozen section analysis respectively. The sensitivity of ICG fluorescence detection is comparable to that of frozen section analysis, but the specificity is poor. The sensitivity increased and the specificity decreased at 1 mg/kg compared to the 0.5 mg/kg dose. ICG fluorescence can be used as a supplementary tool for frozen section analysis. These findings support further development and clinical performance assessment of ICG fluorescence.

Microscopic analysis of preinsertion cutting modalities on custom, flexible iris prostheses.

To determine the induced edge effects of different clinically used device postmanufacture modification styles and modalities on custom iris implants. An academically affiliated multispecialty private practice group and an academic medical center. Laboratory study. Sample custom iris prostheses were cut using patterns, blades, and surgical instruments described in the literature. The cut edges were evaluated with slitlamp microscopy, light microscopy, and scanning electron microscopy. Disposable blades yielded smoother cuts than scissors. Trephine blade brand significantly affected the cut surface smoothness of the silicone matrix. Meshwork-embedded prostheses had some irregular sharp edges where the mesh fibers were cut with all modalities, although these were worse with scissors and one tested trephine brand compared with the other. Pseudoiridectomies and scissor cuts created sharp points and corners in the device periphery. Postmanufacture modifications of iris implants should be minimized. The cut margins of the fiber-free implants have fewer sharp edges and may be preferable for sulcus placement. In-the-bag device placement may mitigate clinical impact of sharp edges and corners. These practices may help to minimize inflammatory sequelae postimplantation.

Cutaneous Layer and SMAS Suspension (CaSS) Lift as a Minimally Invasive Lateral Midface Lift.

In our prior study, the authors determined that pulling on the superficial adipose layer is more effective in lifting the skin than pulling on the superficial musculoaponeurotic system (SMAS). Applying this concept of using the superficial adipose layer to transmit the lifting force to the skin, this study examined improvements in patients who underwent lateral midface lifting using our minimally invasive multilayer lifting technique and measured the duration of those improvements. Along the hairline in front of the sideburns, a W-shaped zigzag incision of 3 to 8mm in width and 3 to 4cm in length was made. On the temporal scalp, 3 to 4cm away from the first incision, a second incision was made more lateral/posterior to the first incision, and an elliptical excision of 3 to 5mm in width and 3 to 4cm in length was made. From the medial cut margin of the anterior first incision, the superficial temporal fascia/SMAS (the deep layer), and the superficial adipose layer (the superficial layer) were purchased with 3-0 polyester sutures, tunneled under the soft tissue, and fixed to the deep temporal fascia of the second posterior temporal incision. Prior to the excised temporal scalp closure, the dermis in the medial cut margin of the second incision was pulled to the rear as much as possible and fixed to the deep temporal fascia. The effects of surgery were monitored for 6 to 42 months after surgery. The nasolabial folds were improved. Skin elasticity also showed significant improvements, which lasted throughout the follow-up period (up to 42mo). Unlike traditional wide dissection SMAS facelift, our method requires minimal incisions and does not require skin undermining. Therefore, the operating time is shorter, and postoperative swelling is minimized. In our technique, the superficial adipose layer, the superficial temporal fascia/SMAS, and the dermis were pulled individually to lift all layers of the lateral midface soft tissues. This results in a significant and long-lasting lateral midface rejuvenation.

In Vitro Regeneration, Conservation, and Field Evaluation of a Medicinal Plant– Greater Burdock (Arctium Lappa L.)

A suitable micropropagation protocol and ex vitro acclimation method have been developed from in vitro grown seedling explants through cotyledonary node and leaf explants in consideration of the vegetable and medicinal properties of Greater Burdock. MS medium with 0.5-4.0 μM BAP showed highest percentage of axillary shoot regeneration from the cotyledonary nodal explants. Direct shoot regeneration was achieved by culturing 1.0 cm2 sections of about 25 days old leaves of in vitro grown shoot on MS medium enriched with 4.0 μM BAP and 2.0 μM IBA or NAA after 5 weeks of culture. Within six weeks of incubation on medium enriched with 4.0 M BAP and 2.0 M IBA or NAA, the leaf explants also developed callus from the cut margins. The greatest number of adventitious shoots could then be formed from the leaf-derived callus within 10 weeks of culture on the same media mix. More than 20 shoots were formed per callus clump at the third subculture, which had the highest rate of shoot multiplication. A. lappa's shoot and callus were both preserved at 5 ºC in MS medium with 4.0 μM Kn and 2.0 μM IBA, as well as 4.0 μM BAP and 2.0 μM IBA, respectively. The in vitro proliferated and elongated shoots were separated from callus clump for rooting. A root-induction MS medium with 6.0 μM IBA or NAA was used to cultivate the microshoots individually. All of the cultured microshoots generated 2-16 roots within 4 weeks of being moved to the rooting medium. Regenerated plantlets were transferred to vermiculite and successfully established in an ex vivo environment with a 98% survival rate. J. Bio-Sci. 31(1): 1-15, 2023

Outcome of Placenta Percreta Management by Planned Peripartum Hysterectomy in a Tertiary Level Hospital

The incidence of placenta accreta spectrum is gradually increasing due to increased rate of caesarean sections (CS). Due to torrential haemorrhage, placenta percreta is one of the main reasons for emergency peripartum hysterectomies and mostly results in subsequent maternal mortalities and morbidities. In such cases, caesarean hysterectomy leaving the placenta in situ without any separation of placenta is preferred. We observed the outcome of such patients managed with planned caesarean hysterectomy. This cross-sectional observational study was conducted at the Department of Obstetrics, Faridpur Medical College Hospital, Bangladesh. A total of 14 patients who underwent planned caesarean hysterectomy due to placenta percreta were studied. We performed delivery of the baby through upper segment transverse incision without placental separation. The umbilical cord was ligated leaving the placenta in the uterine cavity and cut margins of the uterus was closed with few interrupted sutures and then hysterectomy was performed. Among 14 cases, the mean age was 30 years, mean gestational age at the time of delivery was 36 weeks, and all had a history of one or more CS. Before operation, mean Hb% was 8.9 g/dl. A mean of 1.5 units pre-operative and 1.2 units post-operative blood transfusions was needed. Post-operative mean Hb% was 10.5 gm/dl. Half of the women were discharged on their 3rd post-operative day. None of them had serious pre- and post-operative complications. In light of our findings, we recommend managing placenta percreta by planned caesarean hysterectomy with the placenta left in situ to minimise blood loss and subsequent maternal mortality and morbidity.
 Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(2):80-84

Outcomes of Children Diagnosed with Unilateral Retinoblastoma: Retrospective Audit

To evaluate treatment outcomes of children diagnosed with unilateral retinoblastoma. Retrospective study of children diagnosed with unilateral retinoblastoma registered at the Tata Memorial Hospital (TMH), Mumbai from January 2013 to December 2018 and completed the planned curative treatment protocol. For the 98 cases that were analyzed, the median age of presentation was 24 months. The majority of patients had the intraocular disease (n = 72), whereas orbital retinoblastoma was in 26 patients. At the time of presentation, on imaging extra scleral spread was observed in 16 patients whereas 18 patients had optic nerve involvement, 11 patients had both extra scleral invasion and optic nerve involvement. We used the International Classification of Retinoblastoma for grouping. Out of 98 patients, 71 patients were in Group E, 21 were in Group D and 4 were in Group B and 2 were in Group C. For Staging of Retinoblastoma, we used International Retinoblastoma Staging System (IRSS) in our study and 14 patients had Stage 0 disease, 52 patients had Stage I disease, 10 patients had Stage II, 21 patients had Stage III A and 1 patient had Stage III B disease. High-risk features on surgical specimen histopathology were optic nerve cut margin positive in 6 patients, optic nerve involvement in 21 patients, extra scleral spread in 3 patients, Choroidal invasion in 38 and Iris involvement in 10 patients. Primary enucleation was offered in 52 patients whereas 26 patients underwent secondary enucleation. Systemic chemotherapy was received by the patient in the neoadjuvant setting in 17 patients as a form of chemo-reduction and 51 patients received systemic chemotherapy in the adjuvant setting. Intra-arterial chemotherapy was offered to 27 patients as a primary treatment or in conjugation with focal therapy (n = 11). Definitive radiotherapy was offered to only 2 patients and 22 patients received adjuvant radiotherapy. At a median follow-up of 62 months, 2patients had local relapse, which was salvaged by focal therapy in one and enucleation in the other. Ten patients who had leptomeningeal relapse had died. The 5-year local control (LC) is 97.6%, event-free survival (EFS) is 88% and overall survival (OS) is 89.5%. Globe was salvaged in only 16 cases. On univariate analysis, we observed a significant association between overall survival and extraocular and intraocular disease (p-value 0.0), Extra scleral spread (p-value 0.0), optic Nerve involvement (imaging), and an optic nerve cut margin positive (p-value 0.045), ICRB Groups (p-value 0.0) and IRSS stage (p- value 0.024). Retinoblastoma is curable if detected early. Extra ocular disease and high-risk features are associated with inferior outcomes and poor globe salvage rates.

Correlation analysis of hemoglobin, albumin, lymphocyte, platelet score and platelet to albumin ratio and prognosis in patients with lung adenosquamous carcinoma.

To investigate the effect of hemoglobin, albumin, lymphocytes, platelet (HALP) score and platelet to albumin ratio (PAR) on prognosis of patients with lung adenosquamous carcinoma (ASC) after surgery. A total of 52 patients diagnosed with ASC after surgical resection were collected from Nanjing Chest Hospital from 2012 to 2021, and their general clinical data, pathological data and laboratory indexes were collected. The changes of Alb and Plt levels before and after surgery, HALP scores (hemoglobin albumin lymphocytes/platelets), and postoperative PAR, PLR, NLR were retrospectively analyzed, and their influence on the prognosis of patients with ASC was investigated. The cut-off value of △Alb, △Plt, postoperative PAR, PLR and NLR were determined by the receiver operating characteristic (ROC) curve, the optimal cut-off value of HALP score before and after surgery was calculated by using X-tile software, and the clinicopathological characteristics were compared between the high PAR and low PAR groups and between high HALP score and low HALP score group to analyze the factors influencing the prognosis of patients with ASC. Univariate and multivariate Cox proportional regression analyses were used to assess independent risk factors affecting overall survival (OS) and disease-free survival (DFS) in patients with ASC. Kaplan-Meier method was used to evaluate the correlation between OS, DFS and PAR and HALP score. A critical value of PAR was 7.40×10^9 and an area under the curve (AUC) of 0.737 (95%CI: 0.597-0.876, P = 0.004). The best cut-off value of the preoperative HALP score was 24.3. Univariate Cox analysis showed that the cut margin (P = 0.013), the degree of differentiation (P = 0.021), N stage (P = 0.049), △Plt (P = 0.010), △Alb (P = 0.016), PAR (P = 0.003), NLR (P = 0.025), PLR (P = 0.029), preoperative HALP score (P = 0.000) and post-operative HALP score (P = 0.010) were all associated with postoperative OS in ASC patients. Cut margin (P = 0.029), the degree of differentiation (P = 0.045), maximum tumor diameter (P = 0.018), N stage (P = 0.035), △Plt (P = 0.007), △Alb (P = 0.007), PAR (P = 0.004), NLR (P = 0.041), PLR (P = 0.030), preoperative HALP score (P = 0.000), and postoperative HALP score (P = 0.011) were related to postoperative DFS in ASC patients. Multivariate analysis revealed that PAR (HR: 6.877, 95%CI: 1.817-26.038, P = 0.005), differentiation degree (HR: 0.059, 95%CI: 0.006-0.591, P = 0.016) and preoperative HALP score (HR: 0.224, 95%CI: 0.068-0.733, P = 0.013) had significant effect on OS. Tumor maximum diameter (HR: 3.442, 95%CI: 1.148-10.318, P = 0.027) and preoperative HALP score (HR: 0.268, 95%CI: 0.085-0.847, P = 0.025) had significant influence on DFS. PAR and preoperative HALP score were potentially useful biomarkers for evaluating the outcome of patients with postoperative ASC. PAR, the degree of differentiation and preoperative HALP score were independent prognostic factors for postoperative OS in ASC patients. Maximum tumor diameter and preoperative HALP score were independent prognostic factors for postoperative DFS in ASC patients.

Comparative evaluation of use of reciprocating saw and bur in Le fort I osteotomy for superior repositioning of maxilla: A cross-sectional study

BackgroundTraditionally bur has been used to carry out osteotomy. In a developing country like India, the cost of surgical treatment is the important factor in determining treatment plan. Although the use of bur is cost-effective and efficient, with the advent of newer technology, it is getting replaced with a saw. AimTo evaluate and compare the use of reciprocating saw and bur in Le Fort I Osteotomy for superior repositioning of the maxilla. Materials and MethodsPatients referred from the Department of Orthodontics for the surgical correction of vertical maxillary excess (VME). They were divided into two groups. In group I, osteotomy was performed with Synthes Reciprocating Saw and in group II, bur was used. The parameters recorded in both the groups were time required for the completion of down-fracture, precision of the osteotomy cut (margins of the cut), and ease of superior repositioning. Data was collected from both the groups for comparison. ResultsA total of 14 patients with VME were included in the study. They were divided into two groups. Seven study participants were allotted to each group. In group I, Synthes Reciprocating Saw was used while in group II, a bur was used to carry out the osteotomy cut. In group I, the average time required to complete the down-fracture of the maxilla was 3.5–4 min while in group II it was more than 8 min. The margins of the osteotomy cut were smooth and regular and there was bone-to-bone contact during superior repositioning in Group I. ConclusionThe combination of the use of a saw for inferior osteotomy and a bur for the superior cut would be more beneficial in the superior repositioning of the maxilla.

Multifocal biliary carcinoma; whether synchronous or metastatic: A need to conquer

Multiple synchronous primary carcinoma involving gall bladder, liver and common bile duct are rare and difficult to differentiate with hepatic and extrahepatic bile duct metastasis from single primary. Radiological features, molecular landscape, and even integrated mutational profiling are not of much help. We describe a case of 48-year-old male who presented with jaundice and follow up CT scan raised the suspicion of gall bladder carcinoma with hepatic metastasis. Peroperative frozen section examination revealed adenocarcinoma with involvement of cystic duct margin; however revised common duct margin was free from tumor invasion. Final histopathology on resected gall bladder revealed multifocal adenocarcinoma, while histomorphology of hepatic nodule was consistent with cholangiocarcinoma. Common bile duct a one focus had also revealed adenocarcinoma while cut margins were negative form malignancy. In view of different morphology of gall bladder and hepatic tumor, no continuity of three tumors and single large, firm, non umblicated hepatic nodule, diagnosis of multiple synchronous carcinoma was suggested.

Risk Factors of Positive Resection Margin in Hepatectomy for Resectable Ruptured Hepatocellular Carcinoma: Risk Prediction and Prognosis

Background and AimClinical work has revealed that hepatectomy for resectable ruptured hepatocellular carcinoma (rHCC) has a relatively high percentage of positive resection margins found in postoperative pathology. It is necessary to evaluate the risk factors associated with R1 resection in patients undergoing hepatectomy for rHCC. MethodsA total of 408 patients with resectable rHCC originating from three centers undergoing surgery from January 2012 to January 2020 were consecutively enrolled in the study to study the prognostic impact of R1 resection using Kaplan–Meier plotting of survival curves. One center with 280 served as the training group, and the other two centers served as the validation group. Multivariate logistic regression analysis screened for variables affecting R1 and developed prediction models, and the models were tested in the validation cohort using the receiver operating characteristic curves (ROC) and calibration curves. ResultsThe prognosis of rHCC patients with positive cut margins was worse than that of patients with R0 resection. Risk factors for R1 resection were tumor max length (OR = 2.668 [1.161–6.131]), microvascular invasion (MVI) (OR = 3.655 [1.766–7.566]), times of hepatic inflow occlusion (1/0:OR = 2.213 [1.113–4.399]; 2/0:OR = 5.723 [2.010–8.289]) and timing of hepatectomy (OR = 5.284 [2.394–9.661]), using tumor max length, times of HIO, and timing of hepatectomy to construct the nomogram, the area under the curve of the model was 0.810 (0.781–0.842) and 0.782 (0.752–0.805) in the training and validation groups, respectively, and the calibration curve of the model was basically on the 45° line. ConclusionsThis study constructs a clinical model to predict R1 resection after hepatectomy for resectable rHCC, which can be used to better plan perioperative strategies for the incidence of R1 resection during hepatectomy.

Number of dye marks required in virtual-assisted lung mapping.

Virtual-assisted lung mapping is a preoperative bronchoscopic multi-spot dye-marking technique used in sublobar lung resection for hardly palpable lung nodules. However, the number of marks required per nodule remains unknown. Therefore, we examined the correlation between the number of intraoperative visible marks and the successful resection rate. We retrospectively examined 210 consecutive patients with 256 lesions who underwent virtual-assisted lung mapping during January 2014-December 2020 at our hospital. When a nodule was not resected at the initial attempt, or when a nodule was very close to the cut margin in the resected specimen and required additional resection, we categorized it as unsuccessful resection. We divided 256 lesions into successful and unsuccessful groups and compared the numbers of intraoperative visible marks between the two groups. Of 797 attempted marks, 738 (92.4%) were visible during the surgery. Fourteen (5.4%) of 256 lesions were determined to be unsuccessful according to the study criteria. There was a remarkable difference in the average numbers of intraoperative visible marks between both groups (3 [interquartile range: 2-4] vs. 2 [interquartile range: 1-2.8]; p < 0.01). Multivariable logistic analysis revealed a significant difference in the number of intraoperative visible marks (odds ratio: 0.28, 95% confidence interval: 0.14-0.57; p < 0.001) between both groups. Successful sublobar lung resection requires three or more intraoperative visible marks established using virtual-assisted lung mapping per lung nodule.

The Beneficial Impact of Intraoperative Ultrasound on Resection Margin Status during Breast Conserving Surgery.

Surgical resection with clear surgical cut margins is the mainstay of managing malignant breast neoplasms. Multiple techniques have been suggested to enhance resection status during breast-conserving surgery (BCS), including intraoperative ultrasonography (IOUS). Herein, we conducted the current investigation to reveal the benefit of IOUS on the achievement of R0 resection. Patients and Methods. This retrospective investigation included 140 patients who underwent BCS. They were divided into two groups: the IOUS group (40 cases) and the control group (100 cases). Our primary objective was to determine the free resection margin status (R0). Both study groups expressed statistically comparable demographic and clinical data. Additionally, histopathological examination revealed no significant difference between the two groups regarding the tumor type, stage, or grade. Nonetheless, the R0 resection margin was more frequently encountered in association with IOUS application (97.5% compared to 79% in the control group), and that difference was statistically significant (p=0.007). The application of IOUS has a significant beneficial impact on the outcomes of BCS. It is associated with a marked decline in positive resection margins, and its application should be encouraged in the breast oncological practice.

478. ENDOSCOPIC RESECTION OF A HUGE ESOPHAGEAL LIPOSARCOMA WITH LIGASURE INSTRUMENT

Abstract Esophageal liposarcoma is a very rare pedunculated tumor of esophagus. It may cause progressive dysphagia due to mass effect and sudden death due to tumor suffocation. Surgical resection is challenging due to peduncle usually located at the superior esophageal sphincter region. We introduce a novel approach method that can transect the tumor peduncle safe and easy. Review of the chart of Chimei Medical Center. One 70 year old man with progressive dysphagia for 5 months and body weight loss over 8 KGs. A huge tip necrotic pedunculated tumor was found with endoscopy. Cut off the tumor peduncle with ligasure instrument under endoscopic guide was performed and the tumor was removed successfully. No tumor recurrence was found in 2 years. Esophageal liposarcoma is a rare low grade malignancy of esophagus. Ligasure cut off the tumor peduncle can make a clear cut margin and avoid perforation or stenosis of esophagus.

Calcium homeostasis disruption initiates rapid growth after micro-fragmentation in the scleractinian coral Porites lobata.

Coral reefs are ecosystems under increasing threat from global climate change. Coral restoration is a tool for preserving the biological and ecological function of coral reefs by mitigating coral loss and maintaining the structural integrity and complexity of reefs. To generate the necessary stock for coral restoration, larger coral colonies are usually fragmented to generate smaller specimens for outplanting, taking advantage of the high regenerative ability of corals. In this study, we utilized RNA‐seq technology to understand the physiological responses of Porites lobata colonies to physical fragmentation and outplanting, which have thus far not been characterized. Our results demonstrate that P. lobata fragments undergoing physical injury recover through two distinct phases: rapid wound regeneration of the cut margins, followed by a slower growth phase that cements the colony to the substrate. Our study found rapid physiological responses to acute physical injury and outplanting in the coral host that involved significantly increased energy production, calcium homeostasis disruption, and endoplasmic reticulum (ER) stress leading to increased antioxidant expression and rates of protein turnover. Our results suggest that phosphoinositide‐mediated acute calcium homeostasis disruption stimulates wound recovery processes in response to physical injury. Symbiont gene expression revealed extremely low gene differences in response to fragmentation, growth, and outplanting. These results provide insight into the physiological mechanisms that allow for rapid wound healing and stabilization in response to physical injury in corals.

EMR-P for small rectal neuroendocrine tumors: is it a preferred treatment?

Background The selection of endoscopic treatments for small rectal neuroendocrine tumors is controversial. Objective To retrospectively compare the effectiveness and safety of precut endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD) for small rectal neuroendocrine tumors (NETs). Methods Data from 98 patients with small rectal NETs who were hospitalized at Shenzhen Second People's Hospital between August 2014 and November 2021 were collected. The en bloc resection rate, pathological complete resection rate, radical resection rate, operation time, adverse event rate and hospital stay were compared between the two groups. Results The operation time in the EMR-P group was significantly shorter than that in the ESD group. The median hospital stay in the EMR-P group was also significantly shorter than that in the ESD group. There were no significant differences between the two groups in terms of the en bloc resection, complete resection or radical resection rates. There was also no significant difference in the incidence of adverse events between the two groups. The delayed bleeding and delayed perforation rates of the two groups were improved after conservative treatment without surgery. There was no significant difference in the rate of positive vertical margins and horizontal margins between the EMR-P group and the ESD group. No local recurrence or metastasis was found during follow-up. Conclusion EMR-P is an effective and safe endoscopic treatment for rectal NETs with a diameter of less than 10 mm. EMR-P is a significantly shorter procedure and requires a shorter hospital stay than ESD. EMR-P does not increase the cut margin positivity rate.

Application of near infrared fluorescence imaging in detection of residual cancer in oral squamous cell carcinoma

Objective: Local recurrence is the main cause of treatment failure in patients with oral squamous cell carcinoma (OSCC). This study was proposed to investigate the feasibility of near infrared fluorescence (NIF) via indocyanine green (ICG) for monitoring surgical marginal in operation for OSCC patients. Methods: In 35 patients with OSCC treated surgically in the Department of Oral and Maxillofacial Surgery, Nanjing University School of Medicine, from January 2019 to June 2020, ICG (0.75 mg/kg) was administered intravenously via elbow vein at (12±1) hours before surgery, and NIF was performed intraoperatively on the surgical field and the cut edge of the surgically excised specimen, and fluorescence intensity was measured for OSCC tissue and normal oral mucosa, abnormal fluorescence signals were taken and subjected to rapid cryopathological examination. Correlation between NIF tumor boundary grading and pathological tumor boundary grading was analyzed by Spearman correlation analysis. Results: Clear ICG NIF was obtained for tumor lesions in all 35 patients, with a positive rate of 100%. The fluorescence intensity of OSCC tissue was (412.73±146.56) au, which was higher than that of normal oral mucosa tissue [(279.38±82.56) au, P<0.01]. Abnormal fluorescence signals were detected at the tumor bed and the cut edge of the surgical resection specimen in 4 patients, of which 2 cases were pathologically confirmed as cancer cell residue and 2 cases as inflammatory cell infiltration. The rate of positive detection of cut margins using ICG NIF technique in OSCC was 5.7% (2/35). Twenty of the 35 OSCC patients had grade 1, 11 of grade 2, and 4 of grade 3 tumor borders revealed by NIF of surgical resection specimens, which was positively correlated with pathological tumor border (r=0.809, P<0.001). Conclusions: ICG NIF technique can effectively detect the residual cancer cells at the incision margin, which is of great clinical value in reducing local recurrence of OSCC after surgery due to intraoperative cancer residue.

In vitro Regeneration of Japanese Burdock (Arctium lappa L.) from Cotyledon and Leaf Derived Explants

Considering the vegetable and medicinal values, a micropropagation protocol has been established for Japanese Burdock (Arctium lappa L.) by culturing the explants of cotyledon and leaf obtained from in vitro grown seedlings. Direct shoot regeneration was achieved from cotyledon and leaf explants on MS fortified with 4.0 μM BAP and 2.0 μM IBA or NAA after 5 weeks of culture. In addition, both the explants also formed callus from their cut margins within 6 weeks of cultivation on medium complemented with 6.0 μM BAP and 4.0 μM IBA or NAA. Adventitious shoots were also redeveloped through indirect organogenesis from the cotyledon and leaf-derived callus within 10 weeks of culture on MS containing 4.0 μM BAP and 2.0 μM IBA or NAA. The highest rate of shoot reproduction was attained at the third subculture, and more than 12.6 shoots were formed per callus clump. Within 4 weeks of transfer to the rooting medium on MS containing 6.0 μM IBA, the cultured micro-shoots produced highest 5.3 roots per cultured shoot. Rooted plantlets were successfully established on a soil-composed-sand mixture under natural condition with 93.3% survival rate Plant Tissue Cult. &amp; Biotech. 31(2): 123-134, 2021 (December)

Tuck in versus cauterisation of graft edge in pterygium management: A comparative retrospective interventional analysis.

PURPOSE:To compare and evaluate surgical outcome between tuck in and cauterisation in the management of primary pterygium.MATERIALS AND METHODS:Two groups of 56 eyes and 58 eyes with primary pterygium underwent pterygium excision with conjunctival autograft fixation by tucking in alone (Group 1) and with cauterization (Group 2), respectively. A retrospective comparative analysis was done between the two groups.RESULTS:This study included a total of 114 eyes in the final analysis. The recurrence was noted in 3 eyes in Group 1 (5.35%), whereas only 1 eye (1.72%) in Group 2. Other complications included graft edema in 25 eyes (44.64%), in Group 1 and 29 eyes (50%) in Group 2, subconjunctival hemorrhage seen in 28 eyes (50%) in Group 1 and 32 eyes (55.17%) in Group 2, graft retraction observed in 28 eyes (50%) in Group 1 and 13 eyes (22.4%) in Group 2, granuloma formation was seen only in one patient (1.72%) in Group 2, graft loss was observed in four patients (7.14%) in Group 1 and 2 patients (3.44%) in Group 2.CONCLUSION:Graft fixation in pterygium surgery using low-cost procedures with tuck in or cauterization proves to be tolerable, safe and successful method. An additional step of fixing the graft to the cut conjunctival margin using bipolar cautery proves to be safer.

A Case of Intrahepatic Mucinous Cholangiocarcinoma

Background: Mucinous carcinoma of the liver is a rare variant of intrahepatic cholangiocarcinoma. Herein, we report a resected case of mucinous carcinoma of the liver with a literature review. Case presentation: A 78-year-old woman was admitted to our hospital because of a large hepatic tumor, which had been revealed during tests for liver dysfunction. CT examination revealed that the large cystic tumor, 15 cm in a diameter, was located in the left hepatic lobe. Enhanced MRI was unable to visualize any nodules on the cyst wall. PET-CT partially detected FDG accumulation at the tumor margin. Extended left lobectomy was performed under a preoperative diagnosis of hepatobiliary cystadenocarcinoma. The extrahepatic bile duct was preserved because an intraoperative fast frozen section showed that the cut margin of the bile duct was cancer-negative. Pathological examination showed that the tumor cells had proliferated in the form of vesicles, and contained a large amount of mucus in the cytoplasm. Immunostaining demonstrated positivity for CK7 and CK19, and negativity for CK20, Hepatocyte, glypican 3, and CDX2. Finally, the hepatic tumor was diagnosed as intrahepatic mucinous cholangiocarcinoma. Conclusion: This case was an extremely rare variant of intrahepatic cholangiocarcinoma.