ChemInform Research Articles

Current Status of Robotic Surgery for Pharynx and Larynx Cancers

Current Status of Robotic Surgery for Pharynx and Larynx Cancers

A Comprehensive Systematic Review on Functional Results, Speech and Swallowing Outcomes after Trans-Oral Robotic Surgery for Oropharyngeal Squamous Cell Cancer

A Comprehensive Systematic Review on Functional Results, Speech and Swallowing Outcomes after Trans-Oral Robotic Surgery for Oropharyngeal Squamous Cell Cancer

Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients.

We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000-2016); cases stratified into groups as per MFI (0-2) and GLIM. Characteristics, 90-day post-op events, and 5-year follow-up data were analyzed to report survival and complication outcomes. Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR-negative tumors had worse 5-year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy (p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. MFI showed a significant predictive value for 5-year survival for patients ≥ 80 and should be part of the preoperative evaluation.

Associations between pre-operative cholesterol levels with long-term survival after colorectal cancer surgery: a nationwide propensity score–matched cohort study

PurposeAltered lipid metabolism frequently occurs in patients with solid cancers and dyslipidemia has been associated with poorer outcomes in patients with colorectal cancer. This study sought to investigate whether cholesterol levels are associated with clinical outcomes and can serve as survival predictors.MethodsWe conducted a retrospective cohort study with Danish patients diagnosed with colorectal cancer who had surgery with curative intent for UICC stages I to III between 2015 and 2020. Using propensity score adjustment, we matched patients in a 1:1 ratio to examine the impact of total cholesterol (TC) > 4 mmol/L vs. ≤ 4 mmol/L within 365 days prior to surgery on overall survival (OS) and disease-free survival (DFS).ResultsA total of 3443 patients were included in the study. Median follow-up time was 3.8 years. Following propensity score matching, 1572 patients were included in the main analysis. There was no statistically significant difference in OS or DFS between patients with TC > 4 mmol/L compared with TC ≤ 4 mmol/L (HR: 0.82, 95% CI, 0.65–1.03, HR: 0.87, 95% CI, 0.68–1.12, respectively.). A subgroup analysis investigating TC > 4 mmol/L as well as low-density lipoprotein (LDL) > 3 mmol/L found a significant correlation with OS (HR: 0.74, 95% CI, 0.54–0.99).ConclusionTC levels alone were not associated with OS or DFS in patients with colorectal cancer. Interestingly, higher TC and LDL levels were linked to better overall survival, suggesting the need for further exploration of cholesterol's role in colorectal cancer.Trial registrationNot applicable.

Predictive Value of ARISCAT Risk Index in the Development of Postoperative Pulmonary Complications After Major Abdominal Cancer Surgery

Predictive Value of ARISCAT Risk Index in the Development of Postoperative Pulmonary Complications After Major Abdominal Cancer Surgery

Preface: 3rd International Conference on Management Engineering and Economic Analysis (MEEA 2024)

The 2024 3rd International Conference on Management Engineering and Economic Analysis (MEEA 2024) was held in London, United Kingdom during August 17-18, 2024. This conference is to bring together innovative academics and experts in the fields of management engineering, business statistics, marketing strategies, financial economics and economic analysis to a common forum. The primary goal of the conference is to promote research and developmental activities and another goal is to promote information interchange between researchers, developers, engineers, students, and practitioners working all around the world. The conference model of MEEA 2024 was divided into two sessions, including oral presentations and keynote speeches. In the first part, some scholars, whose submissions were selected as the excellent papers, were given 10-15 minutes to perform their oral presentations one by one. Then in the second part, keynote speakers were each allocated 35-45 minutes to hold their speeches. We are glad to share with you that we received lots of submissions from the conference and we selected a bunch of high-quality papers and compiled them into the proceedings after rigorous reviewing. We are really grateful to the keynote speakers, session chairs, organizing committee members, student volunteers, and publication house. Also, we are thankful to all the authors for contributing a large number of papers in the conference. It was the quality of their presentations and their passion to communicate with the other participants that really make this conference series a great success. MEEA 2024 Organizing Committees London, United Kingdom

Exploring the Association between Complexity of Care, Medical Complexity, and Length of Stay in the Paediatric Setting Using a Nursing Minimum Data Set: A Study Protocol.

The complexity of care requires systematic documentation to fully understand its relationship with medical complexity and its impact on patient outcomes. The Nursing Minimum Data Set (NMDS) plays a crucial role by capturing essential nursing data, enabling a detailed analysis of care and its impact on outcomes, such as length of stay (LOS). However, despite its potential, the use of NMDS in paediatric care remains limited. This study aims to explore the association between nursing and medical complexities and LOS in paediatric patients. A descriptive, retrospective, monocentric study will be conducted. The data will be collected through a nursing information system (Professional Assessment Instrument (PAIped)) and the hospital discharge register of patients admitted to the paediatric department in 2022 in an Italian university hospital. Conclusions and Expected Results: The use of PAIped will allow for the description of the complexity of care and enable an analysis of its relationship with medical complexity and LOS.

An Updated Systematic Review and Meta-Analysis of Unimodal Prehabilitation with Exercise Intervention to Enhance Postoperative Outcomes in Cancer Surgery.

The objective of this systematic review and meta-analysis was to update the body of evidence on the efficacy of prehabilitation with exercise interventions, in reducing postoperative complications and length of hospital stay after cancer surgery. A comprehensive literature search was conducted on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED, and PsycINFO to identify randomized controlled trials investigating the impact of prehabilitation with exercise interventions for patients undergoing cancer surgery. Primary and secondary outcomes assessed were postoperative complications and length of hospital stay, respectively. Risk of bias was evaluated using the Cochrane risk of bias tool, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was used to determine the strength of evidence. Relative risk and mean difference were calculated using random-effects meta-analysis. In this updated review, 32 trials (n = 2304 participants) were identified, with 5 trials focused on patients undergoing surgery for genitourinary cancer (n = 422 participants), 9 for lower gastrointestinal cancer (n = 639 participants), 6 for upper gastrointestinal cancer (n = 526), and 11 for lung cancer (n = 717 participants). The majority of included trials exhibited some risk of bias. Evidence of low-to-moderate quality indicated that prehabilitation with preoperative exercise significantly reduced postoperative complication rates by approximately 50% and decreased the length of hospital stay by 2.5 days in patients undergoing lung resection. Preoperative exercise did not demonstrate effectiveness in reducing postoperative complications or length of hospital stay for other cancer populations. Evidence supports the efficacy of prehabilitation with exercise in reducing postoperative complications and length of hospital stay in patients undergoing lung cancer surgery. Further research is warranted to establish the efficacy of unimodal prehabilitation with exercise in genitourinary, lower gastrointestinal, and upper gastrointestinal cancer populations having cancer surgery.

Seaweed extract and fulvic acid application affect the biomass performance, the essential oil yield and composition of Sicilian oregano grown in an organic agricultural system

Origanum vulgare ssp. hirtum is one of the taxa used as ‘oregano’ and is medicinal and aromatic plant (MAP) utilized worldwide in various sectors. Nowadays, agricultural systems are moving towards sustainable, organic, and environmentally friendly agricultural production and biostimulants have been used in recent years as a potential strategy. The objective of this research was to investigate the influence of seaweed extract based on Aschophyllum nodosum (AN) and fulvic acid (FA), applied with two different doses, on morphological parameters, fresh and dry yield, essential oil (EO) traits, total phenolic content (TPC), antioxidant activity (AA) and rosmarinic acid content (RAC) of organic oregano. Two-year experiment was conducted using a randomized complete block design with one main factor (foliar biostimulant) and 3 replicates. In AN- and FA-treated plants, increases in fresh biomass between 0.3 and 8.4 t ha−1 and in dry biomass between 0.5 and 3.0 t ha−1 were observed. The application of the lowest doses of fulvic acid (FA4) produced the highest EO contents (3.49 % and 3.46 %) and EO yields (73.3 and 97.4 kg ha−1) in both years. The application of the lowest doses of FA produced an increase (on average 4 %) in thymol content. Biostimulant application generated contrasting response, and, in some cases, a reduction in some chemical parameters compared with control plants. The findings of this study contribute to add novelty in cultivation of oregano. The application of low doses of AN and FA allows to increase yields and improve some qualities of the secondary metabolites from organic oregano.

Embedding Physical Therapy in the Pediatric Primary Care Setting: Qualitative Analysis of Pediatricians' Insights on Potential Collaborative Roles and Benefits.

The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study sought to gain insights from pediatricians on the potential of embedding pediatric PTs in primary care. Participants were nine pediatricians practicing in both urban and rural, hospital-based and private settings. Semi-structured interviews were recorded, transcribed, and analyzed via thematic analysis per published methods, assuring trustworthiness. Three overarching themes emerged: pediatricians' priorities aligned with the Quadruple Aim of Healthcare, embedded PTs could fill multiple roles in pediatrics, and they could see a wide variety of patients, highlighting real potential benefits in primary care. Participants endorsed in-office focused treatments, screening to determine optimal care pathways, and ongoing patient follow-up as potential PT roles in this setting. Providers thought that PTs could help manage care for musculoskeletal complaints, high-risk infants, medically complex children, autism, and obesity. An advanced-trained PT having attributes of confidence, adaptability, and open-mindedness was desired. All participants endorsed pediatric primary care PTs as having potentially high value in their practice. This is the first known study on the potential of embedding a PT in the pediatric primary care setting, offering valuable insights from pediatricians to be leveraged in implementation planning.

Optimal surgical timing for lung cancer following SARS-CoV-2 infection: a prospective multicenter cohort study

BackgroundWith the ongoing prevalence of the emerging variant and global vaccination efforts, the optimal surgical timing for patients with resectable lung cancer in the Omicron-dominant period requires further investigation.MethodsThis prospective multicenter study involved patients who underwent radical surgery for lung cancer between January 29, 2023 and March 31, 2023. Patients were categorized into four groups based on the interval between SARS-CoV-2 infection and surgery. The main outcomes evaluated were 30-day mortality and 30-day morbidity.ResultsA total of 2081 patients were enrolled in the study, of which 1837 patients (88.3%) had a confirmed SARS-CoV-2 diagnosis before surgery. Notably, no instances of 30-day mortality were observed in any patient. Patients without prior infection had a 30-day morbidity rate of 15.2%, with postoperative pneumonia occurring in 7.0% of cases. In contrast, patients diagnosed with SARS-CoV-2 before surgery had significantly higher rates of 30-day morbidity and postoperative pneumonia when surgery was performed within 4–5 weeks (adjusted odds ratio (aOR) (95% CI):2.18 (1.29–3.71) and 2.39 (1.21–4.79), respectively) or within 6–7 weeks (aOR (95% CI):2.07 (1.36–3.20) and 2.10 (1.20–3.85), respectively). Conversely, surgeries performed ≥ 8 weeks after SARS-CoV-2 diagnosis exhibited similar risks of 30-day morbidity and pneumonia compared to those in the no prior infection group (aOR (95% CI):1.13 (0.77–1.70) and 1.12 (0.67–1.99), respectively).ConclusionsThoracic surgery for lung cancer conducted 4–7 weeks after SARS-CoV-2 infection is still associated with an increased risk of 30-day morbidity in the Omicron-dominant period. Therefore, surgeons should carefully assess the individual risks and benefits to formulate an optimal surgical strategy for patients with lung cancer with a history of SARS-CoV-2 infection.

Pediatric Dental Care and Antibiotics: A Comprehensive Update

Abstract Antimicrobial agents, a foundational component of contemporary medical practice, have significantly transformed the management of microbial infections, effectively protecting human well-being and prolonging life expectancy. Nevertheless, this extraordinary advancement faces a mounting challenge in the form of antimicrobial resistance (AMR). The ongoing evolution of microorganisms to withstand the impact of these substances has led to a decline in the efficacy of formerly dependable treatments, thereby presenting a critical menace to medical progress and prompting an exigent need for action. This paper undertakes a comprehensive exploration of the utilisation and correct application of antimicrobials within the context of paediatric dental healthcare. By meticulously examining the intricate interplay between therapeutic efficacy and the emergence of AMR, the overview delves into the pivotal function these agents fulfil in both preventing and treating dental infections in young patients. In addition, this update sheds light on the potential repercussions stemming from improper prescription practices, unwarranted overutilisation and insufficient adherence to established guidelines.

A multicenter retrospective study on neck dissection and adjuvant radiotherapy with transoral surgery for hypopharyngeal squamous cell carcinoma

ObjectiveThe aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer. MethodsWe compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021. ResultsTwo hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (p = 0.007) and distant metastasis (p < 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (p = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival. ConclusionIn cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary.

Streamlined Preoperative Iron Deficiency Screening and IV Treatment for Colorectal Cancer Patients beyond Clinical Trials

Background/objectives: Iron deficiency anemia is common in patients with colorectal cancer and affects postoperative outcomes. Preoperative intravenous iron supplementation corrects anemia effectively; however, the effect on the postoperative clinical course is unclear. The aim of this study was to investigate the effects of implementing a screening program for iron deficiency anemia and correction in patients with colorectal cancer. Methods: This was a retrospective single-institutional quality-assurance study that included patients undergoing elective surgery for colorectal cancer between January 2019 and December 2021. On 1 March 2020, screening for iron deficiency was implemented. Anemia was corrected by intravenous ferricarboyxmaltose. Patients with hemoglobin &lt;7mmol/L and ferritin &lt;30 µg/L or ferritin 30–100 µg/L and TSAT &lt; 0.2 were divided into iron- and non-iron groups. The primary outcome was a change in hemoglobin concentration, and secondary outcomes included blood transfusion, complications, length of stay, mortality, and implementation efficacy. Data from the patients were extracted from digital patient charts and entered into a database. Results: A total of 532 patients were included, of which 177 patients (33.3%) were anemic, 63 were in the iron group, and 114 were in the non-iron group. Adherence to the screening program was 86.3%. Hemoglobin (iron group) increased from a mean of 5.7 mmol/L (SD 0.8) to 6.9 (0.8) mmol/L, p &lt; 0.001. Iron treatment decreased transfusion rates from 27.7% to 9.1%, p = 0.007, and increased the rate of patients without complications from 53.2% to 79.6%, p &lt; 0.001, which held true after controlling for confounding. In addition, 90-day mortality was lower in the iron group; however, this was not significant. Conclusions: Administration of intravenous iron increased hemoglobin, leading to reduced use of blood transfusion and fewer complications.

Robot-assisted minimally invasive esophagectomy for esophageal cancer in the left lateral decubitus position.

The use of robot-assisted minimally invasive esophagectomy (RAMIE) in the prone position for esophageal cancer has been currently increasing worldwide. In future, as surgical-assisted robots become more widespread, it is estimated that only two methods of transthoracic approach will remain: RAMIE and open thoracotomy for thoracic esophageal cancer. RAMIE in the left lateral decubitus position (RAMIE-LLDP) has the same field of view as open thoracotomy, is safe in emergency situations, and provides education on open thoracotomy. Between September 2020 and April 2024, RAMIE-LLDP was performed in 64 consecutive patients with esophageal cancer. RAMIE-LLDP was performed with the operating table rotated and tilted 45° to the ventral side under artificial pneumothorax. The hand-control setting of the surgical-assist robot system was reversed left to right when the Patient Cart was rolled from the same direction as the RAMIE in the prone position. The mean total surgery and console times during the thoracic procedure were 254-min overall and 225min in the last 24 cases and 195-min overall and 178-min in the last 24 cases, respectively. The mean amount of blood loss was 203.4g overall and 28.3g in the last 24 cases. Postoperative recurrent laryngeal nerve palsy with Clavien-Dindo classification (CD) was ≥ 2 in six patients (9.4%). Postoperative pneumonia with CD ≥ 2 was observed in 11 patients (17.2%). Conversion to open thoracotomy was observed in three patients (4.7%). In all three patients, an immediate conversion to thoracotomy without patients' position change was actually possible and no serious complications were noted. No mortality occurred within 30days postoperatively. RAMIE-LLDP which facilitates emergency thoracotomy has perioperative results comparable to those of conventional thoracoscopic esophagectomy and is educational for open surgery. RAMIE-LLDP is the safest and most optimal surgery for esophageal cancer.

Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study.

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based general anesthesia-on antitumor immunity, including tumor growth factor-β (TGF-β), T-helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I-III fulfilling the inclusion criteria were randomized to either group S (sevoflurane-based general anesthesia) or group T (propofol-based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF-β (higher in group T). There was a statistically significant difference in postoperative interleukin-17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol-based TIVA increases serum TGF-β levels. At the same time, Sevoflurane modulates T-helper cells-based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations.

De novo production of protoberberine and benzophenanthridine alkaloids through metabolic engineering of yeast

Protoberberine alkaloids and benzophenanthridine alkaloids (BZDAs) are subgroups of benzylisoquinoline alkaloids (BIAs), which represent a diverse class of plant-specialized natural metabolites with many pharmacological properties. Microbial biosynthesis has been allowed for accessibility and scalable production of high-value BIAs. Here, we engineer Saccharomyces cerevisiae to de novo produce a series of protoberberines and BZDAs, including palmatine, berberine, chelerythrine, sanguinarine and chelirubine. An ER compartmentalization strategy is developed to improve vacuole protein berberine bridge enzyme (BBE) activity, resulting in >200% increase on the production of the key intermediate (S)-scoulerine. Another promiscuous vacuole protein dihydrobenzophenanthridine oxidase (DBOX) has been identified to catalyze two-electron oxidation on various tetrahydroprotoberberines at N7-C8 position and dihydrobenzophenanthridine alkaloids. Furthermore, cytosolically expressed DBOX can alleviate the limitation on BBE. This study highlights the potential of microbial cell factories for the biosynthesis of a diverse group of BIAs through engineering of heterologous plant enzymes.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Outcomes of adolescent children with severe cardiogenic shock referred for extracorporeal membrane oxygenation: insight from collaboration of adult shock team and paediatric cardiac critical care.

Adolescents with severe cardiogenic shock can present to both paediatric and adult centres. We present six adolescent children who had extracorporeal membrane oxygenation consultation fast-tracked with clinical care input from the adult multidisciplinary team, including interhospital transfers on extracorporeal membrane oxygenation. After recovery on conventional cardiogenic shock care or extracorporeal membrane oxygenation, or bridge to transplant, all had favourable neurologic outcome.

Proof of concept, feasibility, and acceptability of spiritual care assessment and intervention-pediatric with caregivers of children receiving home mechanical ventilation

Caregivers of children with medical complexity face daily tasks comparable to pediatric critical care nursing with multiple stressors. This may result in emotional and spiritual distress. Caregivers may also rely on their religion and spirituality to cope. Chaplains have the potential to support caregivers in this setting, beginning with spiritual assessment. This study’s purpose was to verify the feasibility and acceptability of the Spiritual Care Assessment and Intervention framework adapted for home-based chaplaincy with caregivers of children receiving home mechanical ventilation (SCAI-Peds). A quasi-experimental, proof-of-concept trial with N = 6 caregivers and two board certified chaplains was carried out. SCAI-Peds was acceptable and feasible to caregivers, delivered with high fidelity, and was also acceptable to the chaplains. Home-based intervention delivery may provide more room for reflection and reframing than acute care settings. The results warrant advancing SCAI-Peds beyond the pilot stage.