Incisal Margin Research Articles

Single Port Robotic Hysterectomy after the Previous Robotic Radical Trachelectomy

<h3>Study Objective</h3> The basic treatment for cervix cancer is hysterectomy. For nullipara women, trachelectomy may be considered. In this video, we described the technique of a single port robotic hysterectomy to a patient who underwent a multi-port robotic radical trachelectomy previously. <h3>Design</h3> Case Report. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> This 32-year-old woman presented with a recurrence of cervical cancer. She had a history of robotic radical trachelectomy with pelvic lymphadenectomy for stage IA1 cervical cancer 9 years earlier. <h3>Interventions</h3> At first, we described the typical multi-port robotic radical trachelectomy which preserved the main uterine artery and round ligament. There was no recurrence in follow up MRI and colposcopy after the surgery. But in December 2021, her pap-smear revealed adenocarcinoma. MRI of the pelvis and PET CT were all normal. After careful consideration, our team used DaVinci SP system to perform the hysterectomy and BS. The operation was similar to a general hysterectomy, but there was an adhesion between the uterus and the ovary due to the previous operation. Although several branches of the uterine artery were ligated, the blood supply to the uterus was sufficient. The uterus and bladder also had moderate adhesion. After the colpotomy, the thread of cervical cerclage in the previous operation was confirmed. The subsequent procedure was similar to that of a typical hysterectomy. <h3>Measurements and Main Results</h3> The operation was performed successfully with no intraoperative complications. <h3>Conclusion</h3> Single port robotic hysterectomy after the previous robotic trachelectomy is a safe and effective approach for the recurrence of cervical cancer patients. There was some difficulty in finding the incision margin between the uterus ithmus and the upper vagina. The bladder and vagina fornix should be carefully dissected. The secondary assistant should push the colpotomizer in the same direction as the incision. Single port Robotics can help to overcome the limitations of laparoscopy, especially in complicated procedures.

Study on the Effect of Different Bladder Filling Volume on Target Area and Organs at Risk during Three-Dimensional Brachytherapy for Postoperative Early Cervical Cancer

<h3>Purpose/Objective(s)</h3> To investigate the optimal bladder filling volume in the 3D brachytherapy of postoperative cervical cancer. <h3>Materials/Methods</h3> Patients of early cervical cancer with a positive incisal margin or insufficient safety boundary were included. 50ml, 60ml, 70ml, 80ml, 90ml, and 100ml of normal saline were randomly filled into their bladders. There was a total of 6 groups. The CT simulation positioning was performed. According to ICRU89 report, high-risk clinical target volume, bladder, rectum, and other organs at risk were delineated. The radiotherapy treatment planning system was used to make the treatment plan. The volume of HR-CTV, D90, and D2cc and D1cc of organs at risk under different volumes were recorded respectively. <h3>Results</h3> A total of 111 patients were enrolled and there were 398 person-times of 3D brachytherapy treatment program were performed. Among them, there were 66 person-times in the 50ml group, 69 person-times in the 60ml group, 66 person-times in the 70ml group, 69 person-times in the 80ml group, 72 person-times in the 90ml group, and 56 person-times in the 100ml group. Compared with the 60ml group, the volume and dosage of HR-CTV in the groups of 50ml, 70ml, 80ml, 90ml, and 100ml had no significant difference (P>0.05), D2cc and D1cc of the bladder and rectum significantly decreased, the difference was statistically significant (P<0.05). Pairwise comparison between other 5 groups, the volume and dosage of HR-CTV, D2cc and D1cc of bladder and rectum had no significant difference (P>0.05). <h3>Conclusion</h3> In the 3D brachytherapy of postoperative early cervical cancer, compared with other volumes, the bladder perfusion of 60ml can ensure the volume and dose of HR-CTV and reduce better the dose of the bladder and rectum.

Relationship Between Wound Complication Rates after Breast Reconstruction and Fluorescence Ratio of SPY Indocyanine Green Immunofluorescence: A Quantitative Study

INTRODUCTION: Wound complications are dreaded outcomes of breast reconstruction and can be reduced by adequate perfusion of the mastectomy flap. The use of SPY (Novadaq) immunofluorescence technology gives a quantitative estimate of tissue perfusion. Our study aims to determine what percentage perfusion scores obtained from SPY imaging correlate with development of wound complications after breast reconstruction. METHODS: All female adult patients undergoing immediate breast reconstruction in which SPY was used intraoperatively from January 2018 through January 2021 were reviewed. There were 60 patients with 72 individual breast images. Demographics, number of reoperations, and postoperative wound complications were studied. Major wound complications were determined as return to the operating room for debridement or wound revision. Percent perfusion values were collected at various places on the flap: the incision margin (perfusion at margin, PAM), the lowest percent perfusion (LPP), the highest percent perfusion (HPP), and the average percent perfusion (APP) in the image. RESULTS: Wound complication rates were significantly higher when perfusion scores were lower for all 4 perfusion scores. Using ROC analysis, a cutoff LPP score of 22.5% and above showed a 91.4% negative predictive value (NPV; p = 0.01) and PAM of 33.5% and above showed a 83% NPV (p = 0.01) for having a major wound complication. The LPP, APP and PAM were negatively correlated with the number of re-operations. CONCLUSION: Our study provides a quantitative cutoff value to predict major wound complications in patients undergoing breast reconstruction.

Evaluation of the efficacy and safety of 5-aminolevulinic acid-mediated photodynamic therapy in women with high-risk HPV persistent infection after cervical conization

ObjectiveTo evaluate the efficacy and safety of photodynamic therapy (PDT) in women with high-risk human papillomavirus (hr-HPV) persistent infection after cervical conization, including loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). Materials and methodsThe clinicopathological and follow-up data of 76 women with hr-HPV persistent infection after cervical conization (54 cases with LEEP and 22 cases with CKC) were collected. All the women in this group met these criteria: postoperative pathological diagnosis of LEEP/CKC showed high grade squamous intraepithelial lesions (HSIL) with negative incisal margin, hr-HPV persistent infection after LEEP/CKC ≥ 1 year, colposcopy and histopathology showed no intraepithelial lesions before PDT, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with an interval of 7-10 days. The above patients were followed up 6 months and 12 months after PDT, and the follow-up contents included Roche Cobas HPV classification test, cytology, colposcopy, and pathological examinations. HPV negative conversion rate is an index to evaluate the efficacy of PDT. In addition, we also assessed the safety of PDT. ResultsSix months after PDT, the overall HPV clearance rate was 59.21% (45/76). The HPV negative conversion rates in patients ≤ 50 years old group and > 50 years old group were 68.52% (37/54) and 36.36% (8/22), respectively (P=0.009). But there was no significant difference in HPV clearance rate between the HPV16/18 infection group and other hr-HPV infection group (P=0.3326). 12 months after PDT, 1 case underwent hysterectomy because of progression to HSIL, and 7 cases lost follow-up. The overall HPV clearance rate was 88.24% (60/68). The negative conversion rates of HPV16/18 and other hr-HPV infection groups were 76.00% (19/25) and 95.35% (41/43), respectively (P=0.0458). However, the HPV negative conversion rate was not correlated with the patient's age (P=0.2383). The adverse reactions after PDT were mild, mainly manifested as increased vaginal secretions or burning/tingling. ConclusionsPhotodynamic therapy could be an effective treatment for patients with hr-HPV persistent infection after cervical conization and it could promote the negative conversion of hr-HPV and prevent the recurrence progression of cervical intraepithelial neoplasia (CIN) after LEEP/CKC.

Association of levels of metabolites with the safe margin of rectal cancer surgery: a metabolomics study

BackgroundRectal cancer is one of the most lethal of gastrointestinal malignancies. Metabonomics has gradually developed as a convenient, inexpensive and non-destructive technique for the study of cancers.MethodsA total of 150 tissue samples from 25 rectal cancer patients were analyzed by liquid chromatography–mass spectrometry (LC–MS), and 6 tissue samples were collected from each patient (group 1: tumor; group 2: 0.5 cm from tumor; group 3:1 cm from tumor; group 4:2 cm from tumor; group 5:3 cm from tumor and group 6:5 cm from tumor). The differential metabolites of tumor tissues and 5 cm from the tumor (normal tissues) were first selected. The differential metabolites between tumor tissues and normal tissues were regrouped by hierarchical clustering analysis, and further selected by discriminant analysis according to the regrouping of clustering results. The potential safe margin of clinical T(cT)1,cT2 stage rectal cancer and cT3,cT4 stage rectal cancer at the metabolomic level was further identified by observing the changes in the level of differential metabolites within the samples from group 1 to group 6.ResultsWe found 22 specific metabolites to distinguish tumor tissue and normal tissue. The most significant changes in metabolite levels were observed at 0.5 cm (cT1, cT2) and 2.0 cm (cT3, cT4) from the tumor, while the changes in the tissues afterwards showed a stable trend.ConclusionsThere are differential metabolites between tumor tissues and normal tissues in rectal cancer. Based on our limited sample size, the safe distal incision margin for rectal cancer surgery in metabolites may be 0.5 cm in patients with cT1 and cT2 stage rectal cancer and 2.0 cm in patients with cT3 and cT4 stage rectal cancer.

The Debulking of Recurrent Right Testicular Seminoma with Anterolateral Thigh Flap Reconstruction

Introduction: Radical orchidectomy is considered both a therapy and a part of the staging procedure. Stage I seminoma may be treated with orchiectomy alone while the remaining 15% to 20% may have a relapse if they receive no additional treatment during the five-year surveillance. Most recurrences occur within the first 2 years after diagnosis, and the location of the recurrence is typically in the retroperitoneum. This article aims to share the experience in the management of testicular seminoma recurrence in a multidisciplinary approach.Case Presentation: We are reporting a case of a 26-year-old male with a growing mass at the right scrotum just two months after right radical orchidectomy. This patient was previously treated with a stage I seminoma and underwent surveillance. Tumor debulking and right inguinoscrotal reconstruction using a pedicled anterolateral thigh (ALT) flap were done through collaborative surgery between urology and plastic surgery. However, according to National Comprehensive Cancer Network (NCCN), with the relapsed mass, this patient can be classified as having a stage III seminoma and considered as having a good-risk disease due to no evidence of non-pulmonary visceral metastasis. With the risk of bleomycin causing lung fibrosis, four cycles of etoposide and cisplatin can be considered the chemotherapy regimens for this patient. Evaluation after chemotherapy should be done by checking tumor markers and imaging studies.Conclusions: The reappearance of testicular seminoma in this patient unexpectedly occurred quite in a short period, that is in two months after surgery. Immediate multidisciplinary intervention by a urologist and plastic surgeon was done through tumor debulking with a wide incision margin and ALT flap reconstruction. Unfortunately, however, after the second month of follow-up, there was a bulging mass growing beneath the flap which needed further evaluation with ultrasonography to confirm the possibility of tumor recurrence or seroma. If tumor recurrence is confirmed, chemotherapy should be scheduled as soon as possible.

Evaluation of the effect of milling mode and margin definition on adaptation of chairside digitally designed and fabricated ceramic veneers.

The present study aimed to evaluate the effect of the milling mode and margin defining method on the marginal and internal adaptation of digitally designed and fabricated ceramic veneers. Forty extracted central incisors were prepared for ceramic veneers. The veneers were categorized into four groups (n = 10) based on the milling mode (fine or extra-fine) and design (automatic or manual defining of cervical and incisal margins). The veneers were cemented to the teeth using resin cement and then polished. After cementation, the teeth were embedded in clear polyester resin, then cut into three sections. Absolute marginal gap at the cervical margins (AMGC), marginal gap at the incisal (MGI) and cervical (MGC) margins, and internal gap (IG) at the axial wall were evaluated using a scanning electron microscope. Two-way analysis of variance (ANOVA) and t tests were used (α = 0.05) for the statistical analysis. The margin defining method affected the adaptation of the internal and incisal margin; the automatic (software) margin defining method resulted in a smaller MGI (P = 0.038) and IG (P = 0.009) than the manual defining method. The type of milling mode did not affect the marginal gap. The margin defining method affected the marginal gap at the incisal margin and the internal gaps. (Int J Comput Dent 2022;25(3):277-285; doi: 10.3290/j.ijcd.b2588153).

Evaluation of the prognostic nutritional index for the prognosis of Chinese patients with high/extremely high-risk prostate cancer after radical prostatectomy.

BACKGROUNDThe incidence of prostate cancer (PCa) is on the rise in China. The risk level of patients with PCa is associated with disease-free survival rate at 10 years after radical prostatectomy. Predicting prognosis in advance according to the degree of risk can provide a reference for patients, especially treatment options and postoperative adjuvant treatment measures for high-risk/extremely high-risk patients.AIMTo explore the predictive value of the prognostic nutritional index (PNI) for biological recurrence in Chinese patients with high/extremely high-risk PCa after radical prostatectomy.METHODSThe biochemical test results and clinical data of 193 patients who underwent radical prostatectomy for the first time from January 2015 to December 2020 were retrospectively collected. The PNI value of peripheral blood within 1 wk before surgery was calculated, and during the follow-up period, prostate-specific antigen ≥ 0.2 ng/mL was considered to have biological recurrence. The receiver operating characteristic (ROC) curve was used to calculate the optimal critical value and area under the curve (AUC) of the patients. According to the critical value, the progression-free survival of the high PNI group and low PNI group was compared. The independent influencing factors of the patients' prognosis were obtained by the Cox proportional hazards regression model.RESULTSThe non-biological recurrence rates at 1, 3, and 5 years were 92.02%, 84.05%, and 74.85%, respectively. The optimal critical value for PNI to predict biological recurrence was 46.23, and the AUC was 0.789 (95% confidence interval: 0.651-0.860; P < 0.001). The sensitivity and specificity were 82.93% and 62.30%, respectively. In accordance with the optimal critical value of the ROC curve (46.23), 193 patients were further divided into a high PNI group (PNI ≤ 46.23, n = 108) and low PNI group (PNI > 46.23, n = 85). The incidence of postoperative complications in the high PNI group was lower than that in the low PNI group (21.18% vs 38.96%). Kaplan-Meier survival analysis showed that the overall survival rate at 5 years in the low PNI group was 87.96% (13/108), which was lower than that in the high PNI group (61.18%, 33/85; P < 0.05). Low PNI [hazard ratio (HR) = 1.74; P = 0.003] and positive incisal margin status (HR = 2.14; P = 0.001) were independent predictors of biological recurrence in patients with high/extremely high-risk PCa.CONCLUSIONThe PNI has predictive value for the prognosis of patients with high/extremely high-risk PCa, and is an independent prognostic factor. Patients with low PNI value have a shorter time of non-biological recurrence after prostatectomy. It is expected that the combined prediction of other clinicopathological data will further improve the accuracy and guide postoperative adjuvant therapy to improve the quality of prognosis.

Positive Deep Initial Incision Margin Affects Outcomes in TORS for HPV+ Oropharynx Cancer.

Evaluate the effect of initial incision margins (IIM) on clinical outcomes after transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) squamous cell cancers of the oropharynx (OPSCC). Retrospective chart review of patients undergoing TORS for HPV+ OPSCC from 2007 to 2015 was performed. Overall survival (OS), disease-specific survival (DSS), recurrence, and metastases were evaluated in the context of pathology, IIM, final margins, adjuvant therapy, and patient characteristics. Ninety-five patients with HPV+ OPSCC undergoing primary surgery were identified. 88% of these patients had no evidence of disease at the conclusion of the study (average follow-up 45 months). Twenty were identified that had true positive IIM and 16 had very close IIM, with the remainder demonstrating widely negative margins. Tumor very close to or involving the deep margin but not a mucosal margin was associated with a higher risk of recurrence. Perineural invasion and lymphovascular invasion were associated with positive IIM. Positive or very close IIM on the deep margin was found to impact DSS and recurrence. Obtaining negative IIM while performing TORS for HPV+ OPSCC is a modifiable factor that affects recurrence and DSS. Larger surgical margins should be considered in patients with perineural invasion or whose tumor abuts the initial deep margin. 4 Laryngoscope, 133:1132-1137, 2023.

Comparative analysis of intraoral scanners accuracy using 3D software: an in vivo study

BackgroundThe purpose of the present in vivo study was to compare the accuracy, in terms of trueness, between full-arch digital impressions of different intraoral scanning systems, using as a reference the ideality of the conventional impression technique.MethodsPolyvinyl siloxane (PVS) two-step technique impressions of 27 subjects were taken, and the stone casts were scanned using desktop scanners R500 3Shape. For each arch, in vivo scans were taken with intraoral scanners Carestream CS3600, CEREC Omnicam and Trios 3Shape. All the files were compared, superimposing them on the reference model to calculate the total 3D and 2D deviations. The efficiency of the digital and conventional workflows was evaluated by measuring the work time in minutes. Statistical analyses were performed using R software (R Core Team 2020) with a p-value < 0.05.ResultsThe three intraoral scanners differed from the PVS impression by differences of the order of 100–200 µm, and there was a trend of greater imprecision in the molar area in both dental arches. In comparison with PVS technique, CEREC tended to reduce the size of the impression, Trios presented the trend of greater precision, and Carestream showed minor differences the transversal distance. The areas of greatest discrepancy both in excess and in defect with respect to the PVS impression were the molar areas and incisal margins. Trios 3Shape recorded the shortest times and therefore with a more performing speed.ConclusionThe Trios 3Shape was found to be the most accurate single-tooth scanner, while the Carestream CS 3600 showed better inter-arch diameter performance compared to PVS impressions. The 3D and 2D analyses showed a trend of greater distortion of the impressions compared to the conventional one in the molar region.

Preliminary experience with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after total laparoscopic proximal gastrectomy for the treatment of adenocarcinoma of esophagogastric junction

(1) adenocarcinoma of esophagogastric junction (Seiwert type II-III) was diagnosed by endoscopy and pathological examination; (2) ability to preserve at least 1/2 of the distal stomach after R0 resection of proximal stomach was evaluated preoperatively. (1) evaluation indicated distant metastasis of tumor or invasion of other organs; (2) short abdominal esophagus or existence of diaphragmatic hiatal hernia was assessed during the operation; (3) mesentery was too short or the tension was too high; (4) existence of severe comorbidities before surgery; (5) only palliative surgery was required in preoperative evaluation; (6) poor nutritional status. operation time, intraoperative blood loss, postoperative complications, time to first flatus and time to start liquid diet, postoperative hospital stay, operation cost, etc. Continuous variables that conformed to normal distribution were presented as mean ± standard deviation, and those that did not conform to normal distribution were presented as median (Q1,Q3). Results: All the patients successfully completed TLPG with double-tract reconstruction combined with π-shaped esophagojejunal anastomosis, and postoperative pathology showed that no cancer cells were found on the upper incision margin. The operation time was (247.9±62.4) minutes, the median intraoperative blood loss was 100.0 (62.5, 100.0) ml, no intraoperative blood transfusion was required, the incision length was (4.9±1.0) cm, and the operation cost was (55.5±0.7) thousand yuan. The median time to start liquid diet was 1.0 (1.0, 2.0) days, and the mean time to flatus was (3.1±0.9) days. All the patients were discharged uneventfully. Only 1 patient developed postoperative paralytic ileus and infectious pneumonia with Clavien-Dindo classification of grade II. The patient recovered after conservative treatment. There was no surgery-related death. The postoperative hospital stay was (8.3±2.1) days. Conclusion: The double-tract reconstruction combined with π-shaped esophagojejunal anastomosis after TLPG is safe and feasible, which can minimize surgical trauma and accelerate postoperative recovery.

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.

Huge perianal basal cell carcinoma

Abstract Introduction: Basal cell carcinoma (BCC) is a common skin malignancy, but perianal BCC is rare and usually small. Here, we present a patient with a condyloma-like huge perianal BCC. Patient concerns: A 60-year-old Chinese man presented with a progressively growing perianal mass that had been growing for 8 years. The diameter of the perianal mass was ultimately up to 7 cm, accompanied by intermittent bleeding. Diagnosis: Histopathological evaluation of the punch biopsy specimen revealed BCC. Interventions: Total excision of the mass and transverse colostomy was performed. The postoperative pathological result was BCC, but part of the specimen's incisal margin was infiltrated by cancer. Therefore, after a month of recovery, local radiotherapy was started, and the wound healed completely. Stoma reversal was performed 4 months after the surgery. Outcomes: Postoperative anal function was satisfactory. The patient was asymptomatic and showed no signs of BCC recurrence one year after surgery. Conclusion: We present a case of isolated large perianal BCC in a patient with no known risk factor. As for huge perianal BCC, local wide resection is the preferred treatment. If the wound is large and close to the anus, transverse colostomy is needed. However, it is difficult to ensure a safe incisal margin because of the large size of the tumor; therefore, radiotherapy is also required.

A Cadaveric Study of Thread Cubital Tunnel Release with Newly Developed Threads.

ObjectiveThe percutaneous thread transection technique is a surgical dissecting method using a dissecting thread inserted through a needle under ultrasound guidance without skin incision. As the new dissecting threads were developed domestically, this cadaver study was conducted to compare the effectiveness and safety between the new threads (ultra V sswire and smartwire-01) and a pre-existing commercial dissecting thread (loop & shear) by demonstrating a modified looped thread cubital tunnel release. MethodsThe percutaneous cubital tunnel release procedure was performed on 29 fresh cadaveric upper extremities. The preexisting commercial thread was used in 5 upper extremities. The two newly developed threads were used in 24 upper extremities. Two practitioners performed the procedures separately. After the modified looped thread cubital release, anatomical and histological analyses were performed by a blinded anatomist. The presence of the dissected cubital tunnel and damaged adjacent soft tissue was assessed. ResultsOut of the 29 cadaveric upper extremities, 27 specimens showed complete dissection of the Osborne ligament and the proximal fascia of the flexor carpi ulnaris muscle. One specimen was incompletely dissected in each of the ultra V sswire and smartwire-01 groups. There were no injuries of adjacent structures including the ulnar nerve, ulnar artery, medial antebrachial cutaneous nerve, or flexor tendon with either the commercial thread or the newly developed threads. The anatomical analysis revealed clear and sharp incisional margins of the cubital tunnel in the Smartwire-01 and loop & shear groups. All three kinds of threads maintained proper linear elasticity for easy handling during the procedure. The smartwire-01 provided higher visibility in ultrasound than the other threads. ConclusionThe newly developed threads were effective and safe for use in the thread cubital tunnel release procedure.

Clinical application of indocyanine green fluorescence navigation technology to determine the safe margin of advanced oral squamous cell carcinoma.

Advanced oral squamous cell carcinoma (OSCC) has large lesions and deep infiltration, and the control of safe surgical margins was difficult. If residual tumor remains after incomplete tumor resection, it can lead to local tumor recurrence or even distant metastasis. This study sought to investigate the clinical application of indocyanine green (ICG)-based near-infrared fluorescence (NIF) molecular imaging in the intraoperative detection of surgical margins of advanced OSCC. Twenty-nine patients with advanced OSCC treated at the First Ward of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital were divided into the ICG group and non-ICG group. In the ICG group, the tumors were removed with the assistance of ICG fluorescence navigation technology. In the non-ICG group, the tumors were removed with conventional methods, and the cutting-edge tissues of the two groups underwent frozen biopsies. The margin abnormality rates were calculated and compared. Under the excitation of NIF in the ICG group, tumor fluorescence development was observable in all lesions, and the tumor boundary was clear. The abnormal rates of the incisional margin in the ICG group and non-ICG group were 0.78% and 6.25%, respectively (P<0.05). ICG-mediated NIF imaging technology provides a new method for observing and completely resecting tumors under direct vision during operation, and finding residual tumors at the cutting edge in time. These results will inform the treatment of advanced OSCC.

Hsa_circ_0005729 enhances accuracy in diagnosing parathyroid carcinoma.

BackgroundParathyroid carcinoma (PC), often misdiagnosed as a parathyroid adenoma (PA), is prone to local relapse due to the initial surgery being restricted to parathyroid lesions instead of en bloc resection of parathyroid lesions with negative incision margins. However, it is very challenging to distinguish PC from PA preoperatively; hence, this study investigated an effective biomarker for increasing accuracy in PC diagnosis.MethodFirst, the differentially expressed circular RNAs between three PC tissues and three PA tissues were screened by high-throughput circular RNA sequencing, and the expression of hsa_circ_0005729 was verified by qRT-PCR in 14 patients with PC and 40 patients with PA. Secondly, the receiver operating characteristic curve and the area under the curve (AUC) were used to analyze the diagnostic efficiency of hsa_circ_0005729 in PC by combining with laboratory data. Thirdly, RNF138mRNA, the corresponding linear transcript of hsa_circ_0005729, was measured, and the relationship between hsa_circ_0005729 and RNF138 mRNA was analyzed in patients with PA and patients with PC.ResultsHsa_circ_0005729 expression was significantly higher in patients with PC than in patients with PA. Serum calcium (P = 0.045), alkaline phosphatase (ALP) (P = 0.048), and creatinine levels (P = 0.036) were significantly higher in patients with PC than in patients with PA. The AUC increased to 0.86 when hsa_circ_0005729 combined with serum calcium, creatinine, and ALP. In addition, hsa_circ_0005729 was positively correlated with RNF138 mRNA in patients with PA but not in patients with PC.ConclusionThe novel circular RNA hsa_circ_0005729 was found to have a higher expression in patients with PC, indicating its usefulness for distinguishing PC from PA.

62 - Compression Force Testing of Veneer-Retained Anterior Fixed Partial Dentures

The focus of this study is twofold; the first objective is to evaluate the resistance of veneer-retained anterior fixed partial dentures to compression testing. The second objective is to determine if veneer retainers with these axial grip extensions improve the restorations resistance to compressive forces as demand for biomaterial and access to care is often globally differentiated. Two maxillary typodont models with edentulous spaces in the left lateral incisor area were obtained. On each typodont model, the central incisor and canine neighbouring the edentulous space were given veneer-type preparations with a chamfer finish line. On one model, 2-mm axial grip extensions were added to the prepared facial surface of the abutment teeth. Metal duplicates of the prepared abutment teeth and edentulous spaces of each typodont model were produced using the lost wax casting technique. The two metal duplicates were scanned, and ten identical CAD/CAM restorations were produced for each metal duplicate. The restorations were cemented to metal duplicates and were subjected to compressive strength testing using a universal testing machine. Compressive forces were applied from the incisal margin towards the cervical in order to determine the force at which the restorations undergo debonding or fracture. Subject specimen N tested totalled 20. The veneer-retained restorations without axial grip extensions all underwent debonding but none fractured. In the veneer-retained restorations with axial grip extensions retention, nine cases of debonding (90%) were recorded and one case of fracture (10%) was recorded. The veneer-retained restorations with axial grip extensions (M = 302 N, SD = 79) compared to the restorations without axial grip extensions (M = 228 N, SD = 60) withstood significantly higher compressive forces (p < 0.05). This study shows that veneer-retained anterior fixed partial dentures with axial grip extensions can withstand higher compression forces than veneer-retained anterior fixed partial dentures without axial grip extensions. Veneer-retained anterior bridges can be useful in addressing esthetic concerns in a minimally invasive manner. This study shows that axial grip extensions can play a crucial and important role in addressing concerns about resistance and long-term success of this type of restoration. An important clinical relevance will be highlighted for endodontically treated dentition versus non-endodontic treated dentition. Additionally, there will be reporting on intersectional pending studies regarding custom geo-position of axial grip extensions preparation design.

Altered arginine metabolism in colon cancer: A sign of increased proliferative potential of tumor-adjacent tissue

Colorectal cancer (CRC) is one of the most frequent forms of malignant tumors in the human population. The literature data about the role of arginine metabolism in CRC point out its double-faced role. In three tissue specimens of 50 patients who underwent surgical resection for colon adenocarcinoma (tumor, adjacent and healthy tissues more than 10 cm from the tumor border ? at the incision margin) taken during surgery, polyamines and the concentration of NO2+NO3 and arginase activity were determined. Polyamine levels and arginase activity were significantly increased in cancer and adjacent tissue specimens compared to healthy ones, while the level of NO2+NO3 was significantly lower in cancer compared to both adjacent and healthy tissues. The high polyamine content in the adjacent colonic mucosa indicates a high proliferative potential of tumor-adjacent tissue. Although we found individual correlations indicating the possible prognostic value of arginase, the performed statistical analysis did not show a predictive significance of arginase activity in the examined tissue specimens for five-year survival of the patients. Nevertheless, the obtained results provide the rationale for further studies of arginine metabolism in tissue specimens after surgery in patients with CRC, which could be useful in the evaluation of the risk for tumor growth, recurrence, metastases and survival after surgical intervention.

Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study.

BACKGROUNDThe long-term effect of anatomic resection (AR) is better than that of non-anatomic resection (NAR). At present, there is no study on microvascular invasion (MVI) and liver resection types.AIMTo explore whether AR improves long-term survival in patients with hepatocellular carcinoma (HCC) by removing the peritumoral MVI.METHODSA total of 217 patients diagnosed with HCC were enrolled in the study. The surgical margin was routinely measured. According to the stratification of different tumor diameters, patients were divided into the following groups: ≤ 2 cm group, 2-5 cm group, and > 5 cm group.RESULTSIn the 2-5 cm diameter group, the overall survival (OS) of MVI positive patients was significantly better than that of MVI negative patients (P = 0.031). For the MVI positive patients, there was a statistically significant difference between AR and NAR (P = 0.027). AR leads to a wider surgical margin than NAR (2.0 ± 2.3 cm vs 0.7 ± 0.5 cm, P < 0.001). In the groups with tumor diameters < 2 cm, both AR and NAR can obtain a wide surgical margin, and the surgical margins of AR are wider than that of NAR (3.5 ± 5.8 cm vs 1.6 ± 0.5 cm, P = 0.048). In the groups with tumor diameters > 5 cm, both AR and NAR fail to obtain wide surgical margin (0.6 ± 1.0 cm vs 0.7 ± 0.4 cm, P = 0.491). CONCLUSIONFor patients with a tumor diameter of 2-5 cm, AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin, reduce postoperative recurrence, and improve prognosis.

Comparison of single incision robot-assisted laparoscopic radical prostatectomy with and without extraperitoneal special channel device

Objective: To compare the clinical effects of single-incision robot-assisted laparoscopic radical prostatectomy (RARP) with and without extraperitoneal special channel device. Methods: The clinical data of 70 patients who had undergone RARP in the Robotic Minimally Invasive Surgery Center of Sichuan Provincial People's Hospital from September 2020 to February 2021 were analyzed retrospectively, including 29 cases who were operated on without special channel device (group A) and 41 cases with special channel device (group B). All operations were performed by robot-assisted single-incision retrograde bladder neck exfoliation via extraperitoneal approach in patients by the same operator. The operation time, intraoperative blood loss, the bladder neck urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, positive rate of incisal margin, indwelling time of urinary catheter, retention rate of postoperative erectile function, satisfaction rate of immediate postoperative urine control, positive rate of postoperative lymph node pathology, incision length, treatment cost and the rate of prostate specific antigen (PSA)lower than 0.2 μg/L at 6 weeks after operation were compared between the two groups. Results: All 70 cases were operated successfully. The difference of age[ (68.9±3.9) vs (69.4±5.4) years], preoperative PSA level[14.1(6.3, 19.8)vs13.7(5.8, 18.1)μg/L], prostate volume[44.8(30.7,172.6)vs 56.3(40.9,163.4)ml ] of the two groups was not statistically significant(all P>0.05). The difference of operation time [ (59.1±18.5) vs (59.6±18.0) min ], intraoperative blood loss [93(66,198)vs 95(68,203) ml ], bladder neck urethral anastomosis time [ (12.6±1.3) vs (13.7±2.8) min ], postoperative hospital stay [ (8.1±2.3) vs (9.1±1.3) d], postoperative exhaust time [ (1.4±0.6) vs (1.3±0.6) d], positive rate of incisal margin (20.7% vs 19.5%), indwelling time of the urinary catheter after operation [ (6.8±1.5) vs (7.1±2.0) d ], the retention rate of postoperative erectile function (31.0% vs 27.0%), the satisfaction rate of immediate postoperative urine control (79.3% vs 75.6%), the positive rate of postoperative lymph node pathology (17.2% vs 14.6%), the length of incision [ (5.1±0.5) vs (6.1±0.4) cm ], the rate of PSA lower than 0.2 μg/L at 6 weeks after operation (86.2% vs 83.0%) of the two groups was not statistically significant(all P>0.05). The operation cost of group A[(62 000±4 000) yuan]was lower than group B[(68 000±4 000) yuan] (P<0.05). Conclusion: Extraperitoneal non-special channel device single-incision RARP is safe and feasible.