Favorable Long-term Outcome Research Articles

Complication rates of guided bone regeneration using titanium-reinforced PTFE membranes: a retrospective analysis.

This study analyzed complication rates of guided bone regeneration (GBR) using titanium-reinforced polytetrafluoroethylene (PTFE) membranes for alveolar ridge augmentation. 84 patients treated with GBR using titanium-reinforced PTFE membranes (91 sites) were retrospectively analyzed. Complications such as membrane exposure and early removal were analyzed concerning patient age, defect site position, size, simultaneous vs. two-stage implant placement, smoking, and the use of bone grafts (BG) and substitutes (BS). Early removal due to membrane exposure was necessary in 14/91 sites (15.4%). No correlation was found between early removal and patient age (p = 0.917). Analyzing early removal between the upper and lower jaw and between both jaws' anterior and posterior tooth regions revealed no correlations (p = 0.381 and 0.477, respectively). Defect sites sizes of 5-6mm exhibited the highest rate of membrane exposure, requiring early removal, accounting for 57.1% of these sites (8/14). No correlation was observed between the defect sites size and early removal (p = 0.660). Comparison of simultaneous (74 sites) vs. two-stage implant placement (16 sites) showed no correlation with early removal (p = 0.706). Membrane exposure incidence was 42.9% among smokers (27 patients, 32.1%) and 57.1% among non-smokers (57 patients, 67.9%), without correlation. No correlation was found between the type of BG and BS and early removal (p = 0.500). GBR using titanium-reinforced PTFE membranes is effective for alveolar ridge augmentation and has favorable long-term outcomes. Careful surgical technique and postoperative care can minimize the notable risk of PTFE membrane exposure.

Cancer chemotherapy in pregnancy and adverse pediatric outcomes: a population-based cohort study.

Administration of chemotherapy during pregnancy is often delayed, while preterm delivery is common. If in utero exposure to chemotherapy is associated with adverse pediatric outcomes, it is unknown whether that relationship is directly attributable to the chemotherapy or is mediated by preterm birth. Cases were identified from Canadian cancer registries and administrative data in Alberta, British Columbia, and Ontario, 2003-2017, with follow-up until 2018. The primary exposure was receipt of chemotherapy during pregnancy. Severe neonatal morbidity and mortality (SNM-M), neurodevelopmental disorders and disabilities (NDDs) and pediatric complex chronic conditions (PCCC) reflected short- and long-term pediatric outcomes. Modified Poisson and Cox proportional hazard regression models generated adjusted risk ratios (RR) and hazard ratios (HR), respectively. The influence of preterm birth on the association between exposure to chemotherapy in pregnancy and each study outcome was explored using mediation analysis. Of the 1150 incident cases of cancer during pregnancy, 142 (12.3%) received chemotherapy during pregnancy. Exposure to chemotherapy in pregnancy was associated with a higher risk of SNM-M (RR 1.67, 95% CI: 1.13-2.46), but not NDD (HR 0.93, 95% CI: 0.71-1.22) or PCCC (HR 0.96, 95% CI: 0.80-1.16). Preterm birth <34 and <37 weeks mediated 75.8% and 100% of the observed association between chemotherapy and SNM-M, respectively. Most children born to people with cancer during pregnancy appear to have favourable long-term outcomes, even following exposure to chemotherapy in pregnancy. However, preterm birth is quite common, and may contribute to increased rates of adverse neonatal outcomes.

Beating the clock: the impact of heart failure duration on CRT efficacy

Abstract Background Cardiac Resynchronization Therapy (CRT) stands as an established intervention for selected patients with heart failure (HF) presenting with a wide QRS complex. The optimal timing for CRT implantation remains uncertain. Current evidence suggests superior outcomes post-CRT in patients who have not been previously hospitalised for HF and those receiving the implant during their initial hospitalisation for HF.1 Purpose The primary objective of this study is to investigate the long-term clinical outcomes following CRT implantation relative to the duration of HF previous to the implant. It was analysed in a cohort of consecutive patients from a HF Unit who met the criteria for CRT as recommended by the ESC guidelines (QRS duration ≥150ms, left bundle branch block morphology, and left ventricular ejection fraction (LVEF) ≤35% despite optimal medical therapy). Methods We evaluated all patients who received CRT from January 2011 through September 2022. Follow-up ended in September 2023. Patients with CRT indicated for ventricular pacing due to high-degree atrioventricular block were excluded. Patients were categorized into two groups based on the duration of HF progression prior to CRT implantation: more than 3 years and 3 years or less. The primary outcome was all-cause mortality (ACM). Secondary outcomes included a composite of ACM and HF hospitalisation and the proportion of patients who demonstrated a significant improvement in LVEF (defined as an increase of ≥10% from baseline and a subsequent measurement of LVEF ≥40%). Results The cohort consisted of 127 patients, mean age 65.8±10.7 years, 23.6% were women, mean LVEF was 28.4±8.6% and 36.2% had ischaemic aetiology (Table 1). 62 patients either died or were hospitalized for HF. Mean follow-up was 4.9±2.7 years. After adjusting for age, sex and baseline LVEF, patients with HF for more than three years before CRT implantation had a worse prognosis: HRs of 2.31 for ACM (p=0.016) and 2.13 for the combined endpoint of ACM+HFH (p=0.010) (Figure 1). The proportion of patients with improved LVEF after CRT was significantly higher in the group with shorter HF duration (68.25%) compared to the group with longer HF duration (25%), p &amp;lt;0.001. Conclusions Our findings reveal that patients with a shorter history of HF (less than three years) prior to CRT implantation exhibit significantly better clinical outcomes. These results highlight the role of early intervention with CRT in patients with HF, suggesting that shorter HF duration prior to CRT may lead to more favourable long-term outcomes.

Triggers of type 2 myocardial infarction: implications for long-term prognosis

Abstract Background Type 2 myocardial infarction (T2MI) is characterized by a mismatch between myocardial oxygen supply and demand, unrelated to acute coronary thrombosis. This discrepancy arises from triggers, which may or may not be of cardiac origin. Common cardiac triggers include coronary artery spasm, coronary embolism, and arrhythmias, whereas non-cardiac triggers encompass factors such as anemia, hypertension/hypotension, sepsis, renal damage, and respiratory failure. However, identifying these triggers isn't always straightforward. Aim Our study aimed to identify, whenever possible, the triggers contributing to the oxygen supply-demand mismatch in T2MI cases, as defined by the Fourth Universal Definition of Myocardial Infarction. Additionally, we sought to explore the correlation between these triggers and patient prognosis. Methods We enrolled all consecutive patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) who met the criteria for T2MI and underwent coronary angiography within 72 hours of diagnosis. Patients were categorized into three groups based on the trigger causing T2MI: cardiac, non-cardiac, and unidentified. The primary endpoint was the occurrence of major adverse cardiovascular events (MACEs), including all-cause mortality, new myocardial infarction, hospitalization for heart failure, and ischemic stroke, during long-term follow-up. We estimated MACE-free survival using Kaplan-Meier curves and compared it among the three groups using the log-rank test. Multivariable logistic regression analysis was performed to identify independent predictors of MACE. Results The final cohort comprised 598 T2MI patients, with 308 having a cardiac trigger, 147 having a non-cardiac trigger, and 143 with an unidentified trigger. The mean age of the overall population was 69.6±13.1 years, with a median follow-up time of 25 (13-49) months. Kaplan-Meier curves demonstrated statistically significant differences in MACEs based on the trigger causing T2MI (p&amp;lt;0.001). Specifically, patients with an unidentified trigger exhibited a better prognosis, while those with a non-cardiac trigger had a worse prognosis during long-term follow-up. Multivariable logistic regression analysis confirmed that not having an identified trigger is an independent protective factor for MACEs (HR 0.63, 95% CI 0.45-0.89, p=0.009, unidentified trigger vs cardiac + non-cardiac trigger). Conclusions T2MI is prevalent in clinical practice, yet reliable outcome predictors remain elusive. Our findings indicate a relationship between the type of trigger precipitating T2MI and patient prognosis, notably demonstrating that the absence of a specific identifiable trigger is linked to a more favorable long-term outcome. Further studies are needed to better define the prognostic stratification of these patients.MACE-free survival Kaplan Meier

The long-term clinical benefit of early versus delayed invasive strategies in elderly patients with non-ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention

Abstract Background The data regarding long-term outcomes of early versus delayed invasive strategies in elderly patients who have undergone percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction (NSTEMI) is limited. Purpose We aimed to investigate the long-term clinical benefit of early versus delayed invasive strategies in elderly patients who underwent PCI for NSTEMI. Methods From a nationwide, prospective, real-world registry of 13,104 patients with acute myocardial infarction (MI) who underwent PCI, 2818 elderly patients (aged ≥70 years) who underwent PCI for NSTEMI were included. Of these, 2299 patients were treated with an early invasive strategy (early invasive group), and 519 were treated later (delayed invasive group). The incidence of major adverse cardiac events (MACE; all-cause death, recurrent MI, any revascularization, stroke, readmission due to heart failure [HF], or definite/probable stent thrombosis [ST]) and the components of MACE were compared using multivariable Cox regression, propensity score (PS) matched, and PS-adjusted analyses. Results During a median follow-up of 1047 days, MACE, all-cause death, and cardiac death occurred in 1018 (36.1%), 660 (23.4%), and 423 patients (15.0%), respectively. The early invasive group showed significantly lower risks of MACE (entire: 35.0% vs. 41.2%, hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66-0.90, p=0.001; PS-matched: n=984, 33.3% vs. 40.8%, HR 0.75, 95% CI 0.62-0.91, p=0.005), all-cause death (entire: 22.5% vs. 27.4%, HR 0.76, 95% CI 0.63-0.92, p=0.004; PS-matched: 21.8% vs. 27.2%, HR 0.75, 95% CI 0.58-0.90, p=0.005), cardiac death (entire: 13.8% vs. 20.2%, HR 0.64, 95% CI 0.51-0.79, p&amp;lt;0.001; PS-matched: 13.1% vs. 19.4%, HR 0.67, 95% CI 0.55-0.86, p=0.011), and readmission due to HF (entire: 6.5% vs. 9.2%, HR 0.64, 95% CI 0.46-0.89, p=0.007; PS-matched: 6.7% vs. 9.4%, HR 0.68, 95% CI 0.51-0.96, p=0.017) than the delayed invasive group. There were no significant differences in the risks of recurrent MI, any revascularization, stroke, and definite/probable ST between the groups. Furthermore, in patients aged ≥80 years, the early invasive group had significantly reduced rates of MACE (42.9% vs. 49.5%, HR 0.71, 95% CI 0.55-0.91, p=0.039), all-cause death (31.7% vs. 39.0%, HR 0.71, 95% CI 0.55-0.92, p=0.010), and cardiac death (20.9% vs. 31.0%, HR 0.59, 95% CI 0.44-0.80, p=0.001) compared to the delayed invasive group. Conclusions In elderly patients with NSTEMI, an early invasive intervention strategy was associated with favorable long-term clinical outcomes compared to a delayed invasive intervention strategy.

Long-term outcomes in women with a history of peripartum cardiomyopathy

Abstract Background Peripartum cardiomyopathy (PPCM) remains an important cause of cardiac-related maternal morbidity and mortality in previously healthy young women. Data on the long-term clinical course of PPCM are sparse. In this study, we report the long-term outcomes in patients with PPCM. Methods and Results Long-term follow-up (median 9.6, min 5, and max 24 years) was available in 72 women with PPCM followed in a cardio-obstetrics clinic. Five-year follow-up data were available for 19 PPCM patients, 10-year follow-up data for 24 PPCM patients, and more than 15 years of follow-up data for 24 PPCM patients. Seven patients were lost to cardiac follow-up but are known to be alive. The mean age at diagnosis was 35 ± 7 years, and 85% were Caucasian. The mean parity was 2.2 ± 1.3, and gravidity was 2.7 ± 1.7. Twin pregnancies were reported in 13% of cases. Pre-eclampsia was present in 25% of the patients and the development of hypertension in the long-term was documented in 18%. The mean LVEF was 34.5 ± 9.9% at diagnosis. One-year LVEF data were available in 72 patients: 54 patients (75%) experienced LV recovery (LVEF≥ 50%). After 1 year, the mean LVEF was 53.4± 8.2%. Among patients remained with LV&amp;lt;50% at one year (n=10) no LV function recovery was reported at long-term follow-up. At a median follow-up of 9.6 years (n=66) mean LVEF was 52.1±10.4%, nine patients had a reduction in LVEF (&amp;lt;50%) function in the long-term follow-up with a mean LVEF of 46.1± 2.1%. Out of 72 PPCM patients, 3 patients developed arrhythmia, in one woman coronary artery disease occurred and 7 underwent pacemaker implantation. Almost half of patients (n=65) remained with long term treatment of b-blockers, 38% received medications for hypertension or heart failure. No cases of myocardial infarctions, cardiovascular death, or heart transplantations were reported. Two women died during follow-up: one with normal LVEF died from breast cancer, and another patient with reduced LVEF and severe diabetes. The cause of her death remained unclear. During follow-up, 30 women had ≥ 1 subsequent pregnancy (SSP), and there was no reduction in their mean LVEF before SSP 57.0 ± 5.4% and at long-term follow-up was 59.6± 1.3% (p=ns). Conclusion Our study demonstrates favorable long-term outcomes with high and stable recovery rates with low mortality rates, and no impact of subsequent pregnancies on the clinical course of the condition. Nevertheless, persisting or new diagnosis of hypertension and use of cardiovascular medications were noted in the long term follow up.

The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study.

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

PROVISIONAL STENTING IN LEFT MAIN STEM DISEASE: LONG-TERM OUTCOMES AND IMPACT ON SIDE BRANCH PERFUSION

Left main stem disease (LMSD) is a severe form of coronary artery disease (CAD) that involves a significant risk of mortality if not treated effectively. Traditionally, coronary artery bypass grafting (CABG) has been the primary method for revascularization in LMSD. However, percutaneous coronary intervention (PCI), especially provisional stenting using drug-eluting stents (DES), has gained popularity for its minimal invasiveness and comparable clinical outcomes. Provisional stenting allows treatment of the main vessel with additional side branch stenting only when needed, reducing complications and stent usage. Objective: The primary objective of this study is to evaluate the long-term outcomes of provisional stenting in patients with LMSD, focusing on its impact on side branch perfusion, in-stent restenosis (ISR), and major adverse cardiac events (MACE). Methods: This retrospective cohort study was conducted at a tertiary care hospital specializing in cardiology between January 2023 and December 2023. A total of 284 patients who underwent provisional stenting for LMSD were included. Fractional flow reserve (FFR) and quantitative coronary angiography (QCA) were used to assess side branch perfusion, with follow-up data including clinical outcomes such as ISR, MACE, and survival rates. Multivariate regression analysis was used to identify predictors of poor outcomes, and Kaplan-Meier survival curves were generated to compare outcomes based on side branch perfusion status. Results: The study found that 77.5% of patients achieved adequate side branch perfusion (FFR &gt; 0.80) after provisional stenting, while 22.5% had impaired perfusion (FFR ≤ 0.80). The incidence of MACE was 10.6%, and ISR was reported in 7.0% of patients during the one-year follow-up period. Kaplan-Meier analysis showed a significant survival benefit for patients with adequate side branch perfusion (Log-Rank p &lt; 0.001). Age and diabetes mellitus were significant predictors of MACE. Conclusion: Provisional stenting in LMSD provides favourable long-term outcomes, particularly in terms of side branch perfusion and reduced MACE. However, a subset of patients, particularly those with diabetes, may require additional interventions. Future studies should focus on improving outcomes in patients with impaired side branch perfusion and exploring the role of advanced imaging techniques in optimizing stenting strategies.

Autologous Breast Reconstruction and Radiotherapy: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)

Autologous postmastectomy breast reconstruction is associated with favourable long-term clinical outcomes and superior patient-reported outcomes (PROMs) compared with implant-based reconstruction. However, adjuvant radiotherapy has traditionally been considered a relative contraindication to immediate flap-based reconstruction due to its unpredictable effects on the reconstructive outcome. While modern adjuvant postmastectomy radiotherapy (PMRT) has been able to significantly reduce acute and chronic radiation-induced complications, plastic surgeons still hesitate to offer immediate autologous reconstruction to patients expected to undergo adjuvant radiotherapy. More recently, evidence has emerged suggesting a paradigm shift in favour of immediate autologous reconstruction despite subsequent radiotherapy. At the 44th Annual Meeting of the German-speaking Society for Reconstructive Microsurgery (GSRM) in Bern, Switzerland, a workshop discussed the literature on PMRT and autologous breast reconstruction, aiming to establish consensus among the participants. Several areas of agreement were identified, including the goals of postmastectomy reconstruction, specifically the creation of a soft and sensitive breast symmetrical in shape and size to the unaffected breast via the safest procedure possible. The importance of preserving the maximum amount of native breast skin envelope through skin- and nipple-sparing approaches was emphasised. Finally, a consensus was reached that PMRT should no longer be considered a contraindication to immediate autologous breast reconstruction.

Long-term outcomes of mitral valve repair in children.

Mitral Valve Disease in children presents unique challenges due to the wide range of associated pathologies and the complexities of pediatric cardiac anatomy. Mitral valve repair in this demographic is preferred over replacement due to the drawbacks associated with prosthetic valves in young patients, such as the need for long-term anticoagulation and issues with prosthetic size and growth. This retrospective study reviewed pediatric patients under 18 years who underwent mitral valve repair between January 2002 and December 2023. Exclusion criteria included patients with atrioventricular septal defects or single-ventricle physiology. Surgical outcomes were assessed using preoperative and postoperative transthoracic echocardiography, with follow-up data analyzed via Kaplan-Meier survival estimates. The study included 47 patients with a median age of 4 years. Surgical techniques varied based on the specific mitral valve pathology. The overall early mortality was 6.3%, and the one and ten-year survival rates were 93.6 ± 3.6% and 91.4 ± 4.1%, respectively. Most patients showed improved or stable postoperative cardiac function during a median follow-up of 105 months. Notably, the rate of freedom from re-operation at ten years was 85.1 ± 6.9%, highlighting the durability of the surgical interventions. Mitral valve repair in children demonstrates favorable long-term outcomes with low mortality and reoperation rates, particularly when performed at an older age to accommodate growth and avoid the complexities of smaller, more delicate cardiac structures. These findings suggest that mitral valve repair should be considered a viable and effective option for managing pediatric MVD, with a personalized approach essential for optimizing outcomes.

Current Status and Prospects of Robotic Pancreatic Surgery

Introduction Over the past two decades, the application of robotic surgery (RS) in pancreatic surgery has steadily increased. RS offers advantages such as reduced blood loss, less postoperative pain, and shorter hospital stays. However, there is still no consensus on its safety, efficacy, and learning curve in pancreatic diseases. This study aims to summarize the current state of RS in pancreatic surgery and to forecast its prospects. Method A literature search was conducted in PubMed using keywords including “robotic surgery”, “pancreatic surgery”, “minimally invasive surgery”, “open surgery” and “laparoscopic surgery”. Studies on robotic surgery in pancreatic surgery were collected, including research comparing robotic surgery with open or laparoscopic surgery. Results RS has been applied to various pancreatic surgeries, demonstrating good safety and feasibility. Compared to open or laparoscopic surgery, robotic pancreatic surgery (RPS) shows favorable short-term outcomes such as reduced blood loss, shorter hospital stays, and lower conversion rates, especially in surgeries with narrow operative spaces or complex anatomical structures. No significant differences were reported in postoperative complications or short-term mortality rates. RPS achieves comparable R0 resection rates, lymph node harvest numbers, and long-term outcomes. However, RPS also presents limitations, including a long learning curve, high surgical costs, a lack of dedicated instruments, and the absence of natural tactile feedback. Conclusion Robotic pancreatic surgery demonstrates favorable short-term and long-term outcomes, showing promising potential for application. Further multi-center randomized controlled trials are needed to determine its safety and efficacy conclusively.

Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip.

Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface. The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58years, were operated on during this period. Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported. The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Impairment of perioperative activities of daily living is associated with poor prognosis following pancreatectomy for pancreatic cancer.

It has reported that the prevalence of frailty in patients with pancreatic cancer is 45%. The number of patients with pancreatic cancer is increasing, and within this cohort, patients often suffer from impaired activities of daily living (ADLs). This study aimed to examine the association between perioperative Barthel Index (BI) scores, a validated measure of ADLs, and survival outcomes after pancreatectomy for pancreatic cancer. We analyzed the data of 201 patients who underwent pancreatectomy for pancreatic cancer between 2010 and 2020. Preoperative and postoperative ADLs were assessed using the BI (range: 0-100; higher scores indicated greater independence). A preoperative or postoperative BI score ≤ 85 was defined as an impairment of perioperative ADLs. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) after adjusting for potential confounders. Among the 201 patients, 14 (7.0%) had a preoperative BI score ≤ 85 and 50 (25%) had a postoperative BI score ≤ 85. Impairment of perioperative ADLs was independently associated with shorter overall survival (multivariable HR: 2.66, 95% confidence interval [95%CI]: 1.75-4.03, P < 0.001), cancer-specific survival (multivariable HR: 2.64, 95%CI: 1.15-4.25, P < 0.001), and recurrence-free survival (multivariable HR: 1.94, 95%CI: 1.08-3.50, P = 0.021). Impairment of perioperative ADLs is associated with poor prognosis following pancreatectomy for pancreatic cancer. The maintenance and improvement of perioperative ADLs could play an important role in providing favorable long-term outcomes in patients with pancreatic cancer.

Paediatric donor lung preservation using Paragonix BAROguard.

Paediatric lung transplantation is a lifesaving option in selected patients with end-stage lung disease. Favourable long-term outcomes are limited by impaired mucus clearance, increased risk of infection resulting from immunosuppression, and chronic lung allograft dysfunction. Organ preservation techniques play an important role in the quality of donated organs. Barotrauma to donated lungs may arise from a combination of excessive recruitment manoeuvres and altitude change during air transportation. The Paragonix BAROguard Donor Lung Preservation System is an FDA-approved advanced organ recovery system that maintains continuous airway pressure of 15 cm of water during transportation of the donated lung(s) to the recipient. The Paragonix LUNGguard monitors temperature during transportation of donor lung(s), while the new BAROguard monitors both temperature and pressure during transportation of donor lung(s). In this publication, we present technical aspects of advanced preservation of paediatric donor lungs using the Paragonix BAROguard Donor Lung Preservation System.

Long-Term Outcomes and Risk Factors for Lymph Node Metastasis in Siewert Type II/III Early Gastric Cancer

Objectives: The incidence of adenocarcinomas of the esophagogastric junction (EGJ) and cardia has been gradually increasing in the East. Cancers of the EGJ and gastric cardia have poor prognoses. This study aimed to investigate lymph node metastasis (LNM) rates, their predictive factors, and determine the long-term outcomes of patients with Siewert type II/III early gastric cancer (EGC).Methods: Between January 2014 and June 2022, a total of 573 patients with gastric cancer, including 130 with Siewert type II/III EGC, underwent total gastrectomies at the Kosin University Gospel Hospital. Factors associated with LNM were analyzed using a logistic regression model.Results: Of the 130 patients with Siewert type II/III EGC, 10 (7.7%) demonstrated LNM (LNM-positive group). Macroscopically elevated lesions (I+IIa) (60.0% vs. 16.7%; &lt;i&gt;p&lt;/i&gt;=0.009) and lymphovascular invasion (70.0% vs. 5.8%; &lt;i&gt;p&lt;/i&gt;&lt;0.001) were more common and the depth of invasion was deeper (&lt;i&gt;p&lt;/i&gt;=0.003) in the LNM-positive patients than in the LNMnegative group. Multivariate analysis showed that macroscopically elevated lesions (odds ratio [OR], 19.48; 95% confidence interval [CI], 1.93–197.11; &lt;i&gt;p&lt;/i&gt;=0.012) and lymphovascular invasion (OR, 52.63; 95% CI, 5.26–526.51; &lt;i&gt;p&lt;/i&gt;=0.001) were associated with LNM. Kaplan–Meier analysis revealed that the 5-year overall and disease-specific survival rates of patients with Siewert type II/III EGC were 90.0% and 98.9%, respectively. During a median follow-up period of 49 months (range, 12–122 months), one patient (0.8%) died owing to gastric cancer recurrence.Conclusions: Patients with Siewert type II/III EGC showed favorable long-term outcomes. Macroscopically elevated lesions and lymphovascular invasion are associated with LNM.

Enhancing smile in class II division 2 malocclusion using utility arch – A Case report

Class II Division 2 malocclusion is a dental condition characterized by retroclined maxillary central incisors, often accompanied by a deep bite and a Class II skeletal relationship. The utility arch, an orthodontic appliance designed to exert controlled forces on the dentition, offers a promising approach for correcting this type of malocclusion. By making strategic adjustments, such as a V bend in the vestibular bridge, the utility arch can be effectively used to procline incisors. This case report details the application of a utility arch in treating a growing patient with Class II Division 2 malocclusion. The treatment plan aimed to leverage the patient's growth period to enhance the stability of the correction, ensuring a favorable long-term outcome.

Apert syndrome and obstructive sleep apnea: Timing for midface surgery

ABSTRACT Objective This study aims to determine the optimal timing for midface surgery in patients with Apert syndrome and Obstructive Sleep Apnea (OSA). Methods We reviewed relevant articles from Web of Science and PubMed and conducted a bibliometric analysis. Results A review of 74 documents published between 1981 and 2023 revealed that determining the optimal timing for surgery in cases of airway obstruction necessitates consideration of various factors, including the location and severity of airway abnormalities, craniofacial development, potential impact of treatment on future growth, psychological considerations, and overall physiological conditions. Although midface advancement surgery performed around ages 6 to 7 typically yields symptom relief and favorable long-term outcomes, the ideal surgical timing young children with severe OSA remains a contentious issue. Conclusion While midface surgery is frequently advocated at ages 6 to 7, there is an urgent need for enhanced cooperation and high-quality research to deepen our understanding.

Hepatic artery restriction operation combined with ALPPS (HARO-ALPPS), a novel ALPPS procedure for the treatment of hepatocellular carcinoma with severe fibrosis: retrospective clinical cohort study.

Associating liver partition with portal vein ligation for staged liver resection (ALPPS) has been used in the treatment of patients with advanced or massive liver cancer without sufficient future liver remnant, but concerns remain regarding tumor outcomes and surgical safety. This study aims to evaluate the efficacy and safety of a new procedure, hepatic artery restriction operation combined with ALPPS (HARO-ALPPS), in the treatment of hepatocellular carcinoma (HCC) patients especially with severe fibrosis. This retrospective study analyzed 8 patients who underwent HARO-ALPPS for HCC and compared their outcomes with 64 patients who underwent conventional ALPPS. The primary outcomes assessed were liver regeneration ability (measured by relative and absolute kinetic growth rates), postoperative complications, and mortality. The secondary outcomes included overall survival and disease-free survival. HARO-ALPPS significantly restricted the blood supply of the hepatic artery. One week after surgery, the blood flow of the right hepatic artery dropped to 62.1%. At the same time, HARO-ALPPS shows superior liver regeneration ability, which is particularly prominent in the background of liver fibrosis. No serious complications occurred after HARO-ALPPS. The overall survival rate of HARO-ALPPS was 75%, which was higher than that of ALPPS (64%, P =0.816). Compared to conventional ALPPS, HARO-ALPPS exhibits a better liver regeneration ability, and favorable long-term outcomes. Further prospective studies are needed to validate these findings and evaluate the long-term oncologic outcomes of this novel procedure.

Long-Term Results of Meniscus Allograft Transplantation With Bone Fixation Show Improved Outcomes but Progression of Joint Space Narrowing, Osteoarthritis, and Cartilage Degeneration

PurposeTo investigate the clinical and objective outcomes of meniscal allograft transplantation (MAT) using bone fixation in patients after a minimum follow-up duration of 15 years, and to compare the demographic factors and allograft status between patients who experienced progression of osteoarthritis and those who did not. MethodsThe consecutive patients who underwent primary MAT between December 1996 and January 2008 were retrospectively reviewed. The inclusion criteria was primary MAT with a minimum follow-up duration of 15 years. Clinical outcomes were evaluated using the modified Lysholm score, along with an evaluation of clinical failure. In objective outcomes, the progression of joint space narrowing, osteoarthritis, and the status of the associated cartilages and allografts were evaluated with follow-up radiographs and MRI. ResultsAmong the 79 cases, 54 knees in 52 patients were included in the study and evaluated for clinical outcomes. The mean Lysholm score improved from 73.9 ± 17.5 preoperatively to 86.4 ± 15.6 over a mean follow-up period of 17.5 ± 3.8 years (P<0.001). Regarding the Minimal clinically important differences (MCID), 38 cases (70.4%) showed an improvement in the Lysholm score. The cumulative clinical survival rate was 87.0%. Objective evaluations evaluated in 32 cases with a minimum of 15 years of radiographic data revealed significant progression of joint space narrowing, osteoarthritis, and cartilage degeneration at the final follow-up, with 11 (34.4%) out of 32 cases exhibiting allograft tears involving ˃50% of the allograft. Patients with osteoarthritis progression exhibited more meniscal allograft tears and extrusion on the last follow-up MRI scan than those without progression. ConclusionNotable progression in joint space narrowing, osteoarthritis, and cartilage degeneration were observed in objective assessment. The progression of osteoarthritis might be associated with allograft tears and extrusion. In clinical evaluations, favorable long-term clinical outcomes were consistently demonstrated after MAT using the bone fixation technique. Level of EvidenceLevel Ⅳ, therapeutic case series.

225. LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED VERSUS CONVENTIONAL OPEN ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS

Abstract Background This study aimed to compare the long-term oncologic outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) with those of conventional open esophagectomy (OE) for esophageal cancer. Methods Between January 2006 and December 2021, 1,745 consecutive patients underwent esophagectomy for esophageal cancer at our institution. Among them, we retrieved 1,133 patients (mean age 63.1±7.8 years, 86 [7.6%] women, 1,100 [97.1%] squamous cell carcinomas), who were operated by a single surgeon. These patients were categorized into following two groups based on their surgical approaches: RAMIE (n = 497) and OE (n = 636). The RAMIE and OE groups were matched in a 1:1 ratio using propensity scores. Results Median follow-up was 51.8 months. Five-year overall survival (OS, 70.7% vs. 55.0%) and recurrence-free survival (RFS, 63.3% vs. 50.1%) rates were significantly higher in RAMIE than in OE group (P &amp;lt; 0.01). Following propensity-score matching, 886 patients (443 pairs) were successfully matched, demonstrating no significant intergroup differences. The RAMIE group consistently demonstrated enhanced OS (70.4% vs. 61.8%, P &amp;lt; 0.01) and RFS (62.8% vs. 55.8%, P=0.04) after five years, even after adjustment (Figure). The rate of noncancer mortality was significantly higher in the OE group (P &amp;lt; 0.01), whereas the esophageal cancer-related mortality showed no significant differences (P = 0.25). Conclusions RAMIE could be a safer and more feasible option for patients compared with conventional open esophagectomy with favorable long-term oncologic outcomes.