Postoperative Observation Research Articles

Association of Preoperative Copeptin Levels with Risk of All-Cause Mortality in a Prospective Cohort of Adult Cardiac Surgery Patients.

We aimed to investigate the association of preoperative copeptin, a new cardiovascular biomarker, with short- and long-term mortality in a cohort of adult patients undergoing cardiac surgery, including its potential as a prognostic marker for clinical outcome. Preoperative blood samples of the Bern Perioperative Biobank, a prospective cohort of adults undergoing cardiac surgery during 2019, were analyzed. The primary and secondary outcome measures were 30-day and 1-year all-cause mortality. Optimal copeptin thresholds were calculated with the Youden Index. Associations of copeptin levels with the two outcomes were examined with multivariable logistic regression models; their discriminatory capacity was assessed with the area under the receiver operating characteristic (AUROC). A total of 519 patients (78.4% male, median age 67 y (IQR: 60-73 y)) were included, with a median preoperative copeptin level of 7.6 pmol/L (IQR: 4.7-13.2 pmol/L). We identified an optimal threshold of 15.9 pmol/l (95%-CI: 7.7 to 46.5 pmol/L) for 30-day mortality and 15.9 pmol/L (95%-CI: 9.0 to 21.3 pmol/L) for 1-year all-cause mortality. Regression models featured an AUROC of 0.79 (95%-CI: 0.56 to 0.95) for adjusted log-transformed preoperative copeptin for 30-day mortality and an AUROC of 0.76 (95%-CI: 0.64 to 0.88) for 1-year mortality. In patients undergoing cardiac surgery, the baseline levels of copeptin emerged as a strong marker for 1-year all-cause death. Preoperative copeptin levels might possibly identify patients at risk for a complicated, long-term postoperative course, and therefore requiring a more rigorous postoperative observation and follow-up.

1231 Using Novel Technologies and Innovative Theatre Utilisation Procedures to More Than Triple Operating Theatre Output

Abstract Aim In the current climate of extended waiting lists and increasing demands on theatre time and personnel, efficiency gains are vital in shaping the future of surgical practice. We have utilised novel surgical technology to drive massive increases in throughput for one of the most commonly performed procedures worldwide (tonsillectomies). Method Use of the BiZactTM device, a vessel sealing bipolar instrument, has been shown in our trust and worldwide to be safe and offer greater efficiency. We combined this with a conveyor-belt style theatre arrangement - with a second team preparing and anaesthetising the following patient simultaneously, and changes to anaesthetic and post-op procedures to maximise productivity. Results Contrasting the GIRFT recommended 3 adult half day tonsillectomy list, we were able to safely perform 10 adult tonsillectomies in one session, with no change in expected post-operative complication rates. Average time recorded on the theatre system was 10m:00s per patient, with the average time-on-tonsil just 2m:59s. There was 1 patient who presented post-operatively with secondary haemorrhage that was managed conservatively. Conclusions The implementation of efficient technology, combined with innovative theatre procedural technique, short lasting anaesthetics and reduced post operative observation time allowed the half day list capacity to be increased by 333%. Complication rates in this case, and in our wider use of this technique (n=103), have been within normal range, whilst allowing greatly increased efficiency and rapid reduction of local waiting lists. Lessons learned from this conveyor-belt style practice have wide ranging potential applications across specialties that will drive efficient future practice.

Chinese expert consensus on radiofrequency therapy for gastroesophageal reflux disease 2024

ObjectiveRadiofrequency (RF) therapy is a minimally invasive procedure used to treat gastroesophageal reflux disease (GERD). During the procedure, electrodes are meticulously inserted into the lower esophageal sphincter and cardiac muscle through a gastroscope. By applying heat at various layers and sites around the gastroesophageal junction, the treatment intends to augment the junction's pressure and reduce tissue compliance. This process may also desensitize the esophagus, thereby preventing reflux and relieving symptoms. RF therapy boasts a high success rate and a low risk of adverse effects, making it an increasingly popular choice. However, there is a lack of consensus regarding its indications, contraindications, and the evaluation processes for pre- and postoperative care. To enhance the precision of patient selection and the technical execution of RF therapy, it is imperative to consolidate and standardize its clinical application in China. This will ensure the therapy's safety and efficacy are optimized. MethodsBetween December 2022 and April 2024, a group of 25 Chinese endoscopists, each with experience in over 50 radiotherapy procedures, engaged in six rounds of consensus discussions. The discussions focused on several key aspects of the procedure. During these discussions, each item was put to a vote among the experts. A consensus was reached when an item received agreement from at least 80 ​% of the participants. ResultsThe expert group, comprising 25 specialists from 22 different institutions, had an average experience of over 50 RF procedures. These experts engaged in comprehensive discussions on a total of eight critical items, covering the full spectrum of the procedure, including indications, contraindications, basic working conditions and preparation, preoperative preparation, surgical process and technical skills, postoperative management, therapeutic effects, complications and prevention. The group successfully reached a consensus on all these items, ensuring a standardized approach to RF procedures. ConclusionThis consensus summarized and standardized the clinical application of anti-reflux RF therapy in China. Adoption of this consensus will improve the precision of patient selection and technical implementation, thereby enhancing the safety and effectiveness of anti-reflux radiofrequency therapy.

Использование тулиевого лазера в лечении стриктуры уретры.

Introduction. The thulium laser is relatively recently used in the treatment of various urological diseases. Only a few studies report the use of thulium laser urethrotomy for urethral strictures. The purpose of this study was to evaluate the results of the use of a thulium laser for the treatment of urethral strictures. Materials and methods. A prospective, observational, uncontrolled study included 45 men with urethral stricture, aged 43 to 85 years (median, 65 years), who underwent thulium laser urethrotomy. The length of the stricture ranged from 0.5 to 2.5 cm (median 1.2 cm). A laser fiber with a length of 200 μm was used at an energy of 0.5 J and a power of 10 W. The success of the treatment was considered the absence of complaints of difficult urination in combination with a maximum urination rate of more than 15 ml/s and no or insignificant amount of residual urine (less than 50 ml). The dynamics of various parameters after surgery were assessed using the Wilcoxon test. The difference between the indicators was considered significant at p<0.05. Results. Postoperative follow-up time ranged from 3 to 48 months (median 18 months). With these follow-up periods, treatment was successful in 32 (71.1%) patients. A significant improvement in the median of the following indicators for the entire group of patients after surgical treatment com- pared with preoperative data was established: maximum urination rate – from 9.2 to 21.1 ml/s (p=0.024); average urination rate – from 4.5 to 10.3 ml/s (p=0.025); residual urine volume – from 110 to 42 ml from 9.2 to 21.1 ml/s (p=0.014); indicators of the IPSS questionnaire – from 20 to 7 points (p=0.011); quality of life according to the IPSS questionnaire – from 5 to 2 points (p=0.017). There were no intraoperative complications. Of the postoperative complications, only urinary tract infection was noted in 5 (11.1%) patients. Conclusions. Thulium laser urethrotomy is a fairly safe and effective method for the treatment of short urethral strictures, regardless of the nature, etiology and localization of the cicatricial process. A small number of observations and a short period of postoperative observations in the world literature dictate the need to continue such scientific research.

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

PurposeSASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period.MethodsThis study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022.ResultsThe mean age of the patients was 42 years (range 22–58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%).ConclusionSASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.

Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review.

Extracellular matrix cartilage allograft (EMCA) is a novel biological strategy utilized to augment the repair of osteochondral lesions of the talus (OLTs). However, there is no consensus on the precise role and outcomes following its use in the treatment of OLTs. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of EMCA for the treatment of OLT.During July 2023, the PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following EMCA for the management of OLTs.In total, 162 patients (162 ankles) across five studies received EMCA as part of their surgical procedure at a weighted mean follow-up time of 23.8±4.2 months. Across all five studies, there were improvements in subjective clinical outcomes following the use of EMCA, regardless of the clinical scoring tool utilized. Two studies demonstrated superior postoperative magnetic resonance observation of cartilage repair tissue (MOCART) scores in the EMCA cohort compared to the bone marrow stimulation (BMS) cohort alone.In the EMCA-BMS cohort, there were seven complications (9%) and three failures (4.1%). In the autologous osteochondral transplantation (AOT) cohort, there were 10 complications (38.5%), zero failures, and six secondary surgical procedures (23.1%). In the EMCA alone cohort, there were zero complications and three failures (4.3%), all of which underwent an unspecified revision procedure. This current systematic review demonstrated improvements in both clinical and radiological outcomes following the use of EMCA for the treatment of OLTs.Further prospective comparative studies with longer follow-up times are warranted to determine the precise role of EMCA in the management of OLT.

EMERGENCY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIOPLASTY FOR GARANGEOT'S HERNIA: A CASE REPORT

Abstract Aims This video presentation aims to demonstrate the successful management of a rare and challenging case of Garangeot's hernia through Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty. The primary objectives include highlighting the surgical technique, intraoperative findings, and postoperative outcomes in the context of this uncommon hernia presentation. Materials and Methods An 84-year-old female presented to the emergency department with signs of femoral hernia incarceration. Upon exploration, a Garangeot's hernia, characterized by the presence of the appendix within a femoral hernia sac, was identified. In light of the emergency and the patient's deteriorating condition, an Emergency Laparoscopic TAPP Hernioplasty was performed. The procedure involved meticulous dissection of the hernia sac, reduction of the herniated appendix and appendectomy, and subsequent mesh reinforcement of the femoral defect. Results The video illustrates the step-by-step approach to Emergency Laparoscopic TAPP Hernioplasty in the context of Garangeot's hernia. Intraoperative findings, including the condition of the herniated appendix and associated anatomical structures, are presented. Postoperative outcomes, including recovery, complications, and follow-up observations, are discussed to provide a comprehensive understanding of the case. Conclusions Emergency Laparoscopic TAPP Hernioplasty emerges as a viable and effective intervention for Garangeot's hernia, offering advantages such as reduced morbidity, quicker recovery, and minimal surgical trauma. This video contributes valuable insights into the management of this rare hernia presentation, emphasizing the role of minimally invasive techniques in achieving successful outcomes.

Microscopic internal spermatic-inferior epigastric vein anastomosis for treating left varicocele.

To evaluate the clinical efficacy of microscopic internal spermatic-inferior epigastric vein anastomosis in the treatment of left varicocele and compare it with microscopic spermatic vein ligation for the same condition. A retrospective analysis of 74 patients with left varicocele between July 2020 and July 2022 was performed. The patients were divided into two groups based on the surgical method used. Group A consisted of 37 patients who underwent microscopic internal spermatic-inferior epigastric vein anastomosis, while Group B consisted of 37 patients who underwent microscopic spermatic vein ligation. Comparison of preoperative and postoperative semen quality, reproductive hormone levels, scrotal ultrasound results, duration of surgery, length of hospital stay, postoperative recurrence rate, and occurrence of complications with a follow-up time of 12 mo between two groups. Both groups showed significant improvements in semen quality and serum reproductive hormone levels. The Group A demonstrated significantly improved sperm forward motility compared to Group B, but had longer operation times and hospital stays (P < 0.05). After 1 year of follow-up, 8 partners in Group A and 6 partners in Group B achieved natural conception, with no significant difference between the two groups. There were no recurrences observed in either group during the follow-up period, and no significant statistical differences were found in other postoperative observation indicators. Both microscopic internal spermatic-inferior epigastric vein anastomosis and microscopic spermatic vein ligation are effective surgical methods for treating left varicocele. Anastomosis surgery provides greater improvement in sperm motility, although it is associated with longer operation times and hospital stays.

The severity of lower urinary tract symptoms during the postoperative period as a factor in choosing an approach to surgical treatment for large prostate hyperplasia: holmium enucleation of the prostate (HoLEP) vs laparoscopic simple prostatectomy

Introduction. Analysis of complications after transurethral surgery for benign prostate hyperplasia (BPH) demonstrates that 20 – 30% of patients require prolonged postoperative treatment for severe lower urinary tract symptoms (LUTS) despite improvements in technology and surgical techniques. These complications play a significant role in reducing the quality of life of patients in the postoperative period. Severe storage symptoms and urgent urinary incontinence represent significant challenges in the postoperative phase when performing laser enucleation surgery. There are also limits to standard approaches to perform laparoscopic prostatectomy, which requires the development of improved techniques.Objective. To conduct a comparative assessment of the postoperative dynamics of LUTS in groups undergoing holmium laser enucleation of the prostate (HoLEP), a standard Millin laparoscopic simple prostatectomy (LSP), and a modified LSP.Materials &amp; Methods. This multicenter study included 439 patients who were randomly assigned to 3 groups depending on the surgical treatment technique used for bladder outlet obstruction associated with large-volume BPH: the HoLEP group (n = 151), the standard Millin LSP (n = 142) and the modified LSP, combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis (n = 146). The main criterion assessed during six-months follow-up was the severity of LUTS on the IPSS scale (obstructive and irritative components). Complications that developed during the postoperative observation period were recorded.Results. A lower severity of LUTS was revealed in the group of the modified LSP compared to the standard LSP and HoLEP (p = 0.041 and p = 0.001, respectively). The average irritative component of IPSS was significantly lower in the modified LSP group compared to the standard LSP and HoLEP (p = 0.032 and p = 0.001, respectively). The observed trend continued to the third month after surgery. Comparison of changes in symptom severity six months after surgery demonstrated a significant advantage for the modified LSP both compared to HoLEP (p = 0.017) and a standard LSP (p = 0.032). All three groups showed comparable significant improvements in quality of life.Conclusion. The severity of postoperative storage symptoms is a limitation of HoLEP use, whereas the standard LSP is associated with lower severity of LUTS. The authors' modification of the LSP has the potential to reduce the severity of storage symptoms in patients for up to three months after surgery, and is associated with a low rate of urge incontinence.

Feasibility of Direct Vitrectomy-Sparing Subretinal Injection for Gene Delivery in Large Animals

Purpose To assess the safety and feasibility of direct vitrectomy-sparing subretinal injection for gene delivery in a large animal model. Methods The experimental Liběchov minipigs were used for subretinal delivery of a plasmid DNA vector (pS/MAR-CMV-copGFP) with cytomegalovirus (CMV) promoter, green fluorescent protein (GFP) reporter (copGFP) and a scaffold/matrix attachment region (S/MAR) sequence. The eyes were randomized to subretinal injection of the vector following pars plana vitrectomy (control group) or a direct injection without prior vitrectomy surgery (experimental group). Intra- and post-operative observations up to 30 days after surgery were compared. Results Six eyes of three mini-pigs underwent surgery for delivery into the subretinal space. Two eyes in the control group were operated with a classical approach (lens-sparing vitrectomy and posterior hyaloid detachment). The other four eyes in the experimental group were injected directly with a subretinal cannula without vitrectomy surgery. No adverse events, such as endophthalmitis, retinal detachment and intraocular pressure elevation were observed post-operatively. The eyes in the experimental group had both shorter surgical time and recovery while achieving the same surgical goal. Conclusions This pilot study demonstrates that successful subretinal delivery of gene therapy vectors is achievable using a direct injection without prior vitrectomy surgery.

COMPARISON OF POSTOPERATIVE QUALITY OF LIFE AND UTILITY VALUES FOLLOWING TOTAL HIP ARTHROPLASTY AND BIPOLAR HEMIARTHROPLASTY FOR OSTEONECROSIS OF THE FEMORAL HEAD

Purpose: The appropriate surgical procedure for Stage 3 osteonecrosis of the femoral head (ONFH) remains controversial. This study aimed to evaluate and compare postoperative quality of life (QOL) in patients who underwent total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) for ONFH based on comprehensive and disease-specific scales using patient-directed questionnaires. Methods: We included 54 of 66 patients who underwent artificial joint replacement for ONFH more than 1 year ago at our hospital between April 2013 and September 2020. THA was performed for ONFH Stage 4 and BHA for Stage 3 or below. The mean postoperative observation period in the THA and BHA groups was 3.9 and 3.7 years, respectively. The Short-Form 6-Dimension measure was used to calculate utility values. Results: No significant differences in questionnaire results regarding disease-specific or comprehensive measures were observed after arthroplasty for ONFH between the THA and BHA groups. The utility values were 0.60 and 0.58 in the THA and BHA groups, respectively. Conclusion: The postoperative QOL was similar between patients who underwent THA for Stage 4 ONFH and BHA for Stage 3 ONFH. Therefore, THA or BHA can be performed on patients with ONFH after considering age, stage classification, and previous medical conditions.

Comparison of complications of intrascleral fixation according to the extent of vitrectomy

BackgroundIntraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques.MethodsThis retrospective study included 235 eyes that underwent intrascleral fixation surgery at our hospital between July 2014 and January 2021. The eyes were classified into the anterior vitrectomy group (A-vit group; 134 eyes) and the pars plana vitrectomy group (PPV group; 101 eyes). The age, preoperative and postoperative best-corrected visual acuity, observation period, preoperative and postoperative intraocular pressure, and the incidence of intraoperative and postoperative complications were assessed.ResultsIntrascleral fixation was performed more frequently in the PPV group, and a significant difference was observed between the eyes with a history of vitrectomy and eyes with scleral buckles (p = 0.00041). In terms of the incidence of postoperative complications following intrascleral fixation, the incidence of low intraocular pressure postoperative was higher in the PPV group than that in the A-vit group, and a significant difference was observed between the two groups (p = 0.01).ConclusionsThe visual outcome and complications following intrascleral fixation did not differ according to the extent of vitreous excision.

Analysis of the Relationship between Patient Family Knowledge about Infections in Post-Operative Wounds in Supporting the Post-Operative Patient Wound Healing Process: Study at dr. Soekardjo Regional General Hospital, Tasikmalaya, Indonesia

Introduction: Post-operative wound infection is a serious complication that can hinder the healing process. The patient's family's knowledge about post-operative wound infections can play an important role in supporting the healing process. This study aims to analyze the relationship between the patient's family's knowledge about infections in post-operative wounds and the process of wound healing in post-operative patients at dr. Soekardjo Regional General Hospital Tasikmalaya.&#x0D; Methods: This research used a cross-sectional design with a total of 52 respondents selected by purposive sampling. Data was collected using a questionnaire to measure the patient's family's knowledge about post-operative wound infections and observation sheets to assess the wound healing process. Data analysis was carried out using the Chi-square test.&#x0D; Results: The majority of respondents were 32 years or older. Respondents' education was dominated by secondary level. The majority of respondents have incomes greater than or equal to the UMR. The majority of respondents had sufficient knowledge about post-operative wound infections, but there were still 17.31% of respondents who had insufficient knowledge. The results of the study showed that there was a significant relationship between the patient's family's knowledge about post-operative wound infections and the wound healing process (p-value &lt; 0.05).&#x0D; Conclusion: The patient's family's knowledge about post-operative wound infections can support the patient's post-operative wound healing process.

Fibrin Glue Coating Limits Scar Tissue Formation around Peripheral Nerves.

Scar tissue formation presents a significant barrier to peripheral nerve recovery in clinical practice. While different experimental methods have been described, there is no clinically available gold standard for its prevention. This study aims to determine the potential of fibrin glue (FG) to limit scarring around peripheral nerves. Thirty rats were divided into three groups: glutaraldehyde-induced sciatic nerve injury treated with FG (GA + FG), sciatic nerve injury with no treatment (GA), and no sciatic nerve injury (Sham). Neural regeneration was assessed with weekly measurements of the visual static sciatic index as a parameter for sciatic nerve function across a 12-week period. After 12 weeks, qualitative and quantitative histological analysis of scar tissue formation was performed. Furthermore, histomorphometric analysis and wet muscle weight analysis were performed after the postoperative observation period. The GA + FG group showed a faster functional recovery (6 versus 9 weeks) compared to the GA group. The FG-treated group showed significantly lower perineural scar tissue formation and significantly higher fiber density, myelin thickness, axon thickness, and myelinated fiber thickness than the GA group. A significantly higher wet muscle weight ratio of the tibialis anterior muscle was found in the GA + FG group compared to the GA group. Our results suggest that applying FG to injured nerves is a promising scar tissue prevention strategy associated with improved regeneration both at the microscopic and at the functional level. Our results can serve as a platform for innovation in the field of perineural regeneration with immense clinical potential.

Abstract 111: Establishing orthotopic renal cell carcinoma xenograft in PBMC-humanized immunodeficient NSG-MHC I/II double knock-out mice

Abstract Clear cell renal cell carcinoma (ccRCC), the predominant histological subtype of RCC, is highly correlated with immune cells, an association that is linked to a worse prognosis. Our study aimed to establish an orthotopic ccRCC mouse model reconstituted with human peripheral blood mononuclear cells (PBMCs) and implanted with human ccRCC SKRC-59 cells under the kidney capsule in immunodeficient NSG-MHC I/II double knock-out (DKO) mice. The study was conducted using two experimental designs to optimize humanization and tumor formation. In the first experimental design, the mice were engrafted with SKRC-59 cells under the left kidney capsule 24 hours post-irradiation on study day 0. The PBMCs were then injected intravenously on study day 9. The second experimental design involved irradiating mice on study day -1, followed by engraftment with PBMCs either perfectly (6/6) or partially (3/6) matched human leukocyte antigens (HLA) with the tumors. Subsequently, SKRC-59 cells were placed under the kidney capsule on study day 0. Daily post-operative observations were conducted for six days following surgery to ensure the well-being of the mice. Tumor burden was assessed twice weekly using an in vivo imaging system, along with monitoring body weights and clinical signs. The humanization rates were evaluated 7, 14, and 21 days post-PBMC engraftment, as well as at the end of the study, using peripheral blood. Approximately 5 to 6 weeks post-tumor implantation, the mice were euthanized, and both left and right kidneys were collected and weighed for further analysis. The humanization rates were significantly higher when the PBMCs were engrafted on the same day as irradiation compared to 10 days post-irradiation. The PBMC humanization, and HLA-type PBMC donors did not affect tumor burden. Additionally, we found that distant metastasis in the lungs developed in several mice. Using flow cytometry and immunohistochemistry (IHC) to analyze tumor infiltrating leukocytes (TILs), a predominant number of CD3+ T cells were found in human CD45+ TILs, indicating that this model could be useful for evaluating T cell-mediated immunotherapies. Moreover, lympho-myeloid aggression (LMA) was observed in this peripheral blood leukocytes (PBL) mouse model, showing early stage tertiary lymphoid structures (TLS), which potentially provides a powerful tool to recapitulate TLS formation and study associated mechanisms and therapies. Our study demonstrated the growth of ccRCC SKRC-59 tumors under the renal capsule and observed TILs and metastatic patterns in PBMC humanized DKO mice. This PBMC-humanized orthotopic ccRCC xenograft model can recapitulate tumor microenvironment (TME), and be potentially used to assess the safety and efficacy of various immunotherapeutics. Citation Format: Wonyoung Kang, Yufei Wang, Yasmin N. Laimon, Oanh Pham, Ben Matran, Lauren Bottoms, Sheng Khang, Hsien-Chi Yuan, Nithyassree Murugan, Aseman B. Sheshdeh, Li-chin Yao, Jiwon Yang, Mingshan Cheng, Sabina Signoretti, Wayne A. Marasco, James G. Keck. Establishing orthotopic renal cell carcinoma xenograft in PBMC-humanized immunodeficient NSG-MHC I/II double knock-out mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 111.

Machine learning technology for predicting intraocular lens power. Diagnostics data generalization

Backgraund. Implantation of recent IOLs allows ophthalmologists to effectively solve the problems of surgical rehabilitation of patients with cataracts. The degree of improving the patient's visual functions is directly dependent on the accuracy of the preoperative calculation of the optical power of IOLs. The most famous formulas to calculate this indicator are SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett. All of them work well for an "average patient", however, they are not adequate enough at the boundaries of input variables ranges.&#x0D; Aims. To study the possibility of using mathematical models obtained as a result of deep learning of artificial neural networks (ANN models) to generalize data and predict the optical power of modern intraocular lenses.&#x0D; Materials and methods. ANN models were trained on large-scale samples, including depersonalized data for patients of ophthalmology clinic. Data provided in 2021 by ophthalmologist K.K. Syrykh, and reflect the results of both preoperative and postoperative observation of patients. The source file used to build the ANN model includes 455 records - 26 columns of input factors and one column for the output factor - calculating IOL (diopters). To conveniently build ANN models, we used a simulator program, previously developed by the authors.&#x0D; Results. The resulting models, in contrast to the traditionally used formulas, reflect the regional specificity of patients to a much greater extent. They also make it possible to retrain and optimize the structure based on newly received data, which allows taking into account the non-stationarity of the object. A distinctive feature of such ANN models in comparison with the well-known formulas SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett, widely used in the surgical cataract treatment in ophthalmology, is their ability to take into account a significant number of recorded input quantities, which makes it possible to reduce the mean relative error in calculating the optical power of IOL from 10–12% to 3.5%.&#x0D; Conclusions. This work shows the fundamental possibility of generalizing a significant amount of empirical data on calculating the optical power of the IOL using training ANN models that have a significantly larger number of input variables than when using traditional formulas and methods. The results obtained allow, in principle, to build an intelligent expert system with a continuous flow of new data from a source and a step-by-step retraining of the ANN model.

ASSESSMENT OF VISUAL ACUITY AND COMPLICATIONS POST CATARACT SURGERY IN PATIENTS WITH UVEITIS IN TERTIARY CARE HOSPITAL

Aim and Objectives Aim:To study the visual acuity and operative complications after cataract surgery in patients with uveitis in tertiary care hospital Objectives: 1.To study factors affecting visual acuity. 2.To study surgical complications post cataract surgery in uveitis patients. Materials and Methods:A total of 18 patients were taken, data was collected from all the selected patients using a structured proforma meeting the objectives of the study. • Inclusion Criteria:1.All complicated cataract patients attending ophthalmology OPD 2.A quite eye (without inflammation) for atleast 3 months • Exclusion Criteria: 1.Cataract due to causes other than uveitis 2.Patients with posterior segment pathology Patients were scheduled for follow up on post op day 1, day 3 , day 7 , day 15, day 30, day 60, day 90. Results: The prevalance was more common in males compared to females. Out of 18 patients, 14 (77%) underwent SICS with PCIOL implantation and 4 (22%) underwent phacoemulsification with PCIOL. Intra-operative complications were noted as small non-dilating pupil, peripheral anterior synechiae, pupillary membrane, incomplete capsulorhexis, iris prolapse. In 7 (38%) patients sphincterectomy was done and in 4 (22%) patients stretch pupilloplasty was done. Immediate post-op complications that were noted were anterior chamber reaction and pigment dispersion. Late post-op complications that were noted were posterior capsular opacification Dense posterior synechiae were encountered in 12 (66%) patients and excessive conjunctival bleeding in 6(33%) patients. There was improvement in visual outcomes as follows 8 patients had 6/6 vision, 6 patients had 6/18 vision where as remaining 4 patients had 6/36 vision due to early development of posterior capsular opacification. Conclusion: Cataract development is a very common occurrence in any form of anterior and intermediate uveitis because of chronic intraocular inflammation, long term use of corticosteroids. Reported incidence of cataract in uveitic patients is about 25% in juvenile rheumatoid arthritis and 75% in chronic anterior uveitis. It is possible to achieve successful visual outcomes following cataract surgery in uveitis by proper management of pre-operative inflammation and close post-operative observation. Management of uveitic cataract requires careful case selection, proper timing of surgery, and close monitoring with appropriate handling of complications that may occur.

C-Reactive Protein/Albumin Ratio Is an Independent Risk Factor for Recurrence and Survival Following Curative Resection of Stage I–III Colorectal Cancer in Older Patients

BackgroundThe number of older patients with cancer has increased, and colorectal cancer is expected to be affected by this trend. This study aimed to compare prognostic factors, including nutritional and inflammation-based indices, between patients aged ≥ 70 and < 70 years following curative resection of stage I–III colorectal cancer.Patients and MethodsThis study included 560 patients with stage I–III colorectal cancer who underwent curative resection between May 2010 and June 2018. A retrospective analysis was performed to identify prognosis-associated variables in patients aged ≥ 70 and < 70 years.ResultsPreoperative low body mass index, high C-reactive protein/albumin ratio, and comorbidities were mainly associated with poor prognosis in patients aged ≥ 70 years. Tumor factors were associated with a poor prognosis in patients aged < 70 years. The C-reactive protein/albumin ratio was independently associated with poor overall survival and recurrence-free survival in those aged ≥ 70 years. The time-dependent area under the curve for the C-reactive protein/albumin ratio was superior to those of other nutritional and inflammation-based indices in most postoperative observation periods in patients aged ≥ 70 years.ConclusionsTumor factors were associated with a poor prognosis in patients aged < 70 years. In addition to lymph node metastasis, preoperative statuses were associated with poor prognosis in patients aged ≥ 70 years. Specifically, the preoperative C-reactive protein/albumin ratio was independently associated with long-term prognosis in patients aged ≥ 70 years with stage I–III colorectal cancer after curative resection.

Adjuvant oxaliplatin-based chemotherapy comparing observation alone after radical resection of metachronous metastases of colorectal cancer: interim analysis

Introduction. Despite the registered standard treatment option for patients who underwent radical resection for metachronous metastases of colorectal cancer (CRC), the feasibility of adjuvant chemotherapy (ACT) for all patients seems controversial. Due to studies demonstrating improved disease-free survival rates with postoperative chemotherapy vs observation, it would seem that there is reasonable expectation of improved overall survival (OS) rates, which, however, were not statistically different between groups. This article presents the interim results of our own study.Aim. To analyse the efficacy of ACT vs dynamic observation in patients who underwent surgery for metachronous metastases of colorectal cancer.Materials and methods. It was a prospective-retrospective, non-randomized, non-inferiority study. A total of 120 patients were recruited between June 2008 and September 2022. The ACT group included 71 patients. All patients received only oxaliplatin-based chemotherapy regimens; the dynamic observation group included 49 patients.Results. The interim analysis showed that the median disease-free survival (mDFS) in the ACT group (n = 71) was 20.9 months (13.7–28.3) vs 24.4 months in the dynamic observation group (n = 49) (11.1–37.7), HR: 0.76 (95% CI: 0.45–1.29), p = 0.29. Two-year disease-free survival (DFS) rates were 46.6% in the post-surgery chemotherapy (CT) group (n = 50) and 55.5% in the experimental group (n = 31), HR: 0.69 (95% CI: 0.39–1.2), p = 0.21.Conclusion. ACT has not improved the long-term treatment outcomes in patients who underwent radical resection for metachronous metastases of CRC.

Establishment of a mandible defect model in rabbits infected with multiple bacteria and bioinformatics analysis.

Objective: A model of chronic infectious mandibular defect (IMD) caused by mixed infection with Staphylococcus aureus and Pseudomonas aeruginosa was established to explore the occurrence and development of IMD and identify key genes by transcriptome sequencing and bioinformatics analysis. Methods: S. aureus and P. aeruginosa were diluted to 3 × 108CFU/mL, and 6 × 3 × 3mm defects lateral to the Mandibular Symphysis were induced in 28 New Zealand rabbits. Sodium Morrhuate (0.5%) and 50μL bacterial solution were injected in turn. The modeling was completed after the bone wax closed; the effects were evaluated through postoperative observations, imaging and histological analyses. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway, and protein‒protein interaction (PPI) network analyses were performed to investigate the function of the differentially expressed genes (DEGs). Results: All rabbits showed characteristics of infection. The bacterial cultures were positive, and polymerase chain reaction (PCR) was used to identify S. aureus and P. aeruginosa. Cone beam CT and histological analyses showed inflammatory cell infiltration, pus formation in the medullary cavity, increased osteoclast activity in the defect area, and blurring at the edge of the bone defect. Bioinformatics analysis showed 1,804 DEGs, 743 were upregulated and 1,061 were downregulated. GO and KEGG analyses showed that the DEGs were enriched in immunity and osteogenesis inhibition, and the core genes identified by the PPI network were enriched in the Hedgehog pathway, which plays a role in inflammation and tissue repair; the MEF2 transcription factor family was predicted by IRegulon. Conclusion: By direct injection of bacterial solution into the rabbit mandible defect area, the rabbit chronic IMD model was successfully established. Based on the bioinformatics analysis, we speculate that the Hedgehog pathway and the MEF2 transcription factor family may be potential intervention targets for repairing IMD.