Postoperative Observation Research Articles

The utility of serum osteopontin levels for predicting postoperative complications after colorectal cancer surgery.

Osteopontin (OPN) is a secretory glycoprotein, which is expressed not only in osteoblasts, but immune cells including macrophages and activated T cells. Its pleiotropic immune functions, such as bone remodeling, cancer progression, immune response, and inflammation have been reported previously. However, the association between OPN and postoperative complications (POC) after colorectal cancer (CRC) surgery has not been studied, so far. Peripheral blood samples were collected before (pre) and immediately after surgery (post), and on postoperative days (POD) 1, 3, 5, and 7. Serum OPN levels were measured by ELISA. In total, 78 patients who underwent elective CRC surgery were divided into the No-POC (n = 54) and POC (n = 24) groups. The POC group had significantly higher OPN levels than the No-POC group throughout the postoperative observation period. The maximum OPN levels from pre- to postsurgical samples showed the best predictive potential for POCs (cut off: 20.75ng/mL, area under the curve: 0.724) and were correlated with length of postoperative stays. OPN values were significantly correlated with C-reactive protein on POD3 and were identified as an independent predictive marker for POCs (odds ratio: 3.88, 95% CI: 1.175-12.798, P = 0.026). The severity of POCs was reflected in increased OPN levels. Increased postoperative OPN was associated with increased postoperative inflammatory host responses and POC after CRC surgery. Serum OPN level may be a useful biomarker for early prediction of POC and it may provide additional information for treatment decisions to prevent POC.

A Case of Recurrent Giant Malignant Melanoma of Eyelid with Orbital Infiltration

Objective: To report a case of “recurrent giant malignant melanoma of the right eyelid” in May 2019. Methods: The patient was found to have a recurrence of a huge mass in the right eyelid, which was surgically removed after admission, and histopathological section was given to confirm the diagnosis. Results: CT and histopathological sections were used to finally diagnose the recurrence of giant malignant melanoma of the right eyelid, which prevented the further deterioration of the disease. Conclusion: For this disease, it is easy to diagnose and treat early, and the disease is highly malignant, and it is easy to metastasize to the brain, liver and bone through blood and/or lymph nodes, and it is easy to recur. Therefore, the primary tumor should be enlarged during the operation. After resection, radiotherapy and chemotherapy can be combined according to the situation after operation, and it is particularly important to do postoperative observation and follow-up.

Impact of comorbid renal dysfunction in patients with hepatocellular carcinoma on long-term outcomes after curative resection.

BACKGROUNDHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. However, the number of patients with chronic kidney disease (CKD) is on the rise because of the increase in lifestyle-related diseases.AIMTo establish a tailored management strategy for HCC patients, we evaluated the impact of comorbid renal dysfunction (RD), as stratified by using the estimated glomerular filtration rate (EGFR), and assessed the oncologic validity of hepatectomy for HCC patients with RD.METHODSWe enrolled 800 HCC patients who underwent hepatectomy between 1997 and 2015 at our university hospital. We categorized patients into two (RD, EGFR < 60 mL/min/1.73 m2; non-RD, EGFR ≥ 60 mL/min/1.73 m2) and three groups (severe CKD, EGFR < 30 mL/min/1.73 m2; mild CKD, 30 ≤ EGFR < 60 mL/min/1.73 m2; control, EGFR ≥ 60 mL/min/1.73 m2) according to renal function as defined by the EGFR. Overall survival (OS) and recurrence-free survival (RFS) were compared among these groups with the log-rank test, and we also analyzed survival by using a propensity score matching (PSM) model to exclude the influence of patient characteristics. The mean postoperative observation period was 64.7 ± 53.0 mo.RESULTSThe RD patients were significantly older and had lower serum total bilirubin, aspartate aminotransferase, and aspartate aminotransferase levels than the non-RD patients (P < 0.0001, P < 0.001, P < 0.05, and P < 0.01, respectively). No patient received maintenance hemodialysis after surgery. Although the overall postoperative complication rates were similar between the RD and non-RD patients, the proportions of postoperative bleeding and surgical site infection were significantly higher in the RD patients (5.5% vs 1.8%; P < 0.05, 3.9% vs 1.8%; P < 0.05, respectively), and postoperative bleeding was the highest in the severe CKD group (P < 0.05). Regardless of the degree of comorbid RD, OS and RFS were comparable, even after PSM between the RD and non-RD groups to exclude the influence of patient characteristics, liver function, and other causes of death.CONCLUSIONComorbid mild RD had a negligible impact on the prognosis of HCC patients who underwent curative hepatectomy with appropriate perioperative management, and close attention to severe CKD is necessary to prevent postoperative bleeding and surgical site infection.

Pre- and peri-operative clinical information, physiological observations and outcome measures following flexible ureterorenoscopy (FURS), for the treatment of kidney stones. A single-centre observational clinical pilot-study in 51 patients

BackgroundKidney stone disease contributes to a significant proportion of routine urological practice and remains a common cause of worldwide morbidity. The main aim of this clinical-pilot study was to investigate the effect of flexible ureterorenoscopy (FURS) on pre- and peri-operative clinical information, physiological observations and outcome measures.MethodsIncluded were 51 patients (31 males, 20 females), who underwent elective FURS, for the treatment of kidney stones.Pre-operative and peri-operative clinical information, and post-operative physiological observations and outcome measures were collected using a standard case report form. Pre-operative clinical information included age, gender, BMI, previous history of stone formation and hypertension. Pre-operative stone information included the size (mm), Hounsfield units (HU), laterality and intra-renal anatomical location. Peri-operative surgical details included surgical time in minutes; Laser use; Duration and energy of laser; and post-operative stenting. The physiological outcomes measured included systolic and diastolic blood pressure (mmHg), Likert pain score, temperature, heart rate (bpm) and respiration rate (bpm).Following initial descriptive analysis, a series of Pearson’s correlation coefficient tests were performed to investigate the relationship between surgical factors other variable factors.ResultsA series of significant, positive correlations were observed between; age and surgical time (p = 0.014, r = 0.373); stone size and Hounsfield unit (p = 0.029, r = 0.406); surgical time and duration of laser (p < 0.001, r = 0.702); surgical time and BMI (p = 0.035, r = 0.322); baseline heart rate and Hounsfield unit (p = 0.026, r = − 0.414); base line heart rate and BMI (p = 0.030, r = 0.307).; heart rate at 120-min post FURS and age (p = 0.038, r = − 0.308); baseline pain score and BMI (p = 0.010, r = 0.361); baseline respiration rate and BMI (p = 0.037, r = 0.296); respiration rate at 240-min post FURS and BMI (p = 0.038, r = 0.329); respiration rate at 120 min post FURS and age (p = 0.022, r = − 0.330). Four patients developed post-operative complications (3—UTIs with urinary retention, 1–urosepsis).ConclusionsWe report that following FURS there is an association between various physiological, clinical and surgical parameters. Although these correlations are weak, they warrant further investigation as these may be linked with untoward complications, such as infection that can occur following FURS. This data, however, will need to be validated and reproduced in larger multi-centre studies.

РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ КОМБИНИРОВАННОГО СПОСОБА ПРИ ЛЕЧЕНИИ ДЕТЕЙ С ПЛОСКО-ВАЛЬГУСНОЙ ДЕФОРМАЦИЕЙ В СТАЦИОНАРНЫХ УСЛОВИЯХ

Abstract. Patients (n = 66) were divided into 2 groups. In the main group, tendon-muscle plasty was performed in the form of transposition and tenodesis of the tendon of the anterior tibial muscle in the cleft of the navicular bone, and in the control, a combination of this type of tendon-muscle plasty and subtalar arthroeresis. In the period from 2016-2021, the ortho-paediatric department of Clinic of the Samara State Medical University carried out a comprehensive treatment of 66 children with plano-valgus deformity of the feet, which included surgical correction, immobilization of the limb in the postoperative period and rehabilitation treatment for all periods of postoperative observation. Our results indicate the need for an integrated approach in the treatment of flat-valgus deformity of the feet, which includes the formation of an anatomically correct installation of all elements that make up the child's foot and ankle joint, correction of biomechanics and the development of the correct walking skill in the postoperative period.

Effect of Predictive Nursing Combined with Early Drinking Water Therapy on Patients with Urinary Retention after Vaginal Delivery

The aim of this study is to analyze the effect of predictive nursing combined with early drinking water therapy on patients with urinary retention after vaginal delivery. A total of 600 women who gave birth in our hospital from July 2019 to July 2020 were selected as the research objects. A double-blind method was adopted to divide them into a control group and observation group, 300 cases in each group. In the control group, routine nursing was given. In the observation group, (1) predictive nursing measures were used before surgery. (2) The postoperative observation group used early drinking water therapy; the incidence of urinary retention, the effective rate of urination, postpartum haemorrhage, and the treatment of urinary retention were compared between the two groups. In the observation group, the number of urinary retention was 17, and the incidence of urinary retention was 5.67%. The urination efficiency of the observation group was 98.33%; the urination efficiency of the control group was 86.33%; comparison results showed that P < 0.05. The 24 h postpartum haemorrhage of the observation group was 1.33%; the 24 h postpartum haemorrhage of the control group was 2.66%. Uroschesis therapy was performed in 17 patients in the observation group and 44 patients in the control group.. The observation group had an 88.24 percent treatment rate, while the control group had a 72.73 percent treatment rate. P < 0.05 indicated that the difference was statistically significant.

Intensive care in an older population: Influence of age, comorbidities and sex in 304 plastic and reconstructive surgical patients older than 75 years.

An aging population will lead to an increasing demand for critical care resources. Hence, we evaluated the potential influence of age, comorbidities and sex in plastic and reconstructive patients ≥75 years that were admitted to the intensive care unit (ICU). We included 304 patients who required intensive care between 2000 and 2019. Besides patient demographics, medical case characteristics were statistically evaluated. In this study, 184 patients were female (61%) (120 male), the median age was 81.8 years (25th and 75th percentiles: 77.4-87.2) with a range of 75.0-98.9 years. The median length of stay in the ICU was 12 days (25th and 75th percentiles: 3-28) with a range of 0-382 days. The reasons for admission were burn injury (n=230, 76%), necrotizing fasciitis (n=34, 11%), non-combustion-related traumas (n=22, 7%) and postoperative observation after plastic surgery procedures (n=18, 6%). In total, 108 patients (36%), who were significantly older (P=0.005) and had a significantly shorter stay (P < 0.001) compared with the surviving cohort, died during their stay in the ICU. Our multivariable logistic regression model revealed that age (odds ratio: 1.05 [1.01, 1.09]; P=0.017) and number of operations (odds ratio: 0.75 [0.60, 0.96]; P=0.023) were significant predictors for death in the ICU. Age plays a critical role in determining fatal outcome of old patients requiring intensive care. In contrast, sex and number of comorbidities shows no significant influence. Geriatr Gerontol Int 2022; 22: 597-602.

Abstract 1660: Comparison between surgical and ultrasound-guided orthotopic implantation of hepatocellular carcinoma models in mice using ultrasound and bioluminescence imaging

Abstract Introduction: Orthotopic tumour mouse models are often preferred to subcutaneous models due to their increased clinical relevance and pathophysiological features, as the tumour microenvironment can influence stromal interaction, immune response, angiogenesis, tumour growth and progression as well as response to treatment. Orthotopic implantation of liver cancer cell lines can be time consuming and inefficient due to the surgical procedures involved to establish the tumour. This study assesses the benefits of replacing traditional invasive surgical orthotopic implantation of two hepatic tumour cell lines with a minimally invasive ultrasound guided approach. Tumour growth of both implantation methods were assessed using ultrasound and bioluminescence, as well as duration of surgery and animal recovery time. In addition, the immune landscape of both implantation methods was assessed using flow cytometry. Methods: Hep3B and Hepa 1-6 cells were transfected with luciferase for bioluminescence imaging. Hep3B-luc or Hepa 1-6-luc cells were orthotopically injected into the left liver lobe of C57BL/6 mice via either conventional surgery or ultrasound guided injection. Tumour growth was measured using both Ultrasound (Fujifilm Vevo 3100 imaging system, Visualsonics) and bioluminescence (IVIS® Spectrum in vivo imaging system, Perkin Elmer). Surgery times were recorded as the duration each animal was under anaesthesia. Recovery times were reported as the time animals were held in recovery before returning to their cage. An in house validated flow cytometry T cell panel was used to assess T cell infiltration in the Hepa1-6 syngeneic model. Results: A comparison of tumour volume versus tumour associated bioluminescence demonstrated good correlation between both methods for each cell line. The duration of surgery and post implantation recovery times were significantly reduced for mice that underwent ultrasound-guided implantation compared to surgery, as well as fewer post-operative clinical observations. No significant difference in body weight was observed throughout the study. T cell infiltration by flow cytometry assessment enabled further evaluation of potential differences in the immune landscape of Hepa 1-6 tumours. Conclusion: Ultrasound guided implantation of orthotopic hepatic tumours is a minimally invasive technique that leads to improved recovery times for animals, which adheres to the principles of the 3R’s. The time taken for ultrasound guided implantation compared to traditional surgical methods was also significantly reduced, enabling a higher throughput of animals on study. Tumour growth kinetics in both Hep3B and Hepa 1-6 models were comparable between the 2 methods. Citation Format: Chris Payne, Yasmin Amer, Ruth Storer, Ganisha Hutchinson, Lucy Harris, Amanda Miles, Yinfei Yin. Comparison between surgical and ultrasound-guided orthotopic implantation of hepatocellular carcinoma models in mice using ultrasound and bioluminescence imaging [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1660.

Long-term observation after transplantation of cultured human corneal endothelial cells for corneal endothelial dysfunction

BackgroundCorneal transplantation is the only way to treat serious corneal diseases caused by corneal endothelial dysfunction. However, the shortage of donor corneal tissues and human corneal endothelial cells (HCECs) remains a worldwide challenge. We cultivated HCECs by the use of a conditioned medium from orbital adipose-derived stem cells (OASC-CM) in vitro. Then the HCECs were used to treat animal corneal endothelial dysfunction models via cell transplantation. The purpose of this study was to conduct a long-term observation and evaluation after cell transplantation.MethodsOrbital adipose-derived stem cells (OASCs) were isolated to prepare the conditioned medium (CM). HCECs were cultivated and expanded by the usage of the CM (CM-HCECs). Then, related corneal endothelial cell (CEC) markers were analyzed by immunofluorescence. The cell proliferation ability was also tested. CM-HCECs were then transplanted into monkey corneal endothelial dysfunction models by injection. We carried out a 24-month postoperative preclinical observation and verified the long-term effect by histological examination and transcriptome sequencing.ResultsCM-HCECs strongly expressed CEC-related markers and maintained polygonal cell morphology even after 10 passages. At 24 months after cell transplantation, there was a CEC density of more than 2400 cells per square millimeter (range, 2408–2685) in the experimental group. A corneal thickness (CT) of less than 550 μm (range, 490–510) was attained. Gene sequencing showed that the gene expression pattern of CM-HCECs was similar to that of transplanted cells and HCECs.ConclusionsTransplantation of CM-HCECs into monkey corneal endothelial dysfunction models resulted in a transparent cornea after 24 months. This research provided a promising prospect of cell-based therapy for corneal endothelial diseases.

Research on Nursing Progress of Postoperative Observation of Hypertensive Cerebral Hemorrhage

Research on Nursing Progress of Postoperative Observation of Hypertensive Cerebral Hemorrhage

Adjuvant therapy (AT) in patients (pts) with radically resected ampullary adenocarcinoma (AA): A monocentric retrospective analysis.

e16142 Background: Ampullary adenocarcinoma (AA) is a rare tumor. Radical surgery is the only curative treatment for localized AA. The role of AT is not clearly defined and previous evidence in literature is poor and controversial. Hence, we retrospectively analyzed radically resected AA pts at our Institution, investigating the impact of AT on survival and the role of possible prognostic and/or predictive factors. Methods: Radically resected AA pts were retrospectively included in the analysis, divided into two groups: pts receiving AT and pts undergoing only postoperative observation (PO). The following variables were collected: gender; age (≤ 65 vs &gt; 65 years); baseline ECOG PS (0 vs ³ 1); histologic subtype (pancreatobiliary vs intestinal); tumor stage (T1-2 vs T3-4); nodal status (N0 vs N+), margin status (R0 vs R+); radiotherapy (yes vs no), AT regimen [Gemcitabine (GMZ)-based vs fluoropyrimidine (FP)-based treatment)]. The objective of the analysis was to evaluate the impact of AT on overall survival (OS). Univariate and multivariate analyses were performed. Results: From 2007 to 2021, a total of 69 pts with radically resected AA were identified: 41 (59%) pts received AT, 28 (41%) PO. The median age was 65 years (41-81), 42 (61%) were males, ECOG PS was ³ 1 in 45 (65%) pts. Tumor characteristics were: 31 (45%) pancreatobiliary, 26 (38%) intestinal, 9 (13%) mixed subtype and 3 (4%) not available; 41 (59%) pts had T3-T4 stage tumor; 34 (49%) were N+. Out of 41 pts receiving AT, 27 (66%) pts were treated with FP-based AT, 14 (34%) with GMZ-based AT; 16 (23%) pts received also RT. In the overall population, median OS was 59.8 months. At the univariate analysis, there was a statistically significant association of T status with OS (p 0.03), confirmed at multivariate analysis (p 0.03). Further variables (ECOG PS, AT, nodal status and histologic subtype) were not associated with survival. Among the 41 pts receiving AT, median OS was 58.7 months. At the univariate analysis, AT regimen was significantly associated with OS (p 0.02), and it was confirmed at the multivariate analysis. In particular, median OS was 59.8 and 28.3 months in pts receiving FP- and GMZ-based AT, respectively [HR 0.26, (95% CI: 0.09-0.78), p = 0.001]. Conclusions: Among pts with radically resected AA, AT, compared with PO, was not associated with a significant survival benefit. However, among pts receiving AT, FP-based regimen seems to significantly improve OS in comparison to GMZ-based regimen, independently of histologic subtype. Our findings, from a retrospective and limited case series, add to controversial literature data and miss to clarify the real impact of AT in radically resected AA pts. A randomized trial of AT vs PO would provide further information in this setting.

P-155 Adjuvant therapy (AT) in patients (pts) with radically resected ampullary adenocarcinoma (AA): A monocentric retrospective analysis

Ampullary adenocarcinoma (AA) is a rare tumor. Radical surgery is the only curative treatment for localized AA. The role of AT is not clearly defined and previous evidence in literature is poor and controversial. Hence, we retrospectively analyzed radically resected AA pts at our Institution, investigating the impact of AT on survival and the role of possible prognostic and/or predictive factors. Radically resected AA pts were retrospectively included in the analysis, divided into two groups: pts receiving AT and pts undergoing only postoperative observation (PO). The following variables were collected: gender; age (≤ 65 vs > 65 years); baseline ECOG PS (0 vs 3 1); histologic subtype (pancreatobiliary vs intestinal); tumor stage (T1-2 vs T3-4); nodal status (N0 vs N+), margin status (R0 vs R+); radiotherapy (yes vs no), AT regimen [Gemcitabine (GMZ)-based vs fluoropyrimidine (FP)-based treatment)]. The objective of the analysis was to evaluate the impact of AT on overall survival (OS). Univariate and multivariate analyses were performed. From 2007 to 2021, a total of 69 pts with radically resected AA were identified: 41 (59%) pts received AT, 28 (41%) PO. The median age was 65 years (41-81), 42 (61%) were males, ECOG PS was 3 1 in 45 (65%) pts. Tumor characteristics were: 31 (45%) pancreatobiliary, 26 (38%) intestinal, 9 (13%) mixed subtype and 3 (4%) not available; 41 (59%) pts had T3-T4 stage tumor; 34 (49%) were N+. Out of 41 pts receiving AT, 27 (66%) pts were treated with FP- based AT, 14 (34%) with GMZ-based AT; 16 (23%) pts received also RT. In the overall population, median OS was 59.8 months. At the univariate analysis, there was a statistically significant association of T status with OS (p 0.03), confirmed at multivariate analysis (p 0.03). Further variables (ECOG PS, AT, nodal status and histologic subtype) were not associated with survival. Among the 41 pts receiving AT, median OS was 58.7 months. At the univariate analysis, AT regimen was significantly associated with OS (p 0.02), and it was confirmed at the multivariate analysis. In particular, median OS was 59.8 and 28.3 months in pts receiving FP- and GMZ-based AT, respectively [HR 0.26, (95% CI: 0.09-0.78), p = 0.001]. Among pts with radically resected AA, AT, compared with PO, was not associated with a significant survival benefit. However, among pts receiving AT, FP-based regimen seems to significantly improve OS in comparison to GMZ- based regimen, independently of histologic subtype. Our findings, from a retrospective and limited case series, add to controversial literature data and miss to clarify the real impact of AT in radically resected AA pts. A randomized trial of AT vs PO would provide further information in this setting.

Adjuvant radiation versus observation with salvage radiation after gross-total resection of WHO grade II meningiomas: a propensity score-adjusted analysis.

After gross-total resection (GTR) of a newly diagnosed WHO grade II meningioma, the decision to treat with radiation upfront or at initial recurrence remains controversial. A comparison of progression-free survival (PFS) between observation and adjuvant radiation fails to account for the potential success of salvage radiation, and a direct comparison of PFS between adjuvant and salvage radiation is hampered by strong selection bias against salvage radiation cohorts in which only more aggressive, recurrent tumors are included. To account for the limitations of traditional PFS measures, the authors evaluated radiation failure-free survival (RFFS) between two treatment strategies after GTR: adjuvant radiation versus observation with salvage radiation, if necessary. The authors performed a retrospective review of patients who underwent GTR of newly diagnosed WHO grade II meningiomas at their institution between 1996 and 2019. They assessed traditional PFS in patients who underwent adjuvant radiation, postoperative observation, and salvage radiation. For RFFS, treatment failure was defined as time from initial surgery to failure of first radiation. To assess the association between treatment strategy and RFFS while accounting for potential confounders, a multivariable Cox regression analysis adjusted for the propensity score (PS) and inverse probability of treatment weighted (IPTW) Cox regression analysis were performed. A total of 160 patients underwent GTR and were included in this study. Of the 121 patients who underwent observation, 32 (26.4%) developed recurrence and required salvage radiation. PFS at 3, 5, and 10 years after observation was 75.1%, 65.6%, and 45.5%, respectively. PFS at 3 and 5 years after salvage radiation was 81.7% and 61.3%, respectively. Of 160 patients, 39 received adjuvant radiation, and 3- and 5-year PFS/RFFS rates were 86.1% and 59.2%, respectively. In patients who underwent observation with salvage radiation, if necessary, the 3-, 5-, and 10-year RFFS rates were 97.7%, 90.3%, and 87.9%, respectively. Both PS and IPTW Cox regression models demonstrated that patients who underwent observation with salvage radiation treatment, if necessary, had significantly longer RFFS (PS model: hazard ratio [HR] 0.21, p < 0.01; IPTW model: HR 0.21, p < 0.01). In this retrospective, nonrandomized study, adjuvant radiation after GTR of a WHO II meningioma did not add significant benefit over a strategy of observation and salvage radiation at initial recurrence, if necessary, but results must be considered in the context of the limitations of the study design.

Survival of stage 4 primary breast cancer cases after surgery by intrinsic subtype: HER2-positive subtype potentially curable.

e13026 Background: With the incorporation of anti-HER2 agents in the treatment of HER2 positive primary breast cancer, stage 4 disease of this subtype has become potentially curable. However, the duration of clinical CR that is needed be certain that the patient is cured, and therefore the necessary duration of anti-HER2 treatment is uncertain. We address this issue in this presentation. Methods: We present cases of stage 4 primary breast cancer who underwent breast surgery after their distant metastases were controlled, with continued post-operative systemic therapy. There were 52 cases of which the intrinsic subtype as of immunohistochemical analysis was as follows; Luminal A - 7 cases, Luminal B, - 14 cases, Luminal-HER2 - 9 cases, HER2-enriched - 7 cases, and Triple negative -15 cases. The patients were followed up for duration of treatment and overall survival. Results: The average post-operative observation period for all 52 cases was 32.6 months. The five year overall survival rate for HER2-enriched cases was 100%, for Luminal-HER2 cases 80%, for Luminal A cases 80%, for Luminal B cases 55%, and for Triple-negative cases 0%. Of the 16 HER2 positive cases (Luminal-HER2 and HER2 enriched), there was only one death at 48.4 months post-operation. The survival of 5 of 15 surviving HER2 positive cases exceed 60 months (5 years). Of the five, only one at 72.0 months has clinically observable disease (cSD). The remaining 4 cases all are clinically disease free (cCR). Of the 4 cCR cases, only 1 case which originally had multiple lung metastases is continuing anti-HER2 therapy at 90.3 months post-operation. The remaining three discontinued anti-HER2 therapy at 18.1 months (lung metastases CR, observation period 71.7 months), 72.3 months (liver and lymph node metastases CR, observation period 90.3 months), and 101.9 months (liver and bone metastases CR, observation period 102.3 months), respectively. The last case terminated anti-HER2 therapy after testing negative for ERBB2 related genes on liquid biopsy. Conclusions: With the proper incorporation of anti-HER2 therapy, Stage 4 HER2 positive primary breast cancer disease seems to be a potentially curable disease, and anti-HER2 therapy probably can be discontinued in cCR patients after 5 years. Liquid biopsy for tumor related genes (e.g. ctDNA, miRNA) might facilitate decision making.

Primary characteristics and outcomes of newly diagnosed low-grade endometrial stromal sarcoma

ObjectiveTo assess potential predictive variables for nodal metastasis and survival outcomes in patients with newly diagnosed, low-grade endometrial stromal sarcoma.MethodsWe performed a single-institution, retrospective analysis of consecutive patients with newly...

Vessel anastomosis in free flap reconstruction for oral and maxillofacial defects: techniques and key points.

The quality of vessel anastomosis is a key element for the success of free flap reconstruction. When adopting free flaps for oral and maxillofacial defect reconstruction, skills in selecting vessels, determining the clinical manifestations of the recipient vessel, and anastomosis technique are needed. Key points on postoperative flap observation were also required. We are experienced on this subject given that we have accomplished more than 1 000 free flaps for patients with oral and maxillofacial defects in the last 5 years. In this article, we summarize the skills and key points in free flap reconstruction of oral and maxillofacial defects, including vessel anastomosis skills, vessel selection, and vessel crisis diagnosis.

Bypassing the intensive care unit for patients with acute ischemic stroke secondary to large-vessel occlusion.

Endovascular mechanical thrombectomy is safe and effective for the treatment of acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). Still, despite high rates of procedural success, it is routine practice to uniformly admit postthrombectomy patients to an intensive care unit (ICU) for postoperative observation. Predictors of ICU criteria and care requirements in the postmechanical thrombectomy ischemic stroke patient population are lacking. The goal of the present study is to identify risk factors associated with requiring ICU-level intervention following mechanical thrombectomy. The authors retrospectively analyzed data from 245 patients undergoing thrombectomy for AIS from anterior circulation LVO at a comprehensive stroke and tertiary care center from January 2015 to March 2020. Clinical variables that predicted the need for critical care intervention were identified and compared. The performance of a binary classification test constructed from these predictive variables was also evaluated using a validation cohort. Seventy-six patients (31%) required critical care interventions. A recanalization grade lower than modified Thrombolysis in Cerebral Infarction (mTICI) scale grade 2B (odds ratio [OR] 3.625, p = 0.001), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) < 8 (OR 3.643, p < 0.001), and presence of hyperdensity on postprocedure cone-beam CT (OR 2.485, p = 0.005) were significantly associated with the need for postthrombectomy critical care intervention. When applied to a validation cohort, a clearance classification scheme using these three variables demonstrated high positive predictive value (0.88). A recanalization grade lower than mTICI 2B, ASPECTS < 8, and postprocedure hyperdensity on cone-beam CT were shown to be independent predictors of requiring ICU-level care. Routine admission to ICU-level care can be costly and confer increased risk for hospital-acquired conditions. Safely and reliably identifying low-risk patients has the potential for cost savings, value-based care, and decreasing hospital-acquired conditions.

Postoperative Effect Observation and Clinical Study of Dahuang Zhechong Pills from Jingui Yaolue in Treating Patients with Early-to-Mid Prostate Cancer Undergoing Radical Resection.

Objective To explore the effect of applying Dahuang Zhechong pills (DHZCP) from Jingui Yaolue to patients with early-to-mid prostate cancer undergoing radical resection and carry out a theoretical clinical study of traditional Chinese medicine (TCM) to verify the effect of DHZCP formula under the guidance of TCM theory. Methods The clinical data of 98 patients with early-to-mid prostate cancer undergoing radical resection treated in our hospital (July 2014 to July 2016) were selected for the retrospective analysis, and the patients were divided into group A (n = 49, routine hormonal therapy) and group B (n = 49, routine hormonal therapy plus DHZCP) according to the double blind method, so as to compare the trauma symptoms, cancer recurrence rate, etc., after treatment between the two groups. Results Compared with group A, group B obtained significantly higher total effective rate of complication treatment at different time points (P < 0.05), significantly lower mean HAMA score after treatment (P < 0.05), and significantly lower total recurrence rate (P < 0.05). The “congestion” theory in Chapter VI On Pulse, Symptom Complex and Treatment of Arthralgia Due to Stagnation of Blood and Consumptive Diseases of Jingui Yaolue was the theoretical basis for postoperative effect observation of DHZCP in treating prostate cancer. Combining with the onset theory of congestion, personally, the author believed that cancer is caused by congestion disease formed by the extravasated blood in the human body, and with the passing of time, the intermingled deficiency, blood stasis, and toxicity lead to the qualitative change of endogenous cancer toxicity and develop into consumptive congestion disease, making it the core pathogenesis of cancer. And DHZCP had good preventive and treatment effect. Conclusion DHZCP is an effective drug for improving postoperative complications of early-to-mid prostate cancer, reducing the biological recurrence rate and clinical recurrence rate, and improving mental status. The formula treats both deficiency and excess, combines tonification with purgation, and dispels exogenous pathogen without damaging body resistance, which is a profound formula based on TCM theory to treat “congestion,” “congestion disease,” and “consumptive congestion disease.” Using this theory to guide clinical syndrome differentiation and treatment and modifying the dosage and usage can play an important role in TCM preventive treatment of cancers, early, middle, and late treatment, and clinical prevention of other chronic diseases.

Single Port Robotic-Assisted Removal of an Eroded Inflatable Penile Prosthesis Reservoir and Repair of an Associated Bladder Fistula

ABSTRACT Introduction We present the case of a 73-year-old man who underwent single port robotic removal of a retained Inflatable Penile Prosthesis (IPP) reservoir with intravesical erosion and repair of an associated bladder fistula. The patient had a 3-piece IPP placed in 2014 for erectile dysfunction after radical prostatectomy for prostate cancer. He underwent device explant two years later for infection, at which time the IPP reservoir was “drained and retained”. He developed re-infection one year later and was again taken to the operating room; however, surgery was aborted due to vascular injuries. He presented to us for evaluation of dysuria and gross hematuria six years after initial IPP placement. Work-up with CT imaging and cystoscopy demonstrated intravesical erosion of the retained reservoir. Objective We aim to provide a step-by-step video demonstration of our technique for single port robotic-assisted removal of the eroded penile prosthesis reservoir and repair of an associated bladder fistula. Methods Procedures were performed using the da Vinci SP single port robotic system. The SP robot port was placed through a 3 cm incision superior to the umbilicus, and an additional 12 mm assistant port was placed in the Right Lower Quadrant (RLQ). The peritoneum was incised anteriorly lateral to the medial umbilical ligament, and the space of Retzius was developed by sharp and blunt dissection through densely adherent tissue planes. The pseudocapsule surrounding the eroded reservoir was incised, and the exposed reservoir was removed. Two fistulous tracts identified between the pseudocapsule and bladder were circumferentially excised, and the resultant bladder wall defect was repaired in a single layer with running 3-0 V-Loc suture. A drain was placed alongside the bladder repair and externalized through the RLQ assistant port. Results The patient tolerated these procedures well and without complications. He was admitted for routine postoperative observation overnight after surgery. On postoperative day one, the drain was removed, and the patient was discharged home with the Foley catheter remaining in place. At 2-week follow-up, the patient was recovering well and a cystogram was obtained showing no leaks, and the Foley catheter was removed. Conclusions This surgical case report demonstrates the feasibility and safety of performing removal of an eroded IPP reservoir through a minimally invasive approach with the da Vinci SP surgical system. The accompanying video provides a step-by-step demonstration of our technique. Disclosure No

Clinical effectiveness of sodium hyaluronate gel usage for prevention of postoperative adhesion in children

It was considered expedient to study the effectiveness of intraoperative prevention of adhesion formation in children based on the results of our own experimental and clinical studies on the effectiveness of using an anti-adhesive gel based on cross-linked sodium hyaluronate. Purpose - to evaluate clinical efficacy and safety of cross-linked sodium hyaluronate gel (SHG) usage as a barrier agent for primary prevention of postoperative peritoneal adhesions formation in children. Materials and methods. This is a prospective, randomized, controlled, patient blinded observational study, which includes 62 children. All patients underwent laparotomy for appendicular peritonitis and were randomly divided into two equal groups. Patients from group A (n=31) received conventional surgical treatment, SHG was additionally applied in group B (n=31) before abdominal closure. Immediate and long-term effects of SHG usage were investigated to evaluate the influence on adhesions reformation. The average period of postoperative observation was 14.0±2.4 months. Results. SHG application was associated with no increase in complications rate: duration of postoperative ileus, need in nasogastric decompression, intensive care unit state, hospital state, the incidence of surgical site infection, and need for relaparotomy did not differ significantly between compared groups. The prevalence of peritoneal adhesions at the end of in-hospital treatment differs significantly between groups according to the ultrasound data (χ2=10.930; p=0.005). The incidence of small bowel obstruction (SBO) developed during the follow-up period in group A (16.1%) was significantly higher than in group B (3.23%) where the anti-adhesive gel was applied (χ2=4.026; p=0.045). Conclusions. Intraoperative use of SHG based on sodium hyaluronate allows reduction of postoperative adhesions formation in children without worsening the postoperative course. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: sodium hyaluronate, adhesions, small bowel obstruction.