Post-surgery Patients Research Articles

Erythrocyte modified controlling nutritional status as a biomarker for predicting poor prognosis in post-surgery breast cancer patients

Nutrition and inflammation are closely related to prognosis in breast cancer patients. However, current nutritional and inflammatory measures predict disease free survival (DFS) of breast cancer are still different, and the most predictive measures remain unknown. This study aimed to compare the predictive effects of commonly used nutritional and inflammatory measures on DFS and to improve existing nutritional or inflammatory measures in order to develop a new model that is more effective for predicting postoperative recurrence and metastasis in breast cancer patients. The clinical data of 536 female breast cancer patients with invasive ductal carcinoma who underwent surgery at Shaoxing People’s Hospital from January 2012 to December 2018 were retrospectively evaluated. The predictive effects of nutritional and inflammatory indicators on DFS were evaluated. Machine learning was used to evaluate and rank laboratory indicators, select relatively important variables to modify nutritional or inflammatory indicators with the best predictive power, and evaluate their predictive role in patients’ postoperative recurrence and metastasis. Among various metrics predicting DFS, the CONUT score emerged paramount with an area under the curve (AUC) of 0.667. Interestingly, the combination of the erythrocyte levels with the CONUT score (ECONUT) achieved the highest AUC (0.722). The Kaplan-Meier survival analysis showed that the group exhibiting high ECONUT scores experiencing a notably poorer DFS. ECONUT was identified as an independent risk factor for postoperative DFS (P < 0.001). The ECONUT model could provide an effective assessment tool for predicting DFS in breast cancer patients.

CICARE based communication technique: A passage to faster and smoother visual rehabilitation in post cataract surgery patients.

Visual rehabilitation following cataract surgery is often an overlooked aspect. Healthcare providers have an important role in the counselling of the patients undergoing cataract surgery in clearing all their doubts thus alleviating all their fears and anxiety related to the procedure which will eventually lead to faster and smoother visual rehabilitation. Using standardised communication techniques like CICARE combined with conventional nursing and pain scoring systems can provide an objective and effective method in patient counselling and building a rapport with the patient for a faster visual recovery.

Intercostal Nerve Cryoablation During Lobectomy for Postsurgical Pain: A Safe and Cost-Effective Intervention.

The cost benefit of intercostal nerve cryoablation during surgical lobectomy for postoperative pain management is unknown. The current study compared hospital economics, resource use, and clinical outcomes during the index stay and accompanying short-term follow-up. Patients who underwent lobectomy with standard of care treatment for postsurgical pain management and cryoablation were compared to those with standard of care treatment only. We hypothesized that cryoablation would reduce narcotic use and index hospital and short-term costs. A retrospective, propensity matched cohort of surgical patients treated between 2016 and 2022 from a US National All-Payer Database were used. Cost and outcome comparisons were made between groups using chi-square and ttests. From a cohort of 23,138 patients, 266 pairs with a mean age of 69years were included. Matching variables included age, gender, lobe resected, and prior opioid use. Both groups had significant comorbidity history and prior opioid use; 66% (n = 175 both groups) underwent open lobectomy and 53% (n = 142 vs. 143) had the upper lobe resected. Cryoablation intervention was associated with 1.3days reduced hospital stay (8.8 vs. 10.1days, p = 0.31) and no difference in perioperative safety. After 90days, postsurgery cryoablation patients had lower opioid prescription refills (27.3 vs. 36.9 morphine milligram equivalents, p = 0.03). Cryoablation patient costs trended less than non-cryoablation patients during index ($38,753 vs. $43,974, p = 0.10) and lower through 6months (total costs, $65,703 vs. $74,304, p = 0.10). There was no difference in postsurgery resource use, but a smaller proportion of cryoablation patients had outpatient hospital visits (83.1%, N = 221 vs. 92.9%, n = 247, p < 0.01). Cryoablation during lobectomy is safe and does not add incremental hospital costs. Clinical meaningful reductions in length of stay and postsurgery opioid use were observed with cryoablation intervention. The addition of cryoablation during surgery to reduce postoperative pain appears to be a cost-effective therapy.

Postingestive reward acts through behavioral reinforcement and is conserved in obesity and after bariatric surgery.

Postingestive nutrient stimulation conditions food preferences through striatal dopamine and may be associated with blunted brain responses in obesity. In a cross-sectional study, we tested flavor-nutrient conditioning (FNC) with maltodextrin-enriched yogurt, with maltodextrin previously optimized for concentration and dextrose equivalents (n = 57), and to mask texture cues (n = 102). After conditioning, healthy volunteers (n = 52) increased preference for maltodextrin-paired (+102 kcal, CS+), relative to control (+1.8 kcal, CS-) flavors, as assessed according to intake, but not pleasantness. In a clinical study (n = 61), behavioral conditioning without effects on pleasantness was confirmed across pre-bariatric candidates with obesity, weight-stable post-surgery patients, and healthy controls, without significant differences between groups. Striatal dopamine D2-like receptor (DD2lR) availability, assessed with [123I]IBZM SPECT, was reduced in the obesity group and strongly correlated with conditioning strength and a measure of restrained eating in patients with gastric bypass. These results show that postingestive nutrient stimulation influences human food choices through behavioral reinforcement, and is conserved in obesity and after bariatric surgery. Trial Registration: ISRCTN17965026: Dopaminergic neurotransmission in dietary learning and obesity.

Visual Outcome after Cataract Surgery in a Tertiary Eye Hospital in Southern Region of Bangladesh

Background: Vision is a very important sense for human life which is directly related with education, performance of work and quality of life. Worldwide cataract is considered one of the leading causes of blindness and visual impairment. Cataract surgery is one of the most commonly performed procedures in ophthalmology. Cataract extraction with intraocular lens (IOL) implantation is the only surgical approach available mostly in developing countries. Objective: This study aimed to evaluate the visual outcome who have had their cataract surgery in a tertiary level eye hospital. Method: Prospective interventional study was conducted from 1st January 2019 to 31st December 2019 at Sheikh Fazilatunnesa Mujib Eye Hospital &amp; Training Institute (SFMEHTI), Gopalganj. It was a hospital based study of consecutive cataract-operated patients who had age-related cataract with vision 6/24 or less before surgery. For surgery all the patients were evaluated including their relevant investigations with trained ophthalmologist and allowed as fit for surgery. Total 8776 patients who admitted in this hospital and fulfill the eligibility criteria were included in this study. Patients in age of 40 - 80 years were included in the study. The most common procedure was phacoemulsification (PE) with posterior chamber intraocular lens (PCIOL) 4704 (53.6%) followed by small incision cataract surgery (SICS) with posterior chamber intraocular lens (PCIOL) implantation, operated in4072 (46.4%) eyes. Most of the surgery was done by well-trained ophthalmologists; whereas few surgeries were done by young ophthalmologists under the supervision of senior ophthalmologist. Result: Among 8776 patients operated, the most common group was 40-60 years (65.5%). The mean age of the patients was 60.47 years. Male patients were more (52.8%). In post cataract surgery patients, 5967 (68%) eyes had presenting vision &gt;6/18. Visual acuity (VA) &lt;6/60 was found in 176 (2%) eyes. In 8600 (98%) eyes visual acuity (VA) was improved after best correction. Poor visual outcome was significantly associated with the patients who were in older age, gender female, literacy, hearing impairment and SICS&amp; PE surgery techniques. Conclusion: This study observed that good visual acuity can achieved in cataract surgery. More attention should be given towards monitoring of cataract surgical outcomes and correction of refractive error after surgery. It is also important to meet the WHO standard of visual outcome after cataract surgery. Central Medical College Journal Vol 8 No 1 January 2024 Page: 7-11

A Randomized Controlled Trial Assessing the Impact of Transcutaneous Electrical Acupoint Stimulation on Gastrointestinal Motility, Nutritional Status, and Immune Function in Patients Following Cerebrovascular Accident Surgery

Background Transcutaneous Electrical Acupoint Stimulation (TEAS) is a technique that involves stimulating specific acupoints on the body with electrical currents. It may regulate nerve excitability and improve nerve function. This study aimed to assess the impact of TEAS on gastrointestinal motility, nutrition, and immune function in patients post cerebrovascular accident surgery in the intensive care unit (ICU). Methods A randomized controlled trial included 300 post-cerebrovascular surgery patients at Lishui Central Hospital (January 2021–June 2023). Patients were randomly assigned to TEAS or control groups in a 1:1 ratio. The TEAS group received TEAS at bilateral Zusanli (ST36), Shangjuxu (ST37), Tianshu (ST25), Neiguan (PC6), and Hegu (LI4) according to the International Acupuncture Point Code, plus standard care. The control group received routine enteral nutrition and sham TEAS. Nutritional, immune, and gastrointestinal motility indicators were compared. Results A randomized controlled trial involving 300 post-surgery patients compared TEAS to sham TEAS, demonstrating significant enhancements (p < 0.05) in immune function and gastrointestinal motility. Compared to the control group, the TEAS group showed significant improvements in the patient’s serum nutritional levels (prealbumin, albumin, hemoglobin, and total protein), immune status (IgG, IgA, IgM, and CD4+/CD8+), gastrointestinal motility (daily gastric residual volume, time to achieve target feeding volume, time for nutritional fluid to meet standards, time to first bowel movement, time to first passage of activated charcoal stool, time to reach the defecation volume), and overall condition (the scores of clinical scales and ICU stay duration) (p < 0.05). The TEAS group also experienced a significantly lower incidence of adverse events (p < 0.05). Conclusions Early TEAS intervention positively impacted recovery, shortened ICU stay, and improved outcomes in patients post cerebrovascular accident surgery.

Using a Cognitive Behavioral Approach in Individual Counseling with Patients Undergoing Bariatric Surgery

Morbid obesity is linked to physical and psychological well-being. Bariatric surgery has shown tremendous success with rapid weight loss in patients with morbid obesity. However, some patients experience weight regain post-surgery, which can be linked to psychological and social factors. Mental health counseling is rarely offered in bariatric surgery programs. We used a six-session individual Cognitive Behavioral Therapy (CBT) approach with patients following bariatric surgery, using a single case research design to treat four participants. We measured the effectiveness of a six-session CBT treatment and assessed for psychosocial improvements. Results indicated that each participant experienced psychosocial improvements, decreased comorbid maladaptive behavior post treatment, and lost body weight during the study. In conclusion, CBT treatment may be beneficial for post-surgery bariatric patients.

Microbial Etiology of Surgical Site Infections, Bacterial Isolates and their Antibiotic Susceptibility Patterns at Trauma University Hospital in Tirana, Albania

Hospital acquired infections in general and specifically surgical site infections increase significantly the morbidity and mortality of post-surgery patients. They are considered the most frequent postoperative complication worldwide, and a major public health burden especially in low income countries. The preventability and the high treatment costs of these complications, sets the focus towards identification of the most frequent etiological factors, in order to decrease the incidence of the phenomenon in different levels. This is a retrospective study carried out from January 1 to December 31, 2023. We analysed the microbiology and antibiotic susceptibility reports of specimens accepted and examined at the laboratory department of the Trauma University Hospital, Tirana. We reported standard operating procedure on direct microscopic examination with gram staining, and the susceptibility patterns reported by millimetre scaling the zone of inhibition of the examined antibiotics disks. We reported 40% negativity rate on the examined specimens. The most frequently isolated microorganisms within the positive results were Acinetobacter Baumannii (25.4%), Staphylococcus Aureus (13.5%), and Enterococcus faecalis (10.32%). The combination of cephalosporins together with aminoglycosides was found to be the most effective antibiotic prophylaxis formulation. Continuous surveillance of bacterial profiles through variable rich, statistically significant additional studies become crucial. The results will help toward better hospital acquired infection prevention and control. Received: 21 August 2024 / Accepted: 10 November 2024 / Published: 3 December 2024

Psychological Stress and Its Correlations to Patients with Acute Lymphedema After Breast Cancer Surgery.

Lymphedema and psychological distress, including anxiety and depression, are common in breast cancer patients post-surgery. This study aimed to assess the incidence and determinants of anxiety and depression in patients with acute lymphedema (ALE) following breast cancer surgery. A retrospective study was conducted on 1613 breast cancer patients who underwent surgery at Fudan University Shanghai Cancer Center in 2018. ALE was defined as lymphatic fluid accumulation causing limb swelling and was classified by the difference in arm circumference. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS) at discharge. Descriptive statistics and logistic regression were used to identify psychological distress-related factors. Among the 1613 patients, 363 (22.5%) had ALE. Anxiety was observed in 31% and depression in 21% of patients. ALE significantly impacted anxiety in the multivariate analysis (OR = 1.57, 95% CI: [1.04-2.38], P = 0.033). Multivariate analysis of ALE patients showed that longer hospital stays (OR = 0.51, 95% CI: [0.30-0.88], P = 0.017) and invasive disease (OR = 0.39, 95% CI: [0.19-0.78], P = 0.008) were associated with reduced anxiety; while lymph-vessel invasive disease was associated with increased anxiety (OR = 5.97, 95% CI: [1.15-30.97], P = 0.034). ALE had no significant impact on depression in the multivariate analysis. However, menopause (OR = 0.72, 95% CI: [0.56-0.94], P = 0.014) and longer hospitalization (OR = 1.30, 95% CI: [1.00-1.68], P = 0.047) influenced depression in all patients. In the ALE group, lymph node surgery was the only significant factor for depression (OR = 8.67, 95% CI: [1.56-48.23], P = 0.014) in the multivariate analysis. Psychological stress, influenced by both surgical factors and emotional states, is associated with ALE development. Addressing both psychological and surgical factors is crucial for improving outcomes and quality of life in post-surgery breast cancer patients.

BS SO14 - Is there a correlation between preoperative HbA1c changes and long-term weight loss plus glycemic control in patients with type 2 diabetes undergoing metabolic surgery?

Abstract Background Optimization of patients with type 2 diabetes mellitus (T2DM) prior to metabolic surgery aims to achieve tight glycemic control by the time of surgery. Little is known about the influence of altering preoperative HbA1c on postoperative weight loss and glycemic control. The aim of this study was to determine whether a change in HbA1c during the preoperative period correlated with long term weight maintenance and HbA1c in patients undergoing metabolic surgery. The proportion of glucose-lowering medication used following surgery was also examined. Method Retrospective analysis was conducted of patients with T2DM who underwent metabolic surgery between 2013 – 2017. Preoperative HbA1c change was measured as change in glycemic control during the 1-year pre-surgery. Primary outcomes were % excess weight loss (EWL) and HbA1c at 5 years post-surgery. Secondary outcomes were % EWL and HbA1c at 1-year post-surgery and the use of glucose-lowering medications post-surgery. The Pearson correlation coefficient (r) was used to determine the relationship between the pre-surgery HbA1c change and postoperative % EWL and HbA1c. Chi-squared test was used to calculate the statistical impact of change in medication use post-surgery Results Sixty-nine patients with complete data were included in the study. The mean change in HbA1c in the 1-year pre-surgery, the 1-year post-surgery and 5-years post-surgery was -0.9% (± 1.5), -0.7% (± 1.2) and 0% (± 1.8), respectively. The change in HbA1c in the 1-year pre-surgery did not correlate with % EWL at 1-year and 5-years post-surgery or with HbA1c at 1-year and 5-years post-surgery. There was a significant decrease in the proportion of patients requiring glucose-lowering medications at 1-year and 5 years post-surgery (p&amp;lt;0.05). Conclusion This study demonstrated a significant reduction in the proportion of glucose-lowering medication required long-term following metabolic surgery. Altering pre-operative glycemic control was not associated with long term weight maintenance or glycemic control.

Psychometric and network analysis of kinesiophobia in Iranian surgical patients

Kinesiophobia, the fear of movement, can significantly impede an individual’s ability to engage in daily activities. This fear often stems from past traumatic experiences or witnessing others in pain, leading to an increased fear of injury. This study aimed to evaluate the psychometric properties of the Persian version of the Tampa Scale for Kinesiophobia among Iranian post-surgery patients. A methodological study conducted in 2023 involved a sample of 400 post-surgery patients selected through convenience sampling. The translated scale underwent psychometric evaluation, including network analysis, exploratory and confirmatory factor analysis for construct validity, as well as assessments for convergent and discriminant validity. Internal consistency of the scale was also assessed. The mean age of the participants was 44.38 (SD = 13.49) years and the majority of them (77.8%) were women. Exploratory factor analysis with Promax rotation identified two factors explaining 60.28% of the variance, comprising 17 items. The final model was confirmed after necessary adjustments in confirmatory factor analysis. Both convergent and discriminant validity were established, and alpha and omega coefficients of the subscales were above 0.7. The Persian version of the Tampa Scale for Kinesiophobia showed robust psychometric properties among Iranian post-surgery patients, serving as a valuable tool for evaluating and addressing kinesiophobia in this population. These findings enhance the understanding and management of kinesiophobia within the Iranian healthcare context.

Postoperative Grip Strength and Range of Motion Correlated with Better Patient-Reported Outcomes Following Surgical Management of Distal Radius Fractures

Abstract Background The common methods for assessing postoperative outcomes in patients with distal radius fractures (DRFs) are mostly observational. In contrast to these traditional assessment tools, postoperative assessments based on patient-reported outcomes (PROs) are becoming more popular. The aim of this study was to analyze the postoperative radiological measurements and physical examination measures as predictive measures for patient-reported satisfying outcomes defined by the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Gartland and Werley score. Purpose The aim of this study was to inspect whether postoperative radiological and physical examination measurements are associated with better PROs. This correlation would be beneficial to assess surgery's success and predict patient's recovery process, helping with coordination of patient's expectations postsurgery. Study Design This is a retrospective cohort study. Methods Eligible patients were those who underwent Open Reduction Internal Fixation (ORIF) of DRFs and answered the DASH and Gartland and Werley questionnaires with a minimal follow-up period of 6 months and a 2-year median follow-up time; during follow-up, physical examination measures and radiographic measures were taken. Results This study has found that older patients have a higher probability to achieve better PROs postsurgery and ROM has been found as a factor correlated with DASH score and Gartland and Werley score. A model combining grip strength, supination, and extension was able to predict the DASH score with 63% of variance: DASH score = 88.864–(0.288 × grip strength) – (0.371 × supination) – (0.270 × extension). Conclusions Due to the high prevalence of DRFs and their debilitating effect on patients' functionality, a credible assessment tool must be defined to predict postsurgery patient satisfaction and help in the patient selection process. Level of Evidence III.

Raman spectroscopy on dried blood plasma allows diagnosis and monitoring of colorectal cancer.

Colorectal cancer (CRC) remains challenging to diagnose, necessitating the identification of a noninvasive biomarker that can differentiate it from other conditions such as inflammatory bowel diseases (IBD) and diverticular disease (DD). Raman spectroscopy (RS) stands out as a promising technique for monitoring blood biochemical profiles, with the potential to identify distinct signatures identifying CRC subjects. We performed RS analysis on dried plasma from 120 subjects: 32 CRC patients, 37 IBD patients, 20 DD patients, and 31 healthy controls. We also conducted longitudinal studies of CRC patient's postsurgery to monitor the spectral changes over time. We identified six spectral features that showed significant differences between CRC and non-CRC patients, corresponding to tryptophan, tyrosine, phenylalanine, lipids, carotenoids, and disulfide bridges. These features enabled the classification of CRC patients with an accuracy of 87.5%. Moreover, longitudinal analysis revealed that the spectral differences normalized over 6 months after surgery, indicating their association with the presence of the disease. Our study demonstrates the potential of RS to identify specific biomolecular signatures related to CRC. These results suggest that RS could be a novel screening and monitoring tool, providing valuable insights for the development of noninvasive and accurate diagnostic methods for CRC.

The Effect of Giving Hot-Packs on The Grade of Shivering in Post-Surgery Caesarean Section Patients at Grandmed Hospital Lubuk Pakam

Shivering after anesthesia is a recovery mechanism in the body due to negative side effects such as discomfort and pain due to stretching of the surgical scar, and increased muscle activity following increased oxygen demand. When a client experiences shivering, it is necessary to warm the body with heat therapy given to clients whose temperature is ? 36?C. A hot-pack is a closed package containing gel with a temperature of 40?C. The hot-pack will be given on the right and left inner arms for about 15 minutes. The type of research used is pre-experimental with one group Pre-test and Post-test design. The technique used in sampling in this study is non-probability sampling, in the form of Accidental sampling with a sample size of 20 respondents, while the instrument used in this study is an observation sheet. This study uses univariate and bivariate analysis. In this study, bivariate analysis was carried out using the Paired T-Test. Based on the Statistical Test conducted using the Paired Sample T-test method, the value obtained was p value 0.000 (? &lt;0.05) which means Ho is rejected and Ha is accepted. This means that there is an Effect of Giving Hot-Packs on the Degree of Shivering in Post-Caesarean Section Patients at Grandmed Hospital Lubuk Pakam. This study concludes that giving hot-packs reacts to skin receptors and channels the temperature effect on body heat so that it can reduce shivering.

The Persian version of the fear of pain questionnaire mong Iranian post-surgery patients: a translation and psychometrics

IntroductionThe Fear of Pain Questionnaire (FOPQ) is a self-report tool designed to measure an individual’s fear of pain (FOP). While the Persian version of the FOPQ (FOPQ-P) has been developed, its validity and reliability have not yet been assessed in the Iranian context. This study aims to evaluate the psychometric properties of the FOPQ-P among Iranian patients after surgery.MethodsA methodological study was conducted in 2023 involving 400 post-surgery patients selected with a convenience sampling. The FOPQ was translated into Persian, and its psychometric properties were analyzed using network analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), as well as assessments of convergent and discriminant validity. Internal consistency was measured using Cronbach’s alpha, McDonald’s Omega, average inter-item correlation coefficient, Composite Reliability, and Maximal Reliability.ResultsThe EFA results with Promax and Kaiser Normalization rotation identified two factors that explained 54.32% of the variance, comprising seven items. The CFA confirmed the model’s validity. Both convergent and discriminant validity were established. The reliability analyses showed that Cronbach’s alpha, McDonald’s omega, composite reliability, and MaxR for all constructs were above 0.7. Additionally, the average inter-item correlation coefficient was greater than 0.5, indicating strong internal consistency and construct reliability.ConclusionThe findings suggest that the FOPQ-P possesses a valid structure and was acceptable reliability in patients cultural context of Iran post-surgery, making it a suitable instrument for measuring fear of pain in this population.

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Background and aimsNutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of such support on long-term clinical outcomes is controversial. We thus investigated the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery. MethodsThis was a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery and were included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between the groups. ResultsIn total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage. The adjusted hazard ratio for mortality increased by 1.30 (95% confidence interval [CI] 1.05–1.60, P = 0.016) for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted hazard ratio for mortality between the two groups was 0.69 (95% CI 0.50–0.96, P = 0.026). The results of interaction tests did not yield statistically significant variations in fatality rates across the age, sex, comorbidity, NRS, and American Joint Committee on Cancer stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01–7.08, P = 0.000) in addition to other functional outcomes. ConclusionsNutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk after gastric cancer surgery. The current investigation provides evidence for the recommendation of nutritional support, for post-surgery patients after hospital discharge, in cancer management guidelines.

Radiation-induced Sweet’s Syndrome in a Case of Breast Carcinoma

Sweet’s syndrome is a reactive dermatosis which usually presents as edematous papules and plaques, and very rarely vesicles. It is seen to be associated with various conditions such as autoimmune diseases, malignancy, infections, and drugs. Malignancy associated with Sweet’s syndrome is known to occur anytime during the course of the disease and also after treatment. Very rarely, it is seen during radiation therapy. Here, we are presenting a case of Sweet’s syndrome in a postsurgery and chemotherapy patient with breast carcinoma during radiation therapy.

Machine learning-based prediction of gastroparesis risk following complete mesocolic excision

BackgroundGastroparesis is a major complication following complete mesocolic excision (CME) and significantly impacts patient outcomes. This study aimed to create a machine learning model to pinpoint key risk factors before, during, and after surgery, effectively predicting the risk of gastroparesis after CME.MethodsThe study involved 1146 patients with colon cancer, out of which 95 developed gastroparesis. Data were collected on 34 variables, including demographics, chronic conditions, pre-surgery test results, types of surgery, and intraoperative details. Four machine learning techniques were employed: extreme gradient boosting (XGBoost), random forest (RF), support vector machine (SVM), and k-nearest neighbor (KNN). The evaluation involved k-fold cross-validation, receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and external validation.ResultsXGBoost excelled in its performance for predictive models. ROC analysis showed high accuracy for XGBoost, with area under the curve (AUC) scores of 0.976 for the training set and 0.906 for the validation set. K-fold cross-validation confirmed the model's stability, and calibration curves indicated high predictive accuracy. Additionally, DCA highlighted XGBoost’s superior patient benefits for intervention treatments. An AUC of 0.77 in external validation demonstrated XGBoost's strong generalization ability.ConclusionThe XGBoost-fueled predictive model for post-surgery colon cancer patients proved highly effective. It underlined gastroparesis as a significant post-operative issue, associated with advanced age, prolonged surgeries, extensive intraoperative blood loss, surgical techniques, low serum protein levels, anemia, diabetes, and hypothyroidism.

Post-surgery sequelae unrelated to disease progression and chemotherapy revealed in follow-up of patients with stage III colon cancer

We studied the poorly-known dynamics of circulating DNA (cir-nDNA), as monitored prospectively over an extended post-surgery period, in patients with cancer. On patients with stage III colon cancer (N=120), using personalised molecular tags we carried out the prospective, multicenter, blinded cohort study of the post-surgery serial analysis of cir-nDNA concentration. 74 patients were included and 357 plasma samples tested. During post-operative follow-up, the patients' median cir-nDNA concentration was greater (P<0.0001 in the [43-364 days range]) than both the median value in healthy individuals and the pre-surgery value. These cir-nDNA levels were highly associated with NETs markers (P-value associating MPO and cir-nDNA, and NE and cir-nDNA are 6.6 x 10-17, and 1.9 x 10-7), in accordance with previous reports which indicate that cir-nDNA are NETs by-products. Unexpectedly, in 34 out of 50 patients we found that NETs continued to be formed for an extended duration post-surgery, even in patients without disease progression. Given that this phenomenon was observed in patients without adjuvant CT, and in patients >18 months post-surgery, the data suggest that the persistence of NETs formation is not due to the adjuvant CT. (1), Given the inter-patient heterogeneity, the post-surgery cir-nDNA level cannot be considered a reliable value, and caution must be exercised when determining mutation allele frequency or the mutation status; and (2), specific studies must be undertaken to investigate the possible clinical impact of the persistent, low-grade inflammation resulting from elevated NETs levels, such as observed in these post-surgery patients, given that such levels are known to potentially induce adverse cardiovascular or thrombotic events. This work was supported by the H2020 European ERA-NET grant on Translational Cancer Research (TRANSCAN-2).

Effect of OPEP on lung recruitment and gas distribution in post-surgery patients: A pilot study

BackgroundOscillatory positive expiratory pressure (OPEP) devices are airway clearance tools generating positive pressure, yet evidence supporting their efficacy post-surgery for lung recruitment and gas distribution is limited. ObjectivesInvestigate OPEP's impact on lung recruitment and gas distribution using Electrical impedance tomography (EIT) in post-surgery patients. Methods26 ICU-extubated patients post-major surgery used OPEP at five levels with EIT monitoring. Primary outcome: change in end-expiratory lung impedance (ΔEELI) post-OPEP; secondary outcomes: global inhomogeneity index (GI), respiratory rate, oxygen saturation, blood pressure, and heart rate. ResultsSignificant ΔEELI increase during OPEP versus baseline, correlating with OPEP level. ROI3 (mid-dorsal lung) exhibited highest ΔEELI. Oxygen saturation improved post-OPEP. ConclusionsOPEP effectively increased end-expiratory lung volume post-major surgery, notably in mid-dorsal regions, enhancing short-term oxygenation.