Postoperative Blood Samples Research Articles

Follow-Up Analysis Enhances Understanding of Molecular Residual Disease in Localized Non-Small Cell Lung Cancer.

The prognostic value of molecular residual disease (MRD) in non-small cell lung cancer (NSCLC) is well-established, with treatment-guiding results anticipated. Here, we present updated analyses from our previous published cohort study of 261 NSCLC patients undergoing complete resection. 261 patients with stage I-III lung cancer who underwent radical surgery were enrolled. Enrolled patients underwent follow-up blood draws according to the predefined time points after surgery. As of December 31st, 2023, with a median follow-up of 43.4 months, 948 postoperative blood samples were collected. Landmark and longitudinal MRD exhibited positive predictive values of 91.3% and 92.8%, respectively, with a median lead times of 5.2 months. Negative predictive values were 76.5% and 93.2%, respectively. Patients with landmark undetectable MRD could not be benefited from adjuvant therapy through the updated follow-up (p=0.529). Among the 13 patients with recurrent NSCLC and longitudinal undetectable MRD, seven (53.8%) had brain-only metastases, and four (30.8%) had no updated blood samples for over six months prior to recurrence. Besides, for those with longitudinal detectable MRD, higher maximum variant allele frequency (>0.55%) and ctDNA level (>13 hGE/ml) were associated with a high risk of short-term recurrence. Additionally, updated follow-up data further support the peak time for detectable MRD was 18 months after landmark detection. These findings suggest the significant potential of MRD in guiding personalized treatment for NSCLC. And postoperative longitudinal undetectable MRD can indicate a cured population.

Effect of Anaesthesia Technique on anti-tumor Immunity through TGF-β levels in Adult Patients Undergoing Surgery for Oral Cancer.

There is a paucity of literature regarding the effect of anesthetic techniques on anti-tumor immunity, especially in Oral cavity Malignancies. We designed a study to evaluate the effect of 3 anesthetic techniques - Opioid, Lignocaine infusion and Dexmeditomedine infusion-based on anti-tumor immunity, using TGF-β, T-helper cell profile and inflammatory markers such as IL-6 and IL-10. A pilot prospective randomized trial was conducted in 90 patients undergoing surgery for Oral cavity malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of the American Society of Anaesthesiologists (ASA) physical status I-III fulfilling the inclusion criteria were randomized to either group A (Opioid general anesthesia), group B (lignocaine infusion-based general anesthesia), or group C (Dexmedetomidine infusion-based general anesthesia). Preoperative (morning of surgery) and postoperative (24 hours after surgery) blood samples were obtained. Statistical analysis was done, and the results were analyzed. Demographic profile and pre-operative parameters were comparable between both groups. We did not find any statistically significant difference in the Post-operative levels of TGF-β, neutrophil-lymphocyte ratio (NLR), Monocyte Lymphocyte Ratio (MLR), platelet lymphocyte ratio (PLR), IL-6, IL-10, and T-helper cell profile( IFN-γ, IL-17A, and IL-4 as surrogate markers) among the three study groups. However, it was noted that the overall Opioid consumption was markedly reduced in Group C without any major adverse effects being noted.

Differences in Plasma Extracellular Vesicles of Different Origin in On-Pump Versus Off-Pump Cardiac Surgery.

Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) causes a systemic inflammatory response that can worsen patient outcomes. Off-pump surgery has been associated with a reduced inflammatory response. The precise mechanisms and the role of extracellular vesicles (EVs) in this context are not fully understood. This study aimed to investigate the early immune response, including main T- and B-lymphocyte subsets, cytokine profiles, and plasma EVs, in patients undergoing off-pump (n = 18) and on-pump (n = 18) CABG. Thirty-six patients undergoing isolated CABG were enrolled in this randomized control study. Pre- and 24 h postoperative blood samples were analyzed for immune cell populations, cytokine levels, and plasma EV phenotyping. Off-pump CABG triggered a milder immune response than on-pump surgery. On-pump surgery led to greater changes in circulating EVs, particularly platelet- (CD62P+), endothelial- (CD31+), and B-cell-derived (CD19+), as well as platelet- and erythrocyte-derived aggregates (CD41+CD235a+). Levels of platelet-derived EVs, expressing both constitutional and activation markers (CD41+CD62P+) decreased in both groups of patients 24 h after surgery. On-pump cardiac procedures led to an increase in T-regulatory cell-derived EVs (CD73+CD39+), suggesting a potential mechanism for immune suppression compared to off-pump surgery. There were numerous correlations between EV levels and cytokine profiles following on-pump surgery, hinting at a close relationship. Leucocyte-derived EVs exhibited positive correlations with each other and with GRO but showed negative correlations with endothelial-derived EVs (CD90+ and CD31+). Additionally, CD73+ EVs demonstrated positive correlations with platelet counts and with erythrocyte-derived CD235a+ EVs. EV changes were significantly greater after on-pump surgery, highlighting a more pronounced response to this type of surgery and emphasizing the role of EVs as regulators of post-surgical inflammation.

Links between Nosocomial Endodontic Infections and Bacteremia Associated with Apical Periodontitis and Endodontic Treatment

IntroductionNosocomial endodontic infections can cause treatment failure and are potential risk of bacteremia. This study is aimed to investigate bacteremia associated with apical periodontitis and immediate postendodontic treatment using next-generation sequencing. The study will also elucidate if the endodontic nosocomial pathogens are present in the blood microbiome. MethodsSaliva, blood, and intracanal samples were collected from patients undergoing endodontic treatment (n = 65), while gloves samples were collected from the operator. Bacterial DNA was extracted and the targeted 16S rRNA gene was sequenced using the Illumina Miseq 300 platform for the V1-V2 hypervariable region. The alpha and beta diversities were carried out using the phyloseq package (version-1.36.0) in R (version-4.1). Differences in abundance and diversity were calculated using Mann-Whitney test. Linear discriminant analysis Effect Size was used to compare the biological relevance between different sample sources. ResultsThe phyla firmicutes, actinobacteria, proteobacteria, and bacteroidetes were identified from all sample sources. In blood and glove samples, Cutibacterium genus was highly abundant (14.6%, 17.7%, respectively), while in intracanal samples, Enterococcus took precedence (18.2%). Saliva samples exhibited Prevotella as the most abundant genera (17.9%). Common genera were present between intracanal and postoperative blood samples. Circos graph showed that all the phyla identified from a patient were consistently present in all the samples investigated from the same patient. ConclusionsNosocomial endodontic pathogens being predominant in both; gloves and blood samples, along with common genera present in all sample sources, suggests a potential pathway of transfer of pathogens from saliva to gloves, intracanal, and blood, thus providing evidence of nosocomial endodontic bacteremia.

MiRNA biomarkers to predict risk of primary non-function of fatty allografts and drug induced acute liver failures.

Primary non-function (PNF) of an allograft defines an irreversible graft failure and although rare, constitutes a life-threatening condition that requires high-urgency re-transplantation. Equally, drug induced acute liver failures (ALF) are seldom but the rapid loss of hepatic function may require orthotropic liver transplantation (OLT). Recently, we reported the development of a rodent PNF-disease model of fatty allografts and showed that a dysfunctional Cori and Krebs cycle and inhibition of lactate transporters constitute a mechanism of PNF. Based on findings from the rat PNF-disease model, we selected 15 miRNA-biomarker candidates for clinical validation and performed RT-qPCRs in well-documented PNF cases following OLT of fatty allografts. To assess specificity and selectivity, we compared their regulation in pre- and intraoperative liver biopsies and pre- and post-operative blood samples of patients undergoing elective hepatobiliary surgery. Additionally, we assessed their regulation in druginduced ALF. We confirmed clinical relevance for 11 PNF-associated miRNAs and found expression of miRNA-27b-3p, miRNA-122-3p, miRNA-125a-5p, miRNA-125b-5p and miRNA-192-5p to correlate with the hepatic steatosis grades. Furthermore, we demonstrate selectivity and specificity for the biomarker candidates with opposite regulation of let-7b-5p, miRNA-122-5p, miRNA-125b-5p and miRNA-194-5p in blood samples of patients following successful OLTs and/or liver resection. Moreover, by considering findings from 21 independent ALF-studies, we observed nine PNF-associated miRNAs regulated in common. We report miRNAs highly regulated in PNF and ALF, and their common regulation in different diseases broadens the perspective as biomarker candidates. Our study warrants independent confirmation in randomized clinical trials.

Effect of anesthetic technique on antitumor immunity in patients undergoing surgery for gall bladder cancer: A prospective randomized comparative study.

There is a paucity of literature regarding the effect of anesthetic techniques on antitumor immunity, especially in gall bladder malignancies. We designed a study to compare the effect of propofol-based total intravenous anesthesia and sevoflurane-based general anesthesia-on antitumor immunity, including tumor growth factor-β (TGF-β), T-helper cell profile, and inflammatory markers. A pilot prospective randomized trial was conducted in 64 patients undergoing surgery for gall bladder malignancy under general anesthesia in a tertiary specialty cancer hospital. Adult cancer patients of ASA physical status I-III fulfilling the inclusion criteria were randomized to either group S (sevoflurane-based general anesthesia) or group T (propofol-based total intravenous anesthesia). Preoperative (morning of surgery) and postoperative (24 h and 1 month after surgery) blood samples were obtained. Demographic profile and preoperative parameters were comparable between both groups. There was a statistically significant difference in the postoperative value of TGF-β (higher in group T). There was a statistically significant difference in postoperative interleukin-17A value (indicative of TH17 cells), and it was found to be higher in group S. Propofol-based TIVA increases serum TGF-β levels. At the same time, Sevoflurane modulates T-helper cells-based immunity to increase TH17 cells in patients with gall bladder cancer. Multiple larger studies will be required to validate the results and provide useful recommendations.

Predictive Significance of Combined Plasmatic Detection of BRAF Mutations and S100B Tumor Marker in Early-Stage Malignant Melanoma.

Melanoma is the most aggressive skin cancer with ability to recur also after early-stage tumor surgery. The aim was to identify early-stage melanoma patients at high risk of recurrence using liquid biopsy, estimating of mutated BRAF ctDNA and the level of tumor marker S100B in plasma. Eighty patients were enrolled in the study. BRAF V600E mutation was determined in FFPE tissue and plasma samples using ultrasensitive ddPCR with pre-amplification. The level of S100B was determined in plasma by immunoassay chemiluminescent method. The best prediction of melanoma recurrence after surgery was observed in patients with combined high level of S100B (S100Bhigh) and ctDNA BRAFV600E (BRAFmut) in preoperative (57.1% vs. 12.5%, p = 0.025) as well as postoperative blood samples (83.3% vs. 14.3%, resp., p = 0.001) in comparison with low S100B and BRAF wild-type. Similarly, patients with preoperative and postoperative S100Bhigh and BRAFmut experienced worse prognosis (DFI p = 0.05, OS p = 0.131 and DFI p = 0.001, OS = 0.001, resp.). We observed the benefit of the estimation of combination of S100B and ctDNA BRAFmut in peripheral blood for identification of patients at high risk of recurrence and unfavorable prognosis. There is still no general consensus on molecular markers for deciding the appropriateness of adjuvant treatment of early-stage melanoma. We have shown for the first time that the combined determination of the ctDNA BRAFmut oncogene (liquid biopsy) and the high level of tumor marker S100B in pre- and postoperative plasma samples can identify patients with the worst prognosis and the highest risk of tumor recurrence. Therefore, modern adjuvant therapy would be appropriate for these patients with resectable melanoma, regardless of disease stage.

MicroRNA-26a-5p is a reliable biomarker in the adjuvant setting for pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) has a high recurrence rate even after radical resection because of subclinical tumors. To manage them, a reliable biomarker that can indicate the presence of subclinical tumors and predict their chemosensitivity is required. This study aimed to identify a miRNA as a biomarker that can be used to individualize postoperative adjuvant chemotherapy using postoperative peripheral blood samples. Integrating miRNA microarray data from the blood of 18 patients with PDAC and the in vitro results regarding the phenotypes of chemoresistant PDAC cells, a candidate miRNA was identified. The relationships between candidate miRNA expression and chemosensitivity were examined in vitro and in clinical samples from other cohorts of 33 patients with recurrence. Comprehensive analyses of blood samples detected 5 candidate miRNAs. Of these, miR-26a-5p was considered a candidate biomarker of chemosensitive phenotypes. In validation experiments, chemosensitivity was inversely correlated with miR-26a-5p expression in vitro. Moreover, the ability of miR-26a-5p to predict chemosensitivity was clinically evaluated using blood samples. Patients with high miR-26a-5p expression in the blood after radical resection exhibited a significantly longer survival time after recurrence. Thus, we concluded that miR-26a-5p is a potentially useful biomarker for managing patients with PDAC, especially those undergoing adjuvant chemotherapy.

Analytical and clinical validation of a personalized, tumor-informed circulating tumor DNA assay for minimal residual disease detection.

e14545 Background: The detection of minimal residual disease (MRD) through circulating tumor DNA (ctDNA) analysis provides an advanced molecular method for early identification of surgical patients at high risk of recurrence. In this study, we present the development of mClear, a personalized, tumor-informed next-generation sequencing (NGS) assay for MRD detection. Furthermore, we report the analytical and clinical validation processes conducted to evaluate the performance of the MRD assay. Methods: mClear is designed to assess MRD in patients with solid tumors. Whole exome sequencing (WES) was performed on tumor tissues and matched peripheral blood samples to detect somatic variants comprehensively. Personalized MRD assays were carefully designed by selecting up to 40 prioritized variants, including single nucleotide variants (SNVs), small insertions and deletions (InDels), and fusions while ensuring coverage of 21 additional key driver genes. For analytical validation, we utilized a pan-cancer MRD ctDNA quality control product (LDT-999, LDT Bioscience), characterized by known variant allele frequency (VAF) gradients of 0%, 0.005%, 0.05%, and 0.5%, confirmed through droplet digital PCR (ddPCR). We conducted 18 replicate tests at VAF gradients of 0.5% and 0.05%, 23 replicates at the 0.005% VAF gradient, and 16 replicates at the 0% VAF gradient. For clinical validation, preoperative and postoperative blood samples from a cohort of 264 pan-cancer patients were analyzed. ctDNA collected for MRD detection underwent ultra-deep next-generation sequencing (100,000× average depth of coverage). The library preparation process commenced with an input of 30ng DNA. Results: At VAF gradients of 0.5% and 0.05%, the assay achieved an excellent sensitivity of 100%, and at VAF gradients of 0.005% and 0%, it demonstrated a sensitivity of 95.7% and a specificity of 100%. Preoperative ctDNA was detected in 86.7% (72/83) of the pan-cancer patients with 71.4% (5/7), 90.9% (10/11), 85.5% (47/55), and 100.0% (10/10) in pathological stage (pStage)I, pStage II, pStage III, and pStage IV, respectively. In the pan-cancer cohort, the positive rate of longitudinal MRD was 35.7% (75/210) with 17.8% (21/118), 50.0% (13/26), 55.1% (27/49), and 82.4% (14/17) in pStage I, II, III, and IV, respectively. In four patients who relapsed, MRD detection during surveillance preceded radiological recurrence by a lead time of 1-8 months. Conclusions: Our personalized MRD assay demonstrated excellent analytical sensitivity and specificity with a limit of detection (LoD) of 0.005% VAF at the sample level. Furthermore, it displayed high clinical sensitivity for the detection of ctDNA in the pan-cancer cohort, highlighting its potential for monitoring of recurrence.

LIVER ENZYME ALTERATIONS AFTER LAPAROSCOPIC CHOLECYSTECTOMY IN A TERTIARY CARE CENTER

Objective: Cholelithiasis is a prevalent global health concern, with laparoscopic cholecystectomy (LC) emerging as the preferred surgical intervention. While LC offers an advantage such as shorter hospital stays, it poses potential risks, including cardiovascular impediments because of hemodynamic and ventilatory changes. The current research study was done to assess the impact of LC on hematological parameters, comparing pre-operative and post-operative levels. Methods: The study comprised 51 subjects undertaking LC, and preoperative and postoperative blood samples were analyzed for various hematological parameters. Parameters investigated included hemoglobin (Hb), mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, hematocrit, platelet count, mean platelet volume (MPV), and liver function tests such as alanine transaminase and alkaline phosphatase. Results: Preliminary findings demonstrated significant alterations in hematological parameters post-LC. Changes in MPV, leukocytes, neutrophils, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and coagulation factors were observed. Moreover, there was a notable proliferation in thromboembolic measures connected with pneumoperitoneum pressure and surgery duration. Conclusion: LC induces substantial changes in hematological parameters, potentially contributing to postoperative complications. Understanding these alterations is crucial for implementing appropriate pre-, peri-, and post-operative measures to minimize morbidity, mortality, and overall health-care costs. Further investigations are required in interpreting the principal mechanisms and refine strategies for optimizing patient outcomes in LC.

Levels of Circulating Ketone Bodies in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass.

Ketone bodies (KBs) are energy-efficient substrates utilized by the heart depending on its metabolic demand and substrate availability. Levels of circulating KBs have been shown to be elevated in acute and chronic cardiovascular disease and are associated with severity of disease in patients with heart failure and functional outcome after myocardial infarction. To investigate whether this pattern similarly applies to patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB), we analysed prospectively collected pre- and postoperative blood samples from 192 cardiac surgery patients and compared levels and perioperative changes in total KBs with Troponin T as a marker of myocardial cell injury. We explored the association of patient characteristics and comorbidities for each of the two biomarkers separately and comparatively. Median levels of KBs decreased significantly over the perioperative period and inversely correlated with changes observed for Troponin T. Associations of patient characteristics with ketone body perioperative course showed notable differences compared to Troponin T, possibly highlighting factors acting as a "driver" for the change in the respective biomarker. We found an inverse correlation between perioperative change in ketone body levels and changes in troponin, indicating a marked decrease in ketone body concentrations in patients exhibiting greater myocardial cell injury. Further investigations aimed at better understanding the role of KBs on perioperative changes are warranted.

Prospective analysis of pre and postoperative laboratory parameters associated with thrombosis in patients with ovarian cancer.

Patients with ovarian cancer have a high risk of developing thrombosis. We aimed to investigate pre and post operative biomarkers associated with thrombosis including deep vein thrombosis and pulmonary thromboembolism in patients treated for ovarian cancer. We collected pre and post operative blood samples from 133 patients undergoing surgery for ovarian cancer between December 2021 and August 2022. The measured parameters were white blood cell count, hemoglobin, platelets, monocytes, serum glucose, CA125, D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, antithrombin III, protein C, protein S, plasminogen, plasminogen activator inhibitor 1, homocysteine, N-terminal pro-brain natriuretic peptide, interleukin 6, thrombopoietin, soluble P-selectin and granulocyte stimulating factor. Body mass index of patients were collected. Differences between patients who developed thrombosis and those without were compared with Wilcoxon rank-sum test and we analyzed the continuous variables using logistic regression. Twenty-one (15.8%) patients developed thrombosis ranging from 6 to 146 days (median 15 days) after surgery. Pre operative values of homocysteine (p = 0.033) and IL-6 (p = 0.043) were significantly increased and post operative aPTT (p = 0.022) was prolonged and plasminogen (p = 0.041) was decreased in patients with thrombosis. It is important to find novel biomarkers for thrombosis to carefully manage patients who are prone to develop thrombosis despite preventive measures were applied.

Effects of Drug‐Coated Balloons on Inflammatory Cytokines After Interventional Therapy for Coronary Artery Calcification

Objective: To investigate the effects of a drug‐coated balloon (DCB) on inflammatory cytokines in patients with coronary artery calcification (CAC) after interventional therapy.Methods: This study included 58 patients with coronary heart disease who underwent coronary angiography (CAG) from October 2020 to September 2021. Patients were divided into CAC and non‐CAC groups, and a DCB was used to intervene in the target lesions. Ten‐milliliter preoperative and postoperative blood samples were drawn from the coronary lesions in both groups to detect the expression of serum interleukin‐6 (IL‐6), tumor necrosis factor‐alpha (TNF‐α), and intercellular adhesion molecule‐1 (ICAM‐1). All patients were subjected to a 6‐month follow‐up to observe the incidence of major adverse cardiac events (MACEs).Results: No significant differences in baseline clinical data were found between the groups. Serum IL‐6, TNF‐α, and ICAM‐1 expressions in coronary blood samples immediately before DCB were not significantly different from those after DCB in all patients. After DCB, serum TNF‐α expression in the CAC group was significantly lower than that in the non‐CAC group (p < 0.05). In contrast, no significant difference in serum IL‐6 and ICAM‐1 expression was found between the groups. During the 6‐month follow‐up, no significant difference in the incidence of MACE was found between both groups.Conclusions: DCB reduced the expression of inflammatory cytokine TNF‐α in CAC, which may be one of the key mechanisms underlying the treatment of CAC by DCB.

Comparison of preoperative and postoperative serum thiol/disulfide levels in patients undergoing laparoscopic sleeve gastrectomy for morbid obesity.

Obesity, a prevalent chronic disease, results from an imbalance between energy intake and expenditure. The oxidative stress associated with obesity stems from an imbalance between reactive oxygen species and the cell's antioxidant defense system. Oxidative stress can cause many diseases. The assessment of thiol/disulfide balance, a biochemical test, can be used to detect oxidative stress. The aim of this study is to determine the changes in oxidative stress associated with obesity after obesity surgery by assessing the thiol/disulfide levels. The study was conducted with 40 volunteer patients with a body mass index (BMI) above 40 who underwent obesity surgery at Harran University Hospital General Surgery. Thiol and disulfide levels and other blood parameters were measured from the preoperative and postoperative 2nd and 6th-month blood samples of the patients. BMI was calculated by recording the weights and heights of the cases. Patients with diseases that could affect oxidative stress measurements and those using medication were excluded from the study, and the analyses were performed accordingly. The results showed a statistically significant decrease in native thiol, disulfide, reduced thiol, oxidized thiol, glucose, ALT (alanine aminotransferase), ALP (alkaline phosphatase), total cholesterol, HDL (high-density lipoprotein), triglyceride, and BMI values between the preoperative, 2-month postoperative, and 6-month postoperative measurements (p<0.05). Restrictive methods such as sleeve gastrectomy in individuals with morbid obesity led to weight control and a decrease in adipose tissue, reducing oxidative stress and increasing antioxidant response.

Investigation of the effects of antimicrobial peptides and vitamin D in breast cancer

Breast cancer is the most common cancer in women. In recent years, there have been studies on the effectiveness of cathelicidins, one of the antimicrobial peptides, especially in breast cancer. Cathelicidin expression is regulated by a rather complex mechanism. Under normal conditions, vitamin D induces the release of cathelicidin from human neutrophils via Neutrophil Elastase (NE). Elafin, on the other hand, inhibits cathelicidin as a Neutrophil Elastase inhibitor. However, the effect of these molecules on tumor progression is unclear. In our study, we aimed to investigate the effects of vitamin D and Elafin on cathelicidin in breast cancer patients. Cathelicidin, Elafin, and Vitamin D Receptor levels in the pre and post-operative blood samples of control patients and patients diagnosed with breast cancer were analyzed by western blot method. According to our findings, it was observed that cathelicidin levels were especially high and elafin levels were low in the preoperative group. Since an inflammatory environment occurs in the presence of a tumor, there is an increase in vitamin D receptors and elafin in the postoperative group. It was thought that the low Elafin in the preoperative group caused vitamin D to secrete more Cathelicidin and increased the progression of the tumor, but the formation of cathelicidin was inhibited due to the increase in Elafin levels in the postoperative period. Thus, it was concluded that cathelicidin, which has an effect on the development of breast cancer, can be controlled by Elafin and Vitamin D receptors.

Next-generation sequencing-based liquid biopsy may be used for detection of residual disease and cancer recurrence monitoring in dogs.

The purpose of this study was to evaluate the performance of a next-generation sequencing-based liquid biopsy test for cancer monitoring in dogs. Pre- and postoperative blood samples were collected from dogs with confirmed cancer diagnoses originally enrolled in the CANcer Detection in Dogs (CANDiD) study. A subset of dogs also had longitudinal blood samples collected for recurrence monitoring. All cancer-diagnosed patients had a preoperative blood sample in which a cancer signal was detected and had at least 1 postoperative sample collected. Clinical data were used to assign a clinical disease status for each follow-up visit. Following excisional surgery, in the absence of clinical residual disease at the postoperative visit, patients with Cancer Signal Detected results at that visit were 1.94 times as likely (95% CI, 1.21 to 3.12; P = .013) to have clinical recurrence within 6 months compared to patients with Cancer Signal Not Detected results. In the subset of patients with longitudinal liquid biopsy samples that had clinical recurrence documented during the study period, 82% (9/11; 95% CI, 48% to 97%) had Cancer Signal Detected in blood prior to or concomitant with clinical recurrence; in the 6 patients where molecular recurrence was detected prior to clinical recurrence, the median lead time was 168 days (range, 47 to 238). Next-generation sequencing-based liquid biopsy is a noninvasive tool that may offer utility as an adjunct to current standard-of-care clinical assessment for cancer monitoring; further studies are needed to confirm diagnostic accuracy in a larger population.

Qualitative and quantitative analysis of post-operative drainage: pilot study.

Surgical drains can be placed after an operation to collect postoperative blood loss. However, these could be overestimated. Indeed, the fluid elapsed after the first postoperative day would no longer be pure blood. An early withdrawal of redon could then be considered. A monocentric prospective study of 25 patients undergoing total knee or primary hip replacement surgery, for osteo-arthritis, was conducted. Redon flow was evaluated in total volume and in composition by the sedimentation study. A qualitative analysis of the content of the redon was also carried out. To compare the elements found in the drained liquid with the blood data, a preoperative and two postoperative blood samples were taken. 18 TKA and 7 THA were included. A qualitative analysis of the postoperative flow of 11 TKA and 5 THA was requested. Decreases of sedimentation volumes and protein levels were found in the drained liquid compared to the blood for both TKA and THA. Our results tend to prove that on postoperative D1, the liquid drained in the redon would be blood, but that the liquid drained on D2 and D3 would be a mixture of blood and serum. Therefore, the real postoperative blood loss would be overestimated.

Effect of Surgery on Postoperative Levels of the Gut Homeostasis-Regulating Enzyme Intestinal Alkaline Phosphatase.

Intestinal homeostasis is a crucial factor for complication-free short- and long-term postoperative recovery. The brush border enzyme intestinal alkaline phosphatase (IAP) is an important regulator of gut barrier function and intestinal homeostasis and prevents endotoxemia by detoxifying lipopolysaccharides (LPSs). As IAP is predominantly secreted by enterocytes in the duodenum, we hypothesized that pancreaticoduodenectomy (PD) leads to a significantly stronger decrease in IAP than other major abdominal surgery. Pre- and postoperative blood, stool, and intestinal samples were collected from patients undergoing PD, as well as other major surgical procedures without duodenectomy. The samples were analyzed using enzyme histochemistry, the para -nitrophenyl phosphate method for IAP, and the limulus amebocyte lysate assay for LPS. Overall, 88 patients were prospectively enrolled in the study. Fecal IAP activity negatively correlated with serum LPS (r = -0.3603, p = 0.0006). PD led to a significant decline in IAP compared to preoperative baseline levels (p < 0.0001). The decline in IAP correlated with the length of proximal small intestinal resection (r = 0.4271, p = 0.0034). Compared to controls, PD was associated with a much more pronounced reduction in IAP-also after adjusting for surgical trauma (operative time, blood loss; r = 0.4598, p = 0.0086). Simultaneously, PD triggered a clearly more prominent increase in serum LPS compared to controls (p = 0.0001). Increased postoperative LPS was associated with an elongated hospitalization (r = 0.7534, p = 0.0062) and more prominent in pancreatic cancer (p = 0.0009). Based upon the functional roles for IAP, supplementation with exogenous IAP might be a new treatment option to improve short- and long-term outcome after PD.

Estimation of Titanium Levels in Blood Following Reconstruction of Post-Craniotomy Defect by Titanium Mesh Using Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES).

Titanium and its alloys are the most popular choice of materials for the reconstruction of craniofacial defects. They have lighter weight and are nonferromagnetic, which makes them an advantage in cranial defect reconstruction. Although the formed oxide layer makes them corrosion-resistant, levels of titanium in blood have been seen in trace amounts. This is the first study as per authors' knowledge that a study of such kind has been conducted. A pilot study was carried out at a tertiary level hospital, considering the inclusion and exclusion criteria in patients who were planned for the reconstruction of the residual defect using titanium mesh. Preoperative and 03- and 06-months postoperative blood samples were collected and analyzed for estimating the levels of titanium ions in blood by inductively coupled plasma-optical emission spectroscopy (ICP-OES). Friedman's two-way analysis of variance by ranks was considered for testing of hypothesis summary, owing to the smaller sample size. The analysis suggested an increase in levels was minimal. Considering the asymptotic significances (two-tailed significance), a significance level was 0.050, which directed us to reject the null hypothesis. Pairwise comparison suggested the presence of negative values indicating steady increase in levels. Cluster analysis indicated that although minimal there is a cluster of difference in the values at all three stages. Continuous field information was used to determine the level with regard to the level of titanium at the three stages of study. The study revealed that the levels of titanium ions increase on prolonged contact with living tissues. The trace elements have to be analyzed at regular intervals. This first-of-the-time study if extended to larger sample size would reveal interesting facts.

Efficacy of adding nalbuphine to caudal bupivacaine for postoperative analgesia in children undergoing hypospadias repair surgery. Randomized controlled trial

ABSTRACT Background We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery. Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis. Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p < 0.001). The number of patients who needed postoperative supplemental analgesia was significantly lower in the nalbuphine group (p < 0.001). Total paracetamol consumption was significantly higher in the control group (p < 0.001). The FLACC and RASS were significantly lower in the nalbuphine group. Postoperative cortisol levels were lower in the nalbuphine group compared to the control group. Conclusions Adding caudal nalbuphine 0.1 mg/kg to bupivacaine 0.25% provides better postoperative pain control than bupivacaine alone in children undergoing hypospadias repair.