Preservation Group Research Articles

Resection strategy for colorectal liver metastasis focusing on intrahepatic vessels and resection margins.

We analyzed the impact of surgical margins and vessel preservation on the oncological outcomes of patients with colorectal liver metastases (CRLM). In this retrospective study, resected CRLM (n = 242) from 116 patients were assigned to one of the following groups: Group A, apart from vessels (n = 201); Group B, hepatic vein contact (n = 27); or Group C, Glissonean pedicle contact (n = 25). We analyzed the local recurrence rates (LRR) in each group. The total LRR and that in Groups A, B, and C were 11.6%, 10.4%, 7.4%, and 20%, respectively. In group A, R1 resections were associated with a significantly higher LRR than R0 resections (27.6% vs 7.6%, respectively; P = 0.001); however, the margin widths were not related to the LRR. In group B, the LRR for hepatic vein preservation and resection did not differ. In group C, the Glissonean pedicle preservation group had a higher LRR than the Glissonean pedicle resection group (66.7% vs 5.3%, respectively; P = 0.001). The 5-year overall survival rate of the local recurrence group (25%) was significantly lower than that of the no recurrence group (84%, P < 0.001) and the intrahepatic recurrence group (60%, P = 0.026). R0 resections for CRLM, apart from those involving vessels, can achieve local control. While preserving hepatic vein contact with CRLM is acceptable, the Glissonean pedicle should be resected because of the higher LRR.

Bladder preservation versus radical cystectomy in transitional cell carcinoma and squamous cell carcinoma muscle invasive bladder cancer.

Background:Randomizing patients to bladder preservation or radical cystectomy (RC) for the treatment of bladder cancer has not been practical, due to patient and physician preferences. Therefore, continually comparing the 2 treatment modalities is needed, in order to make the proper choice for each patient.Patients and methods:The records of T1–4N0M0 bladder cancer patients, who presented to the South Egypt Cancer Institute between 2007 and 2017 and were treated by either bladder preservation or RC were reviewed.Results:Out of the 166 included patients, 81 (48.8%) patients were treated by bladder preservation and 85 (51.2%) patients had RC. For the patients treated by bladder preservation and the patients treated by RC, the 5-year overall survival (OS) was 56% and 60% (p = 0.67), the 5-year local recurrence-free survival was 69% and 73% (p = 0.69), and the 5-year disease-free survival was 45% and 53% (p = 0.16), respectively. After propensity matching analysis, the mean 5-year OS was 58% for the bladder preservation patients and 61% for the RC patients (p = 0.51). It is notable that among the bladder preservation group, 8 patients (10%) had squamous cell carcinoma (SCC) pathology and refused RC. Their OS was 56% compared to 53% for the SCC patients treated by RC (p = 0.6).Conclusion:Bladder preservation is a safe alternative to cystectomy in transitional cell carcinoma stages T1–4aN0M0, and its use in SCC bladder cancer should be further studied, as it could be feasible to spare them from initial cystectomy.

Hip-preserving surgery for nonunion about the hip.

Nonunions about the hip occur as a result of femoral neck, intertrochanteric, and certain subtrochanteric fractures. Treatment of a hip fracture nonunion allows for the choice between hip preservation or arthroplasty. The goal of this study was to examine outcomes of hip-preservation nonunion surgery METHODS: Patients who underwent hip preservation for a fracture nonunion of the femoral neck, intertrochanteric and subtrochanteric region to 1cm below the lesser trochanter over a 10-year period were identified in our nonunion registry. Patients were followed for a minimum of 1year. Functional outcomes were recorded at follow-up visits. For comparison regarding surgical and hospital outcomes, a group of 23 patients who underwent conversion total hip arthroplasties (cTHA) at the same academic medical center was reviewed. Quality measures such as length of stay, reoperation, and complications were collected. All statistics analysis utilized IBM SPSS 25 (Armonk, NY) RESULTS: Thirty patients who underwent 30 hip-preserving nonunion surgeries were analyzed and compared with 23 cTHA patients. Twenty-nine nonunions went on to heal (average time to union 6.3months). There was improvement in functional outcome scores for the hip preservation group between baseline and latest follow-up (p < 0.001). Reoperation was required in five patients (17%), including four failed to heal and required a second repair to gain union and one failure that was converted to THA rather than attempt a second nonunion repair. Hip preservation failures were older than those that healed with the index treatment (p = 0.11). There was no significant difference in hospital length of stay, complication rate, or need for reoperation when compared to cTHA group. Hip-preserving surgery is an option that should be considered for patients with nonunion of fractures about the hip. The rates of complications (20.3 vs 17.3%) and reoperation (16.7 vs 17.3%) were equivalent to conversion THA. Excellent outcomes can be achieved in terms of radiographic union and function with hip preservation.

Comparison of clinical outcomes associated with arthroscopic cyst wall preservation or resection in the treatment of popliteal cyst: a systematic review and meta-analysis.

Arthroscopy is commonly used to treat popliteal cysts, but the influence of the cyst wall on treatment outcomes remains controversial. The goal of this study was to compare clinical outcomes associated with arthroscopic cyst wall resection versus preservation in patients undergoing treatment for popliteal cysts. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases to identify all relevant articles published as of April 2020. STATA v15.1 was used for all statistical analyses. Relative risk (RR) and corresponding 95% confidence intervals (CIs) pertaining to study outcomes were calculated. Study heterogeneity was evaluated using the I2 statistic and the χ2 test, with I2 > 50% and P < 0.10 as respective significance threshold values. The risk of bias was gauged with the Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa Scale (NOS). In total, 18 relevant studies were included in this meta-analysis, of which 16 were observational studies and 2 were randomized controlled trials (RCTs). These studies included 573 total patients, of whom 346 underwent arthroscopic cyst resection and 227 underwent arthroscopic cyst preservation. Pooled analyses revealed that clinical outcomes (RR = 0.98, 95% CI 0.94-1.00) and postoperative recurrence rates (RR = 0.90, 95% CI 0.85-0.95) were significantly better among patients that underwent cyst wall resection relative to those that underwent cyst wall preservation (RR = 0, 95% CI 0-0.02 and RR = 0.05, 95% CI 0.02-0.10, respectively). However, complications occurred more often in the cyst wall resection group relative to the cyst wall preservation group (RR = 0.05, 95% CI 0.01-0.12 vs. RR = 0.01, 95% CI 0-0.03). Sensitivity analyses confirmed the stability of these pooled results, and we detected no significant risk of publication bias. Relative to cyst wall preservation, popliteal cyst wall arthroscopic resection can yield more satisfactory clinical results and decrease rates of recurrence, but can also increase the incidence of complications. Future prospective studies comparing the outcomes associated with cyst wall resection and preservation will be required to validate our results.

Translobar Phenomenon of Pulmonary Veins and Its Clinical Significance in Lobectomy

背景与目的肺叶切除术是早期肺癌的主要治疗方式，然而肺部解剖变异繁多，尤其是部分肺静脉会脱离正常解剖位置，甚至跨越肺叶边界进入相邻肺叶，这增加了手术的难度和风险。本研究旨在全面分析肺跨叶静脉的类型和发生频率，并进一步探究其在肺叶切除术中的临床意义。方法纳入南京医科大学第一附属医院2018年12月-2019年11月期间行肺部手术的患者916例，筛选出术前行胸部增强计算机断层扫描（computed tomography, CT）检查的病例310例，应用这些患者的胸部增强CT和三维CT支气管血管成像（three-dimensional computed tomography bronchography and angiography, 3D-CTBA）对跨叶静脉的类型及频率进行分析。进一步从916例手术病例中筛选出行肺叶切除术且手术区域涉及到跨叶静脉的病例共48例（切断组36例，保留组12例），通过手术录像观察两种不同的处理方式对余肺叶的影响。结果共发现26种肺跨叶静脉模式，总发生率为82.26%，右肺远大于左肺（80.65% vs 11.94%）。右肺中主要类型（频率 > 5%）包括：中间支气管后方汇入下肺静脉的VX2（5.48%）、汇集上、下叶静脉属支的叶间静脉V3b（58.39%）、水平裂内汇入V2（13.23%）或V3（12.58%）的VX4、中叶支气管下方汇入左心房的VX4（8.71%）或VX5（7.42%）、肺裂内汇入V2的VX6（29.68%）；左肺中主要类型为整支上肺静脉汇入下肺静脉形成共干的左肺静脉（9.36%），其中共干长度 > 1 cm的占4.84%。观察手术录像发现：与保留组相比，切断组中患者其余肺叶的血液循环功能受到影响（表现为受影响区域停止通气后长时间无法萎陷），术后咯血（13.89% vs 0.00%）和肺漏气（19.44% vs 8.33%）发生率增加，术后住院时间[(4.72±1.86) d vs (3.92±1.62) d]较长，术后3 d引流量[(705.42±265.02) mL vs (604.92±229.64) mL]较多，但差异无统计学意义（P > 0.05）。结论肺静脉跨叶现象种类繁多，且部分类型发生率较高。然而大部分跨叶静脉在手术中被忽视，这可能对手术安全和患者术后恢复产生不利影响。

Echocardiographic comparison between pulmonary valve preservation and transannular patch techniques in children with repaired Tetralogy of Fallot

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Many centers have recently adopted pulmonary valve (PV) preservation procedures to prevent the detrimental long-term effects of chronic pulmonary regurgitation after tetralogy of Fallot (ToF) repair. PURPOSE The aim of our study was to investigate pulmonary valve (PV) and right ventricular function by echocardiography in paediatric patients with repaired Tetralogy of Fallot (ToF), comparing PV preservation surgical strategies to standard transannular patch (TAP) repair. METHODS All patients undergoing transatrial-transpulmonary repair for ToF at our institution between January 2007 and May 2020 were reviewed retrospectively. Patients were divided into 2 main groups, according to the different techniques used: patients undergoing a PV preservation strategy and patients undergoing TAP repair. All patients underwent standard echo-Doppler study including RV end-diastolic area (RVEDA), end-systolic area (RVESA), fractional area change (FAC) and TAPSE; PR was assessed by Color Doppler, continuous-wave (CW) Doppler and derived parameters such as pressure half time (PHT) and pulmonary regurgitation (PR) index. By speckle tracking we measured also, in a subgroup of patients, right atrial strain (RAS), RV and left ventricle (LV) global longitudinal strain (RVGLS, LVGLS) and their time to peak (TTP) values. RESULTS Overall, 82 patients underwent a successful PV preservation strategy while 34 underwent a standard TAP repair. At index surgery, BSA (0.31 ± 0.1 m2, P = 0.3), age (4.8 ± 0.3 months, P = 0.5) and preoperative PV Z-score (-3.20 ± 0.1, P = 0.1) did not different between groups. Five-year actuarial freedom from moderate/severe PV regurgitation was significantly higher in the PV preservation group compared to the TAP (61.3% [95% CI: 48-73%] vs 25.9% [95% CI: 12-43%], respectively; p = 0.02). After adjusting for age, gender, BSA, and type of PV, the use of a TAP was still significantly associated with an increased risk for PV regurgitation at follow up (HR: 1.85, 95% CI: 1.09, 3.15; p = 0.02). At a mean follow-up of 6.9 ± 0.3 years, patients undergoing PV preservation showed an increased right ventricular fractional area change (46.9 ± 0.8% vs 42.5 ± 1.7%, P &amp;lt; 0.001) and tricuspid annular plane systolic excursion (TAPSE) z-score (-3.36 ± 0.3% vs -4.7 ± 0.4%, P = 0.005), while maintaining better PV competence in terms of pulmonary regurgitation index (87.9 ± 1.2% vs 82.7 ± 2.4%, P = 0.02). At speckle tracking subanalysis, patients undergoing PV preservation (n= 23), compared to the TAP group (n = 13) showed also higher values of RAS (37.5 ± 6.0% vs 29.3 ± 8.2% , P &amp;lt; 0.006), shorter right TTP (319 ± 39ms vs 357.5 ± 45.2 ms, P &amp;lt; 0.01) and higher values of LVGLS (-20,6 ± 4,2% vs -17.5 ± 3.0, P &amp;lt; 0.03). CONCLUSIONS Surgical repair of ToF with PV preservation provides excellent outcomes in terms of PV competence and right ventricular function and should be advocated whenever possible. Abstract Figure. Degree of pulmonary regurgitation

Antibacterial (Staphylococcus aureus and Escherichia coli) and Antifungal (Saccharomyces cerevisiae) Activity Assay on Nanoemulsion Formulation of Ethanol Extract of Mangosteen Leaves (Garcinia mangostana L.) as Fruit Preservative

Fruits after harvesting will decay faster if not handled properly. Fruits can be demaged by bacterial and fungal. Mangosteen leaves contain xanthons which are antibacterial and antifungal. 50% ethanol extract of mangosteen leaves is formulated in Nanoemulsion preparations using the SNEDDS (Self-Nanoemulsifying Drug Delivery System) method. The mangosteen leaves 50% ethanol extract nanoemulsion formulation consisted of VCO (Virgin Coconut Oil) as oil, tween 80 as surfactant, and PEG 400 as cosurfactant. There are 3 formulations with variations in the concentration of mangosteen leaves ethanol extract, there are concentrations of 1%, 2%, and 3%. All formulations have a T% of more than 90%. The results of the particles measurement of nanoemulsion using PSA were in formulation 1 amounting to 16.1 nm; formula 2 is 16.7 nm; and formula 3 is 16.6 nm. The zeta potential characterization shows that formula 1 has a zeta value of -40.9 mV. The three formulations had a pH of 5. The largest inhibitory zone in the mangosteen leaf ethanol extract against S.aureus and E. coli bacteria were 11.08 mm and 5.87 mm respectively. Whereas in the S. cerevisiae antifungal test there was no inhibition zone at all concentrations. In the antibacterial and antifungal tests nanoemulsion preparations did not produce inhibitory zones in each concentration. Nanoemulsion preparations can retain the quality of strawberries when compared to the non-nanoemulsion preservative group, both in room storage and refrigerator temperature. The best preservative result is when the fruit is coated with nanoemulsion preservative and stored in refrigerator temperature.

A Comparison of Pronator Quadratus Preservation and Dissection Approaches for Volar Plating of Comminuted Intra-articular Distal Radius Fracture.

Although the pronator quadratus (PQ) preservation approach for volar plating of distal radius fracture has been commonly used recently, its superiority to the conventional PQ dissection approach, especially for comminuted intra-articular distal radius fractures, has not been well established. The purpose of this study was to assess the efficacy of PQ preservation for comminuted intra-articular fractures and to evaluate the healed PQ during hardware removal surgery. From January 2014 to March 2019, 86 patients who underwent both volar plating for AO Foundation/Orthopedic Trauma Association classification type C2 or C3 distal radius fractures and subsequent hardware removal were assessed in this study. Radiographic measurements, clinical outcomes at each follow-up, and the integrity of healed PQ during hardware removal were compared between the PQ dissection (group D) and PQ preservation (group P) groups. Complete union with acceptable reduction on radiographic measurements was achieved in both groups. Group P showed a statistically significant earlier recovery of clinical outcomes at 2 weeks and 1 month postoperatively and improved anatomical restoration of PQ muscle covering the plate, which was identified during hardware removal surgery. Flexor tendon rupture was identified in 2 patients (5%) and tenosynovitis in 6 patients (14%) in group D; no patient had flexor tendon rupture (0%), and 2 patients (5%) had tenosynovitis in group P. Pronator quadratus preservation approach for volar plating is easily applicable and useful even for comminuted intra-articular distal radius fractures and is helpful for earlier restoration of wrist function and in preventing flexor tendon problems in the latter postoperative period.

A propensity score matching study of the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy.

To evaluate the short-term efficacy of azygos arch-sparing McKeown minimally invasive esophagectomy (McKeown-MIE). We retrospectively analyzed the clinical data of 221 patients with thoracic esophageal squamous cell carcinoma who underwent McKeown-MIE at the Department of Thoracic Surgery of Gaozhou People's Hospital from August 1, 2017 to September 30, 2019. According to whether the azygos arch was preserved or not, the patients were assigned to one of two groups: the preservation group (40 cases) and the ligation group (181 cases). Within 3 months of the operation, the perioperative outcomes and the postoperative short-term efficacy of the two groups were compared. After propensity score (PS) matching, 40 pairs of patients were matched successfully. Between the two groups, there were no statistical difference in intraoperative blood loss, the number of lymph nodes dissected, thoracic drainage duration, fasting time, postoperative hospital stay time, and major postoperative complications (P>0.05). Compared with the ligation group, patients in the preservation group had a shorter intensive care unit (ICU) stay time, a shorter operative time, a lower volume of postoperative thoracic drainage (both the first 3 days and overall) following surgery, a tubular stomach that had a smaller caliber, and a lower incidence of tubular gastric malpositioning (P<0.05). Preserving the azygos arch during a McKeown-MIE is safe and feasible. Doing so, not only effectively restricts the expansion of the gastric conduit, leading to a lower incidence of malpositioning, but also dramatically reduces postoperative thoracic drainage, and ICU stay time.

A comparison of short-stem prostheses and conventional stem prostheses in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

BackgroundIn total hip arthroplasty (THA), short-stem prostheses (SS) were designed to achieve better preservation of proximal femoral bone stock and stability than conventional stem prostheses (CS), however these effects are controversial. We aimed perform a systematic review and meta-analysis to evaluate the effectiveness of SS and CS in primary THA.MethodsRelevant randomized controlled trials (RCTs) involving the comparison of SS and CS in primary THA were screened using the electronic databases PubMed, Embase and Web of Science. Data were analyzed with the RevMan 5.3 software program and evaluated with mean difference (MD), risk ratio (RR) and 95% confidence intervals (CIs) by random or fixed-effect models.ResultsSixteen RCTs involving 1,233 patients (1,486 hips) were included. Compared with CS, the incidence of thigh pain was significantly reduced with Proxima SS (RR 0.13, 95% CI, 0.03–0.51; P=0.004). Bone mineral density (BMD) with femoral neck-preserved SS [SS (I)] showed less decrease in Gruen zone 1 (MD 14.60, 95% CI, 10.67–18.54; P<0.00001) and Gruen zone 7 (MD 9.72, 95% CI, 5.21–14.23; P<0.0001) than CS. However, the changes of BMD were not significantly different between the SS without femoral neck preservation group [SS (II)] and the CS group. In addition, no significant differences were found in the revision rate, Harris Hip Score (HHS), or maximum total point motion (MTPM) between the SS and CS groups.ConclusionsThe results of this study showed that compared with CS, Proxima SS decreased the incidence of thigh pain and that SS (I) provided better proximal bone remodeling than CS. But the revision rates, HHS, and MTPM between SS and CS were similar. However, the findings of this meta-analysis require further verification in high-quality RCTs.

Life-Extending Benefit of Chip Sealing for Pavement Preservation

Chip seals are effective pavement preservation treatments that are usually applied to address non-fatigue cracking, weathering, and raveling, to seal the surface, to delay oxidation, and, finally, to improve skid resistance. This study used field performance data of test sections from the Pavement Preservation Group Study being conducted by the National Center for Asphalt Technology and the Minnesota DOT’s Road Research Facility. Data from test sections located in a low-traffic-volume road with a hot, wet, no-freeze climate collected over a period of 7 years were used to evaluate the effect of several chip seal treatments. Treatments range from single layer to multilayer systems, and include different construction techniques such as rejuvenating scrub seal and fiber membrane. Also, a section was crack sealed before the application of a single layer chip seal to assess the benefits. A semi-parametric survival analysis was performed to determine the differences in median time to failure (MTTF) for different chip seal sections versus a controlled section—representing a “do-nothing” scenario. The results showed that the MTTF for a single layer chip seal ranges from 6.8 to 9.1 years depending on the pretreatment condition. Crack sealing before chip seal could extend the MTTF by an additional 1–3 years, depending on initial conditions. Double and triple layer chip seals extend the MTTF beyond 10 years. Finally, the scrub seal provided the highest benefits, with survival rates close to 100% after 10 years of performance.

Direct splenic vein reconstruction combined with resection of the portal vein/superior mesenteric vein confluence during pancreaticoduodenectomy.

Splenic vein (SV) ligation combined with portal vein (PV)/superior mesenteric vein (SMV) confluence resection during pancreaticoduodenectomy (PD) is reported to cause left-side portal hypertension (LPH). The purpose of this study was to present our technique of the SV reconstruction and to evaluate the surgical outcomes with/without SV ligation during PD. Twenty-four patients undergoing PD with PV and/or SMV resection and being followed over 4 months after surgery between March 2013 and December 2019 in our hospital were evaluated. Resection of the PV/SMV confluence were performed in 14, and SV reconstruction was successfully performed in 3. Presence of LPH was assessed by examining changes in splenic volume, newly venous collateral formation, and platelet counts before and 4-8 months after PD. Surgical technique is the direct anastomosis between SV and PV. Splenic volume ratio was significantly higher in the SV ligation group (n = 11) than in the SV preservation group (n = 13) (median (range) 1.11 (0.57-1.62) vs. 1.68 (1.05-2.22), p < 0.01), but no significant differences were found in the incidence of newly formed venous collaterals or platelet counts between groups. SV ligation may represent the cause of LPH after PD combined with resection of PV/SMV confluence. Our simple procedure may help decrease the incidence of LPH.

Gluteus Minimus Debridement During Acetabular Fracture Surgery Does Not Prevent Heterotopic Ossification-A Comparative Study.

To compare rates of heterotopic ossification (HO) after acetabular fracture surgery, through a posterior approach, with and without gluteus minimus muscle (GMM) debridement. Retrospective comparative study. Single academic Level I trauma center. Ninety-four patients in the GMM preserved group and 42 patients in the GMM debrided group met inclusion criteria. GMM preservation or debridement during acetabular fracture surgery through a single-posterior approach. Primary outcomes were incidence and severity of HO. Reoperation for HO excision was assessed. Other risk factors for severe HO (Brooker class III-IV) were secondarily assessed using multivariable logistic regression analyses. Odds ratios (ORs) with 95% confidence intervals were calculated. The significance was set at P-value ≤ 0.05. There was no difference in the incidence or severity of HO between the debrided and preserved groups. Rates of reoperation for HO excision were comparable. American Society of Anesthesiologists physical status class (OR = 3.3), head injury (OR = 4.6), and abdominal injury (OR = 4.5) were associated with severe HO. GMM debridement was not associated with a decreased incidence of HO after acetabular fracture surgery. American Society of Anesthesiologists class is a novel risk factor associated with severe HO formation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anterior Bilateral Sacrospinous Fixation With Transvaginal Mesh: Is Hysterectomy a Risk Factor for Complications?

The aim of the study was to evaluate the effect of hysterectomy on the risk of complications from transvaginal pelvic organ prolapse surgery with mesh. We conducted a retrospective cohort study between October 2010 and December 2017. Transvaginal mesh surgery was performed in patients with symptomatic anterior and/or apical prolapse (Pelvic Organ Prolapse Quantification ≥ stage 2). The primary outcome was rate of severe surgical complications based on the Clavien-Dindo classification (defined as grade ≥3), and the secondary outcome was the anatomical success at the last postoperative follow-up visit. Three hundred and ninety-six patients were included, 289 of these patients underwent anterior sacrospinous fixation with uterine preservation, 50 had a previous hysterectomy and 57 underwent a concomitant hysterectomy. The median follow-up was 12 months (interquartile range, 7 months). The rate of severe complications was 2.1%, 6.0%, and 5.3% in the uterine preservation group, previous hysterectomy group, and concomitant hysterectomy group, respectively (P = 0.2). The operative time was significantly higher in the concomitant hysterectomy group, and the mesh exposure rate was significantly higher in the previous hysterectomy group. The overall recurrence rate was 7.6%, with no differences between the study groups. Concomitant and previous hysterectomy did not appear to increase the severe complication rate or anatomical failure after transvaginal mesh surgery. However, a history of hysterectomy appears to be a risk factor for vaginal mesh exposure. This must be considered in the choice between prosthetic and autologous management options for the treatment of posthysterectomy vault prolapse.

Risk Evaluation of Human Corneal Stromal Lenticules From SMILE for Reuse.

To investigate the pathogenicity and immunogenicity of human corneal stromal lenticules from small incision lenticule extraction (SMILE). Serological testing was completed prior to sample collection to rule out infectious diseases. Pathogens herpes simplex viruses (HSV) type 1 and type 2 were screened for by real-time fluorescent quantitative polymerase chain reaction, and bacteria, fungi, and Acanthamoeba from 128 lenticules of 64 patients were cultured. A total of 132 lenticules from 93 patients were randomly assigned to the fresh group, -78 °C anhydrous glycerol preservation group (glycerol group), and 0.1% sodium dodecyl sulfate decellularization group (SDS group) in pairs and detected by immunohistochemistry, Western blot, transmission electron microscopy, transmittance, and nanoindentation. The fresh lenticules were all negative for HSV-1, HSV-2, bacteria, fungi, and Acanthamoeba. HLA-I A/B/C and HLA-II DR antigens were all expressed in fresh lenticules but were clearly reduced after preservation at -78 °C in anhydrous glycerol or decellularization in 0.1% SDS. The collagen fibers of the lenticules in the fresh group were regularly arranged, and the keratocytes were intact. The fibers in the glycerol group were regularly arranged, and the integrity of keratocytes was destroyed. The fibers in the SDS group were disordered and had no cellular structure. The transmittance and Young's modulus were highest in the fresh group, lower in the glycerol group, and lowest in the SDS group. Risk of infection is low, but risk of rejection exists on the reuse of fresh human corneal stromal lenticules from SMILE. Anhydrous glycerol preservation at -78 °C is an ideal method for reducing antigens without damaging the structure and function of lenticules. [J Refract Surg. 2021;37(1):32-40.].

Preservation of the Arterial Arc Formed by Left Colic Artery, Proximal Inferior Mesenteric Artery, and the First Branch of Sigmoid Arteries in Anus Saving Treatment of Low Rectal Cancer

Low anterior, ultralow anterior, and intersphincteric resection are conventional, elective anus-sparing techniques for low rectal cancer, and good prognosis depends on a good blood supply and tension-free anastomosis. The goal is to assess the effect of preserving the arc formed by the left colic and proximal inferior mesenteric arteries (IMAs), and first branch of the sigmoid arteries on the anastomotic blood supply, tension, and leakage rate in anus-sparing surgery for low rectal cancer. From 2011 to 2020, a patient with low rectal cancer resection was distributed into the ligation group (42 cases with inferior mesenteric artery ligation) and the preservation group (61 cases with preservation of the left colic and proximal IMAs and first branch of the sigmoid artery). We evaluated patient characteristics, operative results, morbidity, and postoperative follow-up results. There were comparable outcomes between ligation and preservation groups in relations to the number of patients in each operative procedure, duration of surgery, operative blood loss, postoperative hospital stay, and the number of patients with protective stoma (P >.05). In postoperative morbidity, there were similar outcomes between ligation and preservation groups in terms of anastomotic subclinical dehiscence, bleeding and stricture, and urinary retention (P >.05). There were significant differences in anastomotic leakage and intra-abdominal abscess (P < .05). Preservation of the arterial arc formed by left colic artery, proximal IMA, and the first branch of sigmoid arteries with apical lymph node dissection could increase anastomotic blood supply, reduce anastomotic tension, and leakage rate in anus-saving treatment of low rectal cancer.

Clinical study on preserving right gastroepiploic vein during laparoscopic right hemicolectomy

Objective: The operative approach and steps of laparoscopic right hemicolon cancer radical resection have been standardlized and professional consensus has been reached. However, some detailed issues such as the handling of Henle's trunk and whether to preserve the right gastroepiploic vein (RGEV) still remain controversial. This study investigates the safety, feasibility, short- and long-term outcomes of preserving RGEV during laparoscopic right hemicolectomy. Methods: A retrospective cohort study was carried out. Clinical data of 92 patients undergoing laparoscopic right hemicolectomy in Taizhou People's Hospital from March 2016 to May 2018 were retrospectively analyzed. All the patients were treated with complete mesocolon resection (CME) and had complete postoperative pathological data and follow-up data. Based on the tumor location, 49 patients preserved RGEV (preservation group) and 43 did not (non-preservation group). Pathological data, postoperative complications, short- and long-term outcomes were compared between the two groups. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No significant differences were found in operation time, intraoperative blood loss, unplanned reoperation, anastomotic leak, number of harvested lymph nodes, number of metastatic lymph node, and time to food intake after surgery between two groups (all P>0.05). Compared with non-preservation group, the preservation group had faster recovery of anal gas passage after operation [(3.1±1.0) days vs. (4.0±1.7) days, t=-2.787, P=0.007], shorter length of hospitalization [(11.5±1.5) days vs. (15.0±7.9) days, t=-2.823, P=0.007], and reduced the hospitalization expenses [(46 000±5000) yuan to (57 000±33 000) yuan, t=-2.076, P=0.044]. No postoperative gastroparesis (PGS) occurred in the preservation group, while 6 cases in the non-preservation group developed gastroparesis during perioperative period (P<0.05). The median time of follow-up time was 31.8 (5.2-43.7) months. The overall survival time of the preservation group and non-preservation group was (35.4±1.8) months and (37.6±1.7) months, respectively without significant difference (P=0.336); the disease-free survival was (32.0±2.2) months and (35.5±2.0) months, respectively without significant difference as well (P=0.201). Conclusions: Dissection of the Henle's truck and preservation of RGEV is safe and feasible during laparoscopic right hemicolectomy, which can significantly reduce the incidence of postoperative gastroparesis, shorten the recovery time of postoperative intestinal function and hospitalization, and decrease the cost of hospitalization. The efficacy of RGEV preservation is similar to non-preservation of RGEV.

Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial

BackgroundUrinary incontinence and sexual dysfunction are common after robot-assisted radical prostatectomy (RALP). New surgical techniques to improve these functions after the operation are under evaluation for example, preservation of endopelvic fascia during RALP. However, the benefits of this technique have not been critically scrutinized in a randomized setting. AimIn this study, we compared endopelvic fascia preserving operation with the standard surgical procedure in a randomized trial at the Tampere University Hospital, Finland. MethodsA total of 158 men with localized prostate cancer and scheduled for RALP were randomized 1:1 into endopelvic fascia–preserving RALP or a control group that is, standard operation. All operations were performed by a single surgeon. OutcomesUrinary and sexual function were evaluated by the Expanded Prostate Cancer Index Composite-26 questionnaire at baseline and 3, 6, and 12 months after the surgery. ResultsThere was no difference in urinary incontinence or sexual function between the groups at any time point (urinary incontinence domain at 12 months after RALP for fascia preserving and control group 73.6 ± 3 vs 78.9 ± 2.5 and sexual domain 43 ± 3.2 vs 40.3 ± 3, respectively). Clinical and pathologic tumor characteristics, duration of surgery, blood loss, rate of complications, and time to hospital discharge were similar between the study arms. Compliance of filling out the Expanded Prostate Cancer Index Composite-26 questionnaire varied from 91% to 98%, with no difference between study arms. Clinical ImplicationsBased on our results, endopelvic fascia preservation alone during RALP is not recommended over the standard surgical method. Strengths & LimitationsThis is a randomized clinical study with sufficient statistical power. As a limitation, only a minority of participants underwent magnetic resonance imaging before the operation, thus we could not evaluate the role of urethral length or shape of the prostate. Urinary and sexual function results are based on questionnaires filled out by the patients, however, participants completed the surveys independently unassisted by health care personnel. ConclusionEndopelvic fascia–preserving RALP does not improve urinary continence or sexual function as compared with the standard surgical technique. Future studies aiming to improve functional outcomes after RALP should focus on evaluating other technique modifications.Siltari A, Riikonen J, Murtola TJ. Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function – A Randomized Clinical Trial. J Sex Med 2021;18:327–338.

Preliminary Study of Standard Artificial Temporomandibular Joint Replacement With Preservation of Muscle Attachment

To evaluate the effect of preserving the muscle attachments when performing standard artificial temporomandibular joint replacement (TJR). The clinical and radiological imaging data of patients who underwent standard artificial TJR with and without preservation of lateral pterygoid muscle (LPM) and masseter muscle attachments from January 2017 to December 2019 were collected. The maximum interincisal opening (MIO), lateral excursions and protrusion distances, visual analogue scale (VAS) scores of pain, diet, and quality of life (QoL) were recorded before the operation, and 1, 3, 6, and 12months after the operation. The volumes of LPM and masseter muscles were measured and analyzed by computed tomography (CT) scans. Twenty-seven patients with 36 joints were included in the study. Among them, 11 joints had muscle attachment preserved, and 25 had no muscle attachment preserved. After surgery, the MIO, lateral excursions, and scores of diet, pain, and QoL in the preserved muscle attachment group were significantly better than those in the unpreserved group (P<.05). The measurement volumes of LPM and masseter muscles in the preserved group were significantly larger than that in the unpreserved group (P<.05). Changes of lateral excursion from the TJR side with and without LPM preservation were statistically correlated with the LPM volume (P<.05). Preserving muscle attachment for the standard artificial TJR is beneficial to the recovery of postoperative mandibular function.

A clinical study of post cataract surgery epiphora in relation to the type of cataract surgery and different types of post-operative topical medication

Aim: To assess incidence, determinants and outcome of epiphora after cataract surgery. Methods: 650 eyes having uncomplicated senile cataract were enrolled routine preoperative evaluation, underwent phacoemulsification (n=462) or SICS (n=188). Post-operatively, patients were randomized into 2 groups according to the preservative status of steroid antibiotic drops. Symptomatic patients were assessed at 5 weeks, using slit lamp, investigated using Fluoroscein Dye Disappearance Test (FDDT), sac syringing, probing and TBUT. Results: At 5 weeks, the incidence of epiphora after phacoemulsification was 7.1%, and that after SICS was 6.9%. 41.38% complained of epiphora after phacoemulsification, and 54.54% after SICS. There was no difference in epiphora after phacoemulsification using preservative free or preservative containing drops. Epiphora after SICS was more in the preservative group, compared to preservative free group (4.4%), which increased with frequency of dosage. Epiphora after phacoemulsification was significantly more-14% in patients above 70 yrs of age, as compared to 4% in younger patients, and more in the female population-10.5% of total females as compared to 3.8% of males. Epiphora after SICS was significantly more-26.7% in patients above 70 yrs of age, compared to 4% in younger patients, and more in the female population-9.5% of total females as compared to 1.94% of males. Conclusion: Epiphora occurs in 7% patients 5 weeks after cataract surgery, irrespective of phacoemulsification or SICS. It is significantly more in elderly age group and in females, after SICS was more with the use of preservatives, more frequent dosage and harder grade of cataract. Keywords: Epiphora, Post cataract, Preservative.