Standard Treatment Plan Research Articles

Analyzing factors associated with the receipt of surgery in clear cell sarcoma.

447 Background: Clear cell sarcoma (CCS) is a ultrarare soft tissue sarcoma, which is highly aggressive and associated with a poor prognosis. CCS is histologically characterized by clear cells, representative of intracellular glycogen accumulation. Primary tumors commonly arise from tendinous sheaths or aponeuroses in the upper and lower extremities—the most common site being around the ankles. Average age at diagnosis is 25 years old. 5-year survival is between 40 and 60%. CCS is the result of fusion gene EWSR1/ATF1. Multimodal therapy, including wide surgical excision with radiotherapy, is often used to treat CCS. Chemotherapy may be used if patients are not eligible for surgery. No significant study has analyzed the factors which predict the utilization of wide surgical excision. This study aims to describe the factors involved in the receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with CCS from 2004 to 2020 using histology codes 9044 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: 669 patients with CCS formed the initial sample. Of these patients, 466 patients (69.7%) received a surgical procedure of the primary site. Additionally, 14 patients (2.09%) received radiation and 69 patients (10.31%) received adjuvant chemotherapy. The receipt of surgery was associated with a marked increase in median survival ( 91.5 months vs. 8.525 months; p<0.05). Surgical resection with clear margins was achieved in 409 patients (61.14%), of whom experienced improved survival compared to patients with residual tumor burden. Each additional year of age in a patient conferred a 2.4% decrease in likelihood of the patient receiving surgery. Lower stage disease was significantly more likely to be treated surgically (OR 11.4; p<0.001), while stage IV disease and abdominal primary site tumors were associated with lower rates of surgery. Facility type (academic vs. nonacademic), insurance, or distance travelled for care had no effect on rates of surgery. Conclusions: As a significant portion of CCS patients receive surgical treatment, this study confirms that tumor resection is associated with increased overall survival of patients with CCS. Improved survival with surgery correlates with clear surgical margins and full tumor resection. It appears that patients are more likely to be treated surgically if their disease is of lower stage. Patients with abdominal primary site tumors or stage IV disease are less likely to receive surgery. This research serves as the beginning of developing standardized treatment plans for CCS patients. Further studies are needed to better understand the factors involved in receiving surgery and other treatment modalities as part of CCS treatment.

Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach.

Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], β = -0.42) and affective (B = -3.40 [-5.02, -1.80], β = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], β = -0.21) and affective (B = -1.97 [-5.07, -0.17], β = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], β = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.

Salivary Biomarkers and their Relationship with Periodontal Clinical Parameters: A Cross-Sectional Study

Background: Traditionally, periodontal clinical parameters are used to diagnose and design standardized treatment plans. The scientific literature has not widely reported the inclusion of salivary biomarkers in this diagnostic and therapeutic process. Objectives: To analyze the correlation between salivary biomarkers and periodontal clinical parameters of a group of patients undergoing the periodontal maintenance phase in a private dental office located in the southwest of Colombia. Material and Methods: A cross-sectional study was carried out. A sample of 92 patients undergoing the periodontal maintenance phase was analyzed. Conventional periodontal parameters were determined, and salivary biomarkers were measured by chromatography (cariogenic bacteria, acidity, buffering capacity, blood, and erythrocytes). To determine its correlation, a bivariate statistical analysis was developed. Results: According to Spearman's correlation matrix, among the periodontal clinical parameters, there were statistically significant correlations between the extension and severity of the complete and proximal attachment loss (r=0.93) and between the bleeding on probing (BOP) and the plaque index (PI) (r= 0.37). Within the salivary biomarkers, a statistically significant correlation was found between acidity and the buffering capacity of saliva (r= -0.54); between buffering capacity and proteins (r=0.36); between blood and erythrocytes (r=0.42); between blood and proteins (r=0.58), and between erythrocytes and proteins (r=0.48). Finally, a statistically significant correlation between periodontal parameters and salivary biomarkers was observed between teeth lost due to periodontal disease and acidity (r=0.26) and between teeth lost and buffer capacity (r=0.30). Conclusion: Periodontal parameters and salivary biomarkers correlate with variables of the same group to which they belong. Still, only the variable teeth lost due to periodontal disease correlates with acidity and buffer capacity. The findings suggest that both periodontal parameters and salivary biomarkers should be evaluated throughout the periodontal process. It is possible that both parameters could express different moments of the pathophysiology of the disease.

Advances in Research on Risk Factors for Disease Progression in Advanced Prostate Cancer

Advanced prostate cancer has mostly lost the chance of surgery, and has a low 5-year survival rate and high mortality rate. Therefore, exploring the risk factors for advanced prostate cancer disease progression can help formulate scientific and standardized treatment plans and strategies for advanced prostate cancer disease progression. Intervention measures provide evidence to improve the quality of life and survival rate of patients. Based on the existing research reports at home and abroad, I reviewed the risk factors related to the progression of advanced prostate cancer.

Surgical Management in Isolated Squamosal Craniosynostosis: A Systematic Review.

Although craniosynostoses involving the major sutures have been well described, the frequency of isolated minor suture craniosynostoses is much lower. Squamosal craniosynostosis (SQS) is a rare form of cranial synostosis, and the paucity of literature has made the creation of a standardized treatment plan difficult. We present a systematic review of the literature on isolated SQS to identify disease characteristics that lead to a need for operative intervention and to delineate patterns in surgical management. A systematic literature review was performed using the electronic databases of PubMed, Scopus, and MEDLINE and the key words "squamosal AND craniosynostosis," "squamous AND craniosynostosis," "squamosal craniosynostosis, "squamosal suture craniosynostosis," and "isolated squamosal craniosynostosis." Only human studies that described presentation and management of SQS were included. A blinded, 2-reviewer analysis of the articles was performed. Data collected included patient and disease characteristics, imaging workup, and treatment specifics, which were analyzed by descriptive statistics. A total of 19 studies examining 119 patients with SQS were reviewed, with 97 (82%) multisutural cases and 22 isolated cases (18%). Of the isolated cases, 6 (27%) required surgical craniosynostosis repair, of which 1 (17%) had unilateral sutural involvement and 5 (83%) had bilateral involvement. Of the patients with isolated SQS, 7 (32%) had a congenital syndrome and comprised 33% of patients who required surgical intervention. The nonsyndromic patients with isolated SQS who required surgery presented with a wide array of phenotypic findings; 3 patients underwent some form of cranial vault remodeling, whereas 1 patient underwent ventriculoperitoneal shunt only. Of the 4 nonsyndromic patients with isolated SQS who underwent surgical repair, half required operative intervention because of elevated intracranial pressure and the other half because of dysmorphic head shape. The findings of this updated systematic review suggest a trend toward surgical management in bilateral SQS versus unilateral SQS, and that patients with isolated SQS, previously considered to be a nonsurgical finding, should be carefully monitored, as there remains risk of increased intracranial pressure. Pooled systematic review data suggest isolated SQS has a 27% operative intervention rate, with the presence of coexisting syndromic diagnoses increasing that risk.

Changing trends in central midface fracture – A proposal for revised classification and holistic management

BackgroundMidface fractures are one of the common facial fractures encountered in the current era. High energy impact injuries that lead to gross comminution of the midface warranting modification of the standard treatment plan, often cannot be categorized by existing classification systems. The aim of the current paper is to describe the changing trends in midface fracture patterns and propose a modification for the current classification system and describe the holistic approach for management. Materials and methodsA retrospective study was conducted at our center to include all the patients who reported to us for the management of maxillofacial trauma between 2020 and 2022. The details of the cause of facial trauma and pattern of injury, clinical presentation, diagnosis were retrieved from the medical records and the radiographic details including computed tomography details of the fracture pattern were tabulated for evaluation. The Fractures which could not be classified based on the classical Le fort fracture lines were isolated and were classified based on the current classification system and the modifications in the treatment plan and management were recorded. ResultsA total of 673 trauma cases reported between the given time frame. Out of which 205 were midface fractures. 109 patients from the foresaid group had central mid face fracture. 62 fractures of these cases could not be classified based on conventional Le fort classification due to fragmentation, bone loss and combination with other Le fort level injury of the opposite side of the midface and involvement of orbit/ anterior cranial fossa. The modified Le fort classification (Table 1) was used to reclassify these fractures and according to the same 12 cases of Le fort IA, 9 cases of le fort IB, 4 cases of Le fort IIA, 20 cases of Le fort IIB, 4 cases of Le fort IIIA, 9 cases of Le fort IIIB and 4 cases of Le fort IV fracture.The details of the management strategy along with the timing of repair are discussed. ConclusionWith continual rise in the high impact injuries, the pattern of midface fracture presentation is changing. Advanced fixation modalities that are currently available can be applied only when a precise diagnosis and planning can be performed. The current modification of the midface fractures provides a better insight in defining the fracture patterns which will enable the surgeon to plan the midface reconstruction adequately.

Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea

BackgroundInformation regarding incidence of treatment plan changes may be useful when discussing postoperative treatment plans for patients. Moreover, it may help establish a standardized postoperative treatment plan. This study aimed to evaluate the incidence of early complications requiring treatment plan changes in patients following vitreoretinal surgery and investigate its risk factors.MethodsThis single-center retrospective study included 465 patients who had undergone vitreoretinal surgery. The reasons, incidence, and timing of treatment plan changes within 14 days of surgery were identified. Potential factors associated with the changes, such as patient demographics, surgeon’s experience, diagnoses, and type of surgery were also analyzed.ResultsThe treatment plan was changed in 76 patients (16.3%) at a mean of 4.0 ± 3.2 days after vitreoretinal surgery. The reasons for the plan changes were increased intraocular pressure (IIOP) in 66(86.8%), intraocular inflammation in 2(2.6%), corneal edema in 3(3.9%), leakage from the sclerotomy wound in 3(3.9%) patients, and combined IIOP and intraocular inflammation in 2(2.6%). The date of discharge was postponed because of treatment plan changes in 17 patients (22.4%). The incidence of plan changes was higher in patients who underwent gas or oil tamponade (P < 0.001) and those who underwent surgery performed by less experienced surgeons (P = 0.034).ConclusionsTreatment plan was changed in 16.3% of patients after vitreoretinal surgery. The risk of treatment plan changes was associated with the surgeon’s experience in vitreoretinal surgery and the type of surgery. These results should be considered when establishing standardized care plans for patients who require vitreoretinal surgery.

Research Progress on the Mechanism and Treatment of Ferroptosis in Brain Glioma

Ferroptosis is a new type of programmed cell death discovered in recent years. It is a regulatory cell death induced by iron dependent lipid peroxide injury. Ferroptosis plays a critical role in the development of glioma, affecting tumor proliferation, angiogenesis, tumor cell necrosis, and the formation of an immune-resistant tumor microenvironment. Glioma is the most common intracranial malignant tumor, with the characteristics of high incidence rate, high recurrence rate, high mortality rate and low cure rate. At present, the main standard treatment plan is tumor surgical resection, synchronous radiotherapy and chemotherapy, etc. Because of the extremely low 5-year survival rate and high recurrence rate of glioma patients, new effective treatment strategies are expected. With the extensive study of regulatory cell death in malignant tumors, there is increasing evidence that iron death is closely related to the development and outcome of glioma. Inducing iron death becomes an attractive strategy for glioma treatment. In this paper, we summarize the research on this aspect and summarize it in gelatin. The mechanism of action and therapeutic research value of tumor are expected to develop new therapeutic strategies and provide a certain theoretical basis for the in-depth research in this field.

Bilateral anterior thalamic symmetrical infarction: a case study

BackgroundBilateral anterior thalamic symmetrical infarction is very rarely observed in clinical practice and has rarely been reported in the literature. In this paper we introduce a patient with bilateral anterior thalamic symmetrical infarction and discuss his symptoms, treatment process, and follow-up visit results, as well as the potential pathological mechanisms of the disease.Case presentation: A 71-year-old male had a sudden cognitive decline four days prior to medical consultation. The patient’s brain MRI showed symmetrical high signals in the anterior part of both sides of the thalamus. The patient’s head MRV and immunological tests were normal, and we considered that this patient had a rare case of bilateral anterior thalamic infarction. After 10 days of anti-platelet aggregation that lowered blood lipids and improved circulation, the patient’s symptoms significantly abated. Two years later, we found through telephone follow-up that the patient’s symptoms had not relapsed substantially and that he was able to perform self-care, having only continued to suffer a slight decline in short-term memory.ConclusionFor patients with bilateral prethalamic lesions who have only acute cognitive impairment, if the lesions conform to the blood supply area of both thalamic nodular arteries and DWI shows a high signal, the diagnosis of acute cerebral infarction should be considered, and the standard treatment plan for cerebral infarction should be given as soon as possible.

Measurements of fetal dose with Mevion S250i proton therapy system with HYPERSCAN.

To characterize potential dose to the fetus for all modes of delivery (dynamic adaptive aperture, static adaptive aperture, and no adaptive aperture) for the Mevion S250i Proton Therapy System with HYPERSCAN and compare the findings with those of other available proton systems. Fetal dose measurements were performed for all three modes of dose delivery on the Mevion S250i Proton therapy system with HYPERSCAN (static aperture, dynamic aperture and uncollimated). Standard treatment plans were created in RayStation for a left-sided brain lesion treated with a vertex field, a left lateral field, and a posterior field. Measurements were performed using WENDI and the RANDO with the detector placed at representative locations to mimic the growth and movement of the fetus at different gestational stages. The fetal dose measurements varied with fetus position and the largest measured dose was 64.7 μSv per 2 Gy (RBE) fraction using the dynamic aperture. The smallest estimated fetal dose was 45.0 μSv per 2 Gy (RBE) at the base of the RANDO abdomen (47 cm from isocenter to the outer width of WENDI and 58.5 cm from the center of the WENDI detector) for the static aperture delivery. The vertex fields at all depths had larger contributions to the total dose than the other two and the dynamic aperture plans resulted in the highest dose measured for all depths. The reported doses are lower than reported doses using a double-scattering system. This work suggests that avoiding vertex fields and using the static aperture will help minimize dose to the fetus.

Mesenchymal stem cells: a trojan horse to treat glioblastoma

Glioblastoma multiforme (GBM) is the most common and lethal primary tumor of the central nervous system. What makes it so dreadful is the very low survival rate, despite the existence of a standard treatment plan. An innovative and more effective way to treat glioblastoma based on Mesenchymal Stem Cells (MSCs) has been explored recently. MSCs are a group of endogenous multipotent stem cells that could mainly be harvested from adipose tissue, bone marrow, and umbilical cord. Having the ability to migrate toward the tumor using multiple types of binding receptors, they could be used either as a direct treatment (whether they are enhanced or not) or as a delivery vehicle carrying various anti-tumoral agents. Some of these agents are: chemotherapy drugs, prodrug activating therapy, oncolytic viruses, nanoparticles, human artificial chromosome… Promising results have started to surface; however, more evidence is needed to perfect their use as a glioblastoma multiforme treatment option. Alternative treatment, using unloaded or loaded MSCs, leading to a better outcome.

A 3D-Printed Graphene BioFuse Implant for Postsurgical Adjuvant Therapy of Cancer: Proof of Concept in 2D- and 3D-Spheroid Tumor Models.

Three-dimensional printing is an emerging technology that is finding its niche applications in diverse fields owing to its flexibility concerning personalization and design. Surgery followed by adjuvant therapy is the standard treatment plan in most cancers from stage I to stage III. Most of the available adjuvant therapies, like chemotherapy, radiation therapy, immunotherapy, hormonal therapy, etc., are associated with severe side effects that considerably reduce the quality of life of patients. In addition, there is always the chance of tumor recurrence or metastasis development followed by surgery. This investigation reports the development of a 3D-printed, biodegradable, laser-responsive implant with a chemo-combined thermal ablating potential for adjuvant therapy of cancer. The 3D-printable ink was developed using poly(l-lactide) and hydroxypropyl methylcellulose as the base polymer, doxorubicin as the chemotherapeutic agent, and reduced graphene oxide as the photothermal ablating agent. The personalized implant released the drug pH-dependently (p value < 0.0001) for an extended period (93.55 ± 1.80% → 28 days). The 3D-printed implant exhibited acceptable biophysical properties (tensile strength: 3.85 ± 0.15 MPa; modulus: 92.37 ± 11.50 MPa; thickness: 110 μm) with laser-responsive hyperthermia (ΔT: 37 ± 0.9 °C → 48.5 ± 1.07 °C; 5 min; 1.5 W/cm2) and inherent biodegradable property (SEM analysis). The 3D-printed implant was evaluated for its therapeutic potential in 2D- and 3D-spheroid tumor models (MDA-MB 231 and SCC 084 2D cells) employing MTT cytotoxicity assay, apoptosis assay, cell cycle analysis, and gene expression analysis. The biomolecular aspects and biomechanics of the 3D-printed BioFuse implant were also evaluated by determining the effect of treatment on the expression levels of HSP1A, Hsp70, BAX, and PTEN. It is advocated that the knowledge developed in this project will significantly assist and advance the science aiming to develop a clinically translatable postsurgical adjuvant therapy for cancer.

A systematic review of auricular therapy for poststroke cognitive impairment and dementia: A protocol for systematic review and meta-analysis.

Post-stroke cognitive impairment and dementia (PSCID) is the main source of morbidity and mortality after stroke worldwide. It is one consequence of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive impairment and dementia after the clinical stroke may contribute to the clinical expression of PSCID, which are prevalent clinical symptoms, especially in the elderly. Current problems in the field of PSCID are related to a lack of harmonization of the classification and definition, deficiency of well-defined diagnosis, deficiency of standardized and objective treatment plans, etc. Auricular therapy can effectively improve the symptoms of patients with PSCID. However, there has been no systematic review of auricular therapy for PSCID. This study aimed to evaluate the efficacy and safety of auricular therapy in patients with PSCID. Before December 2022, a systematic literature search was conducted using the following databases: PubMed, Embase, SinoMed (previously called the Chinese Biomedical Database), Web of Science, Chinese National Knowledge Infrastructure, and Wanfang Database. Review Manager software (version 5.3) will be used for statistical analysis; otherwise, descriptive analysis or subgroup analysis will be conducted. The quality of evidence for outcomes will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. This meta-analysis further confirmed the beneficial effects of auricular therapy in patients with PSCID. This study investigated the efficacy and safety of auricular therapy in patients with PSCID, providing clinicians and patients with additional options for this disease.

Long Covid: A call for global action

AbstractThe COVID‐19 pandemic has resulted in another global health crisis with millions of individuals with Long Covid experiencing disability, worse health‐related quality of life, and productivity and income losses. Despite its impact on population health outcomes, health systems, and the economy, there remains a need for a global consensus on its standard definition, diagnostic approaches, and treatment plans to manage symptoms. In many low‐ and middle‐income countries (LMICs), there are limited published estimates on Long Covid, limited studies on its diagnostics and therapeutics, and limited media and news coverage. We advocate for a global action plan and necessary investments on Long Covid research and treatment, meaningful involvement of patients and cooperation between high‐income countries and LMICs, stronger and more effective public health communication surrounding the risks of Long Covid, and support toward financial risk protection as advocated by Universal Health Care.

Is a Standardized Treatment Plan for Incidental Durotomy Plausible?

Is a Standardized Treatment Plan for Incidental Durotomy Plausible?

Contour first-retrospective study of an algorithmic approach of auricular keloids.

Auricular keloids are difficult to treat, and recurrent keloids are more aggressive and more likely to develop aural deformities. Surgical excision, injections, or radiotherapy alone have high recurrence rates. An algorithmic approach of auricular keloid remains to be explored. To investigate the sequential treatment protocol for the treatment of auricle keloids to maintain auricle morphology and reduce the postoperative recurrence rate. A retrospective analysis of 42 patients who attended the scar minimally invasive treatment center of the Hospital of Plastic Surgery, Chinese Academy of Medical Sciences for serial treatment from January 2019 to June 2021. According to the size and involvement of the keloid, the core excision of the scar was excised under the condition of ensuring the priority of the auricular contour, and the scar flap was repaired to reconstruct the auricular appearance, and electron beam treatment was performed within 24h after the operation, ray energy: 6-7MeV, dose: Dt18Gy/2f; regular trimethoprim combined with 5-Fu injection treatment and the application of silicone ear clips for local compression treatment were performed 1 month after the operation. Thirty-five patients were followed up from 12 to 40 months after surgery, and three of them showed a tendency of recurrence, and early local treatment with trimethoprim and 5-Fu injection achieved favorable results. A standardized and sequential treatment plan for keloids with different morphology and anatomical locations can achieve remodeling of the auricular morphology and maintain long-term results.

Dexamethasone's Connection to COVID-19

Dexamethasone is known for its use as an anti-inflammatory and immunosuppressant medication. This medication has been present for many years, and its benefits have been observed in the treatment of various conditions. With the rise of COVID-19 cases on an international scale, healthcare professionals globally searched for a therapeutic medication, either existing or under development that could help those who were ill with the virus. The Recovery Trial aims to find a pharmacotherapeutic medication that would assist in treating hospitalized individuals who were diagnosed with COVID-19. In this trial, Dexamethasone’s ability to reduce hospitalization durations, and patient fatality was observed. These results increased curiosity about Dexamethasone's potential in the fight against COVID-19. As we work towards a standardized treatment plan for COVID-19, investigate Dexame- thasone’s mechanisms of action, and how it impacts different populations; together, these findings may help to determine this medication’s effectiveness as a COVID-19 treatment option.

1409. Infectious Complications in People Who Inject Drugs (PWID): A Retrospective Review and Recommendations for Improved Care

Abstract Background Suffolk County, NY is home to 1.5. million people and has a higher drug related deaths per capita rate compared to NY state average (19.9 vs 14.9/100,000). Injection drug use (IDU) is associated with complicated infections and inadequate treatment of substance use disorder (SUD) leads to relapse of infection and treatment failure. Unfortunately, access to SUD treatment services is not optimized in Suffolk County. We aimed to characterize the incidence and outcome of admissions for PWID and identify modifiable risk factors which can contribute to suboptimal care for PWID. Methods A retrospective review of SBUH electronic medical record was conducted from Jan 1, 2015 to June 1, 2021. Length of stay, discharge disposition, 6-month hospital readmission, insurance, employment and housing status, SUD history plus infection type and antimicrobial receipt were assessed. Results Of 425 patients (pts) admitted between Jan 1, 2015 to June 1, 2021, the median age was 34 years, 93% were white, and 59% male. Most pts. (89%) reported stable housing and had government insurance. The average length of stay was 13.6 days with 1/3 of pts. requiring ICU admission. Notably, 34% of pts left prematurely against medical advice and 34% were readmitted within 6 months. Formal ID (63%) and Psychiatry (62.5%) consults were not requested on all pts. Only 18% and 25% of pts. were treated with methadone or suboxone. 60% of screened pts. had HCV but 50% were not screened for co-infections. Complicated skin and soft tissue represented 70%, sepsis/bacteremia 11%, osteomyelitis/arthritis 10% and endocarditis 12% of the cases. 14.8% of pts. with endocarditis died, 48% had recurrent endocarditis, 52% needed surgery including 12% of repeat valve replacements. Staphylococcus species caused 42% of infections. About 2/3 of pts required continued antibiotic therapy at time of discharge, leading to delayed discharge for IV catheter placement. Conclusion Managing infectious complications in PWID is a multi-faceted endeavor extending beyond inpatient care. This study highlights the need for standardized treatment plans involving specialized case managers to reduce LOS and AMA discharges, improve screening for infections and integrate SUD treatment for PWID. Disclosures All Authors: No reported disclosures.

Advances in the relationship between lung cancer and microbiota

Interaction exists in lung cancer and microbiota. Lung microecological homeostasis can improve the immune tolerance, enhance immune suppression, and inhibit inflammatory responses, to reduce the lung cancer; while lung cancer can lead to pulmonary microecological imbalance, change the lung environment, and promote tumor cell proliferation. Therefore, modulating microbial flora and microecological immunotherapy may be a potential and preventive treatment for lung cancer, to restore tumor immunosuppression and improve patient survival. However, the individual differences in the lung microecology, because of different genetics, ethnic characteristics, and dietary habits, increasing the difficulty of precise diagnosis and treatment, which is also the current bottleneck in the application of microecological immunotherapy. Otherwise, the effectiveness of regulatory measures such as probiotics, prebiotics or antimicrobials is questionable. The research on microbial flora is still in its infancy, and further exploration is needed to form a standardized, effective, and precise treatment plan. So, standardized, effective, and precise microbial flora treatment strategies need to be further explored.

A new clinical classification and reconstructive strategy for post-sternotomy surgical site infection.

Post-sternotomy surgical site infection (SSI) is a serious complication of cardiovascular surgery. Here, we proposed a new clinical classification and reconstructive strategy for this condition. A retrospective study based on medical records was performed on 100 consecutive cases requiring wound management by plastic surgeons for post-sternotomy SSI at Kobe University Hospital between January 2009 and December 2021. We classified 100 cases into four categories according to the anatomical invasiveness of the infection (type 1, superficial SSI; type 2, sternal osteomyelitis; type 3, mediastinitis; and type 4, aortic graft infection). The standard treatment plan comprised initial debridement, negative pressure wound therapy with continuous irrigation, and reconstructive surgery. Reconstructive methods and their outcomes (in-hospital mortality rate, follow-up period, and infection recurrence rate) were investigated for each SSI category. There were nine SSI cases in type 1, 28 in type 2, 25 in type 3, and 38 in type 4. The pectoralis major (PM) muscle advancement flap was mainly selected in types 1 and 2 (100 and 70.4%, respectively), while the omental flap or latissimus dorsi (LD) myocutaneous flaps were mainly selected in types 3 and 4 (77.3 and 81.8%, respectively) for reconstructive surgery. The in-hospital mortality rates for types 1, 2, 3, 4 were 44.4, 3.6, 12.0, and 15.8%, respectively. The mean follow-up periods for types 1, 2, 3, 4 were 542.8, 1514.5, 1154.5, and 831.1 days, respectively. Infection recurrence rates for types 1, 2, 3, 4 were 0, 11.5, 13.3, and 19.2%, respectively. All of these recurrent cases, except for 4 cases of type 4 that required surgical intervention, were treated with conservative wound management. A volume-rich flap (omental or LD flap) was required to fill the dead space after debridement in mediastinitis (type 3) or aortic graft infection (type 4), whereas superficial SSI (type 1) or sternal osteomyelitis (type 2) received a less-invasive flap (PM muscle advancement flap). Our new classification method was based on the anatomical invasiveness of the infection, providing both a simple and easy diagnosis and definitive treatment strategy.