Surgery In Conjunction Research Articles

Impact of hyperthermic intraperitoneal chemotherapy on gastric cancer survival: Peritoneal metastasis and cytology perspectives.

Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects. The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to increase survival rates in these patients. Despite these advancements, debates persist regarding the magnitude of survival improvement attributed to this treatment modality. The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis, and it took a comparative analysis of patients exhibiting positive and negative cytological findings. To compare the impact of HIPEC on survival in gastric cancer patients with peritoneal metastasis and positive or negative cytology. Between April 2013 and March 2020, 84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts: HIPEC (20 patients with peritoneal metastasis), cytology-positive (23 patients without peritoneal nodules but with positive wash cytology), and cytology-negative (41 patients with advanced gastric cancer, no peritoneal nodules, and negative wash cytology). The HIPEC cohort underwent gastrectomy with HIPEC, while the cytology-positive and cytology-negative groups received gastrectomy alone. The demographic, pathological, and survival data of the groups were compared. The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss. Nevertheless, the complication rates were consistent across all three groups. Median survival in the HIPEC group was 20.00 ± 4.89 months, with 1-year, 2-year, and 3-year overall survival rates of 73.90%, 28.70%, and 9.60%, respectively. These figures paralleled the survival rates of the cytology-positive group (52.20% at 1 year, 28.50% at 2 years, and 19.00% at 3 years). Notably, 47% of patients experienced peritoneal recurrence. HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis, mirroring the outcomes in cytology-positive patients. However, peritoneal recurrence remained high.

Advancements in treatment strategies for periprosthetic joint infections: A comprehensive review

Periprosthetic joint infection (PJI) presents a critical challenge in orthopedic care, contributing to significant patient morbidity and healthcare costs. This burden is expected to increase secondary to growing demand for total joint arthroplasty (TJA). Despite the profound significance of PJI, there is currently no universally accepted “gold standard” diagnostic criteria using serum biomarker thresholds; latest criteria fail to differentiate acute infections from chronic or consider time since initial surgery. Furthermore, contemporary PJI treatment, which conventionally requires 2-stage revision surgery in conjunction with rigorous antibiotic treatment, can be particularly taxing on patients. Fortunately, recent years have seen marked evolution in both PJI diagnosis and treatment methods. Contemporary research supports time-dependent serum biomarker thresholds with greater sensitivity and specificity than previously reported, as well as alternative surgical options which may be more suitable for certain patients.The following narrative review aims to describe the significance and pathogenesis of PJI before characterizing current challenges, novel innovations, and the future landscape of PJI diagnosis and management. Here, we spotlight the emerging utility of novel biomarkers and metagenomic next-generation sequencing for diagnosis, advancements in patient-centered surgical outcome prediction tools for PJI risk assessment and prevention, and evolving surgical techniques including 1-stage and a “hybrid” 1.5-stage revision surgeries. Additionally, we explore cutting-edge therapeutic modalities including peptide and bacteriophage-based treatments, intraoperative anti-biofilm gel, the VT-X7 antibiotic pump, and promising immune-based interventions. Ultimately, these advancements hold the potential to revolutionize PJI management, offering hope for improved outcomes and reduced burdens on healthcare systems.

A prospective study of surgeons’ workloads and associated factors in real-world practice

New technologies such as laparoscopic and robotic surgery are spreading, and there is a demand for physicians to keep up with novel methods. In contrast to the recent focus on healthcare professional burnout, the mental and physical costs during surgery are not well-understood. We aimed to quantify surgeons’ workloads in daily urological surgical practice and clarify potential background factors associated with such workloads. Urologists in Hokkaido, Japan, were invited to this study. Between December 2020 and December 2021, participants repeatedly reported workloads, which were assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), after each surgery in conjunction with participants’ names, patients’ backgrounds, their roles (independent operator, operator under supervision, instructor, and 1st or 2nd assistant), and surgical outcomes, via SurveyMonkey®. Because of the heterogeneity among individuals, a linear mixed-effects model was utilized to analyze factors associated with NASA-TLX, calculating the parameter estimates (PE) of regression coefficients for each factor and their 95% confidence interval (CI). Sixty-five urologists (5 women) joined the study, and 2169 data were collected within 7 days after surgeries. A linear mixed-effects model revealed that female surgeons (PE + 15.56, 95% CI 2.36–28.77), urgent/emergency surgery (PE + 6.65, 95% CI 4.59–8.70), intraoperative complications (PE + 9.26, 95% CI 6.76–11.76), and near-miss incidents (PE + 3.81, 95% CI 2.27–5.36) were associated with higher workloads. Regarding the surgeons’ role, operator under supervision (PE + 12.46, 95% CI 9.86–15.06) showed the highest workloads. Surgeons’ workloads decreased as the number of previous cases of the same procedure increased. Surgeons’ workloads were associated with various factors. Given that the highest workloads were for operators under supervision, instructors should be aware of trainees’ high workloads and devise appropriate instructional interventions.

Research protocol to identify the effect of concentrated growth factors on healing of apicomarginal defects

Periapical periodontitis can cause damage to both the tooth and the periodontium, thereby affecting the life quality of patients. Traditional periapical surgery takes a long time to heal, and postoperative pain and swelling are obvious. Seeking a good treatment strategy for faster and better healing of periapical periodontitis is an urgent issue that needs to be addressed. Concentrated growth factor (CGF) is considered an ideal biomaterial for retaining abundant and denser growth factors in accelerating bone formation. To investigate the effect of CGF on healing of apicomarginal defects, this prospective study aims to enroll 72 patients with periapical periodontitis in their anterior teeth or premolars who have undergone comprehensive root canal treatment. The patients will be randomly allocated into the following four groups: control group, which will receive apical surgery alone (including apicoectomy, inflammation debridement, and retrofilling of the root apex); bone group, which will undergo apical surgery in conjunction with the use of bone substitute; CGF group, which will undergo apical surgery in conjunction with the use of CGF; and CGF+bone group, which will undergo apical surgery in conjunction with the use of bone substitute and CGF gel. Each group will comprise 18 patients, and all surgeries will be conducted by the same proficient surgeon. The participants will undergo a 1-year follow-up with the assistance of a physician, including questionnaire data and daily records of pain and swelling at 2, 6, and 12 h and 7 days after the surgery. Cone-beam computed tomography images will be taken before the surgery, immediately after the surgery, and at 3, 6, and 12 months after the surgery. This study aims to explore the therapeutic effect of CGF on apicomarginal defects, in order to help clinical doctors find better treatment methods.

Utilising blood-derived products for guided tissue regeneration in periradicular surgery: a systematic review and meta-analysis

Background Since 1982, guided tissue regeneration (GTR) has become increasingly popular. The recent progress in GTR research focuses on the application of blood-derived products. However, no comprehensive systematic review has been conducted to assess its effectiveness specifically in periradicular surgery. Therefore, the aim of this review was to analyse the outcomes of periradicular with GTR using blood-derived products compared to standard periradicular surgery. Methods This review was based on randomised controlled trials comparing periradicular surgery in conjunction with GTR with blood-derived products and the standard periapical surgery. The databases searched included Embase, MEDLINE, Cochrane CENTRAL, and Dentistry and Oral Sciences Source, with the most recent search conducted on December 16th, 2022. Additionally, reference lists of similar systematic reviews were examined, while international trials registries and repositories were consulted for unpublished studies. Two blinded independent reviewers carried out the screening and the included studies underwent critical appraisal. The findings are reported in accordance with the PRISMA guidelines. Results A total of 261 publications were initially reviewed based on their title and abstract, resulting in seventeen studies that underwent full-text screening. At this stage, 14 studies were excluded, leaving three randomised controlled trials to be included. These trials involved a total of 85 patients. A meta-analysis was conducted for the outcome of healing. The overall treatment effect was 0.78 (95% CI 0.18 to 3.34), indicating a preference towards the control group. Conclusion Based on a meta-analysis of three studies, there was no statistically significant distinction observed in terms of healing between the GTR involving blood-derived products and standard procedure groups. However, critical appraisal revealed indirectness and imprecision, resulting in a certainty rating of 'low'. Thus, additional robust evidence is necessary to support the utilisation of blood-derived products in GTR techniques to enhance periradicular surgery outcomes. Systematic review registration number PROSPERO CRD42020222663.

Survival Analysis and Prognostic Factors After Endonasal Resection of Advanced Olfactory Neuroblastomas: A Single Institution Experience.

To explore the prognostic factors in patients with advanced olfactory neuroblastoma (ONB) underwent endoscopic surgery. Retrospective medical records were reviewed of patients with pathologically proven ONB who underwent endoscopic surgical resection. Clinicopathological characteristics including patient demographics, treatment, complications, follow-up, and outcomes were analyzed. Kaplan-Meier overall survival (OS) and disease-free survival (DFS) curves were plotted. Univariate and multivariate Cox regression models were used to determine prognostic factors. Eighty-five patients with Kadish stage C ONB were examined. According to the various staging systems used, most patients harbored modified Kadish stage C (78.8%). Twenty-six patients (30.6%) underwent bony skull base resection, 11 (12.9%) underwent dura resection, and 24 (28.2%) underwent additional intracranial resection that included the olfactory bulb and duct. Median follow-up was 39 months. Five-year OS and DFS rates were 83.7% and 74.9%, respectively. Five-year OS was 100% in patients treated with bony skull base resection and 77.5% in those who were not (P = .052). Dura resection did not improve OS. Multivariate Cox regression analysis identified perioperative complications (P = .009), gross total resection (P = .004), orbital invasion (P = .014), postoperative radiotherapy (P = .030), and bony skull base resection (P = .019) as independent prognostic predictors. For patients with advanced ONB, endoscopic surgery in conjunction with radiotherapy and chemotherapy is effective and safe. Dura resection should be performed with caution in selected patients to balance survival and complications. Postoperative radiotherapy is important to improve OS and DFS.

Initial Experience With Robotic-Assisted Otologic and Lateral Skull Base Surgery.

Robotic-assisted surgery has gained popularity for otolaryngology procedures. It provides high-definition images and surgical precision to perform diverse procedures. It is an alternative to the operating microscope, endoscope, or exoscope when reaching hidden anatomical structures in the ear. In this proof-of-concept study, we aim to demonstrate the possibility of using a robotic-assisted device to perform ear surgery in conjunction with the microscope or the endoscope. In total, there were 9 ear and lateral skull base procedures performed with the use of robotic-assisted surgery. All surgeons underwent surveys to assess the performance and workload of the device compared to the microscope or endoscope. There were no postoperative complications. Robotic-assisted surgery was optimal for providing high image quality, ergonomics, and maintaining surgical performance. The size of the device and mental demand were higher compared to the microscope or endoscope. Robotic-assisted surgery can be an adjuvant to perform otologic and neurotologic surgery.

Technological Innovations in Shoulder Replacement: Current Concepts and the Future of Robotics in Total Shoulder Arthroplasty.

Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision, joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri/preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty. A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on two primary factors: (1) the lack of eligible, peer-reviewed studies with high quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by two independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology-assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics". After exclusion criteria were applied, four studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, non-validated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with patient specific instrumentation (PSI). The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation (CAS), artificial intelligence, machine learning, and virtual/augmented/mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy (RPHA), more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies. The evidence for the use of robotics in THA and TKA demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. While no such data currently exists for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.

Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods

ObjectiveCytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review...

Abstract P2065: Mice Under Transverse Aortic Constriction And Treated With Sodium Oxalate May Develop Cardiac Dysfunction

Background: Experimental models are important for studying the mechanisms of cardiovascular disease. The transverse aortic constriction model (TAC) is among the most used in the literature for the study of cardiac hypertrophy. The soluble sodium oxalate (OXA) model generates renal injury but is also associated with cardiac hypertrophy through hypertensive-like lesions. There is little information in the literature on direct hemodynamic recording in both models mentioned, as well as there is no data on the changes caused by the association of these two models. Therefore, our objective is to evaluate whether TAC associated with OXA gavage could be a new model of cardiac dysfunction. Methods and Results: Male C57BL mice were randomized as follows: SHAM animals that received gavage with vehicle or OXA solution, and animals submitted to TAC and gavage with vehicle or OXA solution. Echocardiography and metabolic cage assessment were used to quantify cardiac and renal function. Direct blood pressure (BP) recording was also performed to assess baroreflex sensitivity and histological analysis. The TAC+OXA group had the highest BP values (mean BP:SHAM:100±5.0 vs. TAC+OXA:132±4.8mmHg, p<0.01), the highest pulmonary congestion index, an increase in the double product, an important reduction in autonomic modulation (AM), heart rate variability (HRV) (SD-PI: SHAM+OXA:12.5±1.8 vs. TAC+OXA:2.8±0.2ms, p<0.01) and alpha index (SHAM:3.6±1.0 vs. TAC+OXA:0.6±0.1, p=0.04). The TAC group showed the greatest weight of the ventricles and the greatest increase in blood pressure variability (DP-SBP). The SHAM+OXA group showed an increase in AM and HRV. The three groups showed a significant reduction in reflex tachycardia. Conclusion: TAC surgery provided cardiac hypertrophy, reduction in reflex tachycardia and changes in autonomic modulation. In the absence of TAC, the treatment with OXA for 15 days increased autonomic modulation. TAC surgery in conjunction with OXA gavage caused greater cardiac dysfunction.

CNSC-04. EVALUATING LONGITUDINAL WORKING MEMORY PERFORMANCE IN PEDIATRIC PATIENTS WITH CRANIOPHARYNGIOMA VIA FMRI

Abstract Craniopharyngioma is a type of benign brain tumor that develops in the suprasellar region of the brain and can lead to long-term neurological, endocrine, and visual impairments as well as neurocognitive deficits resulting from the tumor and its treatment. The contemporary treatment options for this tumor are radical surgery or limited surgery in conjunction with radiotherapy. The current understanding of the impact of brain injury related to the tumor and its treatment such as proton radiotherapy (PRT) on neurocognitive function is limited. The study (NCT01419067) was approved by the IRB and informed consent was obtained from patients or their parents. Functional magnetic resonance imaging (fMRI) was performed in a 3T MRI imaging system (Siemens MAGNETOM Prisma, Erlangen, Germany) and used to evaluate the neurocognitive performance of 58 pediatric patients (31 females and 27 males) before and after proton radiotherapy (PRT). The patients underwent serial imaging at four-time points (baseline, 18, 36, and 60 months after PRT) and performed a working memory (0-back, 1-back, and 2-back) task-based fMRI. A full factorial model was used for longitudinal group analysis at different time points through statistical parametric mapping. Omission errors, commission errors, and reaction time were measured for each task. The results showed robust detection of the working memory network with increased activation (FDR<0.05) in the precuneus, mid-temporal gyrus, and angular gyrus at 36 months compared to 18 months. The behavioral test results showed a gradual decrease in omission errors in the 2-back task group and an increase in reaction time for all three task groups over time. These findings suggest that PRT has a transient effect on brain activation and behavioral performance, potentially indicating improved executive functioning, recovery from the mass effect of the tumor and/or surgery, and the minimal negative impact from PRT.

EE396 Cost-Effectiveness of Gleolan Guided Surgery Compared to Conventional White Light Surgery for High Grade Glioma

To compare the cost per ‘imaging complete resection’ (ICR) with Gleolan (aminolevulinic acid HCl) oral solution (also known as 5-ALA) guided surgery in conjunction with blue light vs. conventional white light surgery in high grade glioma patients.

Assessing the Usage Anesthesia in the Surgical Treatment of Diabetic Macular Edema

Diabetes-related macular edema is a fast-spreading condition that has damaged the lives of countless people throughout the globe. The current incorporation of subthreshold micropulse laser has indicated the precedence of laser therapy in the treatment of diabetic macular edema; nonetheless, vitreoretinal surgery in conjunction with anesthetics correlates with early mitigation of damage to the fovea. Surgery is a delicate procedure that necessitates careful consideration of the types and locations of anesthetics used. Depending on the individual being treated, various drugs and methods may be necessary. For example, some individuals may be allergic to conventional anesthetics, resulting in more severe consequences. In the surgical treatment of diabetic macular edema, the topical anesthetic was utilized more frequently than subconjunctival anesthesia, according to the review’s statistical analysis. The examined literature indicated that topical lidocaine was the most employed anesthetic for vitreoretinal surgery; however, alternatives to lidocaine exist, and their effects should be investigated. Consequently, we would want to highlight the impacts of each of the several surgical medications and anesthetics used to treat diabetic macular edema.

Treatment Strategy for Condyle/Ramus Deficiency Using 3D Virtual Surgery and CAD/CAM Technologies; Total Joint Replacement or Inverted-L Osteotomy.

To introduce a guideline for selecting proper surgical modalities for correction of skeletal Class II malocclusion with moderate-to-severe vertical height deficiency (VHD) of the condyle/ramus complex (CRC) using bimaxillary surgery in conjunction with total joint replacement (TJR) or inverted-L osteotomy (ILO) assisted by 3D virtual surgical planning and CAD/CAM technologies. Four cases of severe skeletal Class II patients with moderate-to-severe VHD of CRC were presented. They underwent bimaxillary surgery using Le Fort I osteotomy in the maxilla and TJR or ILO in the mandible, with the help of virtual surgical planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM)-printed surgical guides and osteosynthesis plates. Guidelines are as follows: (1) if a patient has a moderate degree of VHD and the function of the temporomandibular joint (TMJ) is normal, ILO would be preferred for vertical elongation of the ramus; (2) if a patient has congenitally small condyle or severe condylar resorption, TJR would be preferred to resolve severe VHD of CRC; and (3) when a patient has a metal allergy, foreign body reaction or anatomic limitations (ie, thin cranial base cortex for fossa fixation), ILO would be a better option than TJR. TJR or ILO using VSP and CAD/CAM-printed surgical guides, wafers, and customized plates can provide a proper selection of the surgical plan, accurate transfer of surgical plans to actual surgical procedures, and esthetic improvement of the facial profile. This guideline based on the degree of VHD and functional aspects of CRC might help clinicians to select effective surgical modality for correction of skeletal Class II malocclusion with moderate-to-severe VHD of CRC.

Benefits and Relevant Risk Factor Assessment of Neoadjuvant Chemotherapy in Combination with Surgery in Limited-Stage Small-Cell Lung Cancer.

To illustrate the benefits of surgery in conjunction with neoadjuvant chemotherapy in patients with limited-stage small cell lung cancer (LS-SCLC), and to evaluate risk factors affecting patient's survival. Forty-six LS-SCLC patients who received surgery in our center from September 2012 to December 2018 were retrospectively analyzed. Twenty-five patients with LS-SCLC diagnosed after surgery who received postoperative adjuvant chemotherapy were classified into control group, and 21 patients with LS-SCLC who received preoperative neoadjuvant chemotherapy were classified into observation group. The observation group were divided into subgroup 1 (negative lymph nodes) and subgroup 2 (positive lymph nodes). Progression-free survival (PFS) and overall survival (OS) of patients were analyzed. Univariate and multivariate Cox regression were utilized to analyze independent risk factors affecting patient's survival. PFS and OS of patients in the control group and observation group had similar outcomes (P > 0.05). Subgroup 1 and subgroup 2 had similar PFS and OS (P > 0.05). PT2, pN2, BM, and two or more positive lymph nodes were significantly associated with poor PFS and OS (P < 0.05). Furthermore, the pT, number of lymph node positive stations and BM were independent risk factors affecting patient's survival (P < 0.05). Surgery combined with neoadjuvant chemotherapy can achieve long-term survival benefit for some patients with LS-SCLC. It is necessary to find a better plan that enables to select patients suitable for surgery after neoadjuvant chemotherapy.

Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners.

This retrospective two-centre study aimed to evaluate the occlusal outcomes in patients undergoing orthognathic surgery with clear aligners. A retrospective chart review and occlusal outcomes for 15 patients (10 females and five males) with different types of dentofacial deformities in the anteroposterior, vertical and transverse dimensions, who underwent orthognathic surgery in conjunction with clear aligners were evaluated. Weighed Peer Assessment Rating (PAR) index scores of the pre-treatment and post-treatment digital models were used to assess initial complexity, final occlusal outcomes and degree of improvement with surgery and clear aligners. The mean post-treatment PAR score was 3.5± 2.54, which was a statistically significant improvement from the pre-treatment PAR score of 27.63 ± 12.09, an 87% improvement was achieved. All subcategories of the PAR index showed statistically significant improvement except for midline assessment component. Occlusal outcomes with aligners showed great improvement as indicated with the PAR index scores. Orthognathic surgical cases can be treated efficiently with aligners and future studies should compare occlusal outcomes between orthognathic surgical patients treated with clear aligners and those treated with fixed appliances.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

Associating resistance to immune checkpoint inhibitors with immunological escape in colorectal cancer.

Colorectal cancer is a common malignant tumor that ranks third in incidence and second in mortality worldwide, and surgery in conjunction with chemotherapy and radiotherapy remains the most common treatment option. As a result of radiotherapy’s severe side effects and dismal survival rates, it is anticipated that more alternatives may emerge. Immunotherapy, a breakthrough treatment, has made significant strides in colorectal cancer over the past few years, overcoming specialized therapy, which has more selectivity and a higher survival prognosis than chemoradiotherapy. Among these, immune checkpoint inhibitor therapy has emerged as the primary immunotherapy for colorectal cancer nowadays. Nonetheless, as the use of immune checkpoint inhibitor has expanded, resistance has arisen inevitably. Immune escape is the primary cause of non-response and resistance to immune checkpoint inhibitors. That is the development of primary and secondary drug resistance. In this article, we cover the immune therapy-related colorectal cancer staging, the specific immune checkpoint inhibitors treatment mechanism, and the tumor microenvironment and immune escape routes of immunosuppressive cells that may be associated with immune checkpoint inhibitors resistance reversal. The objective is to provide better therapeutic concepts for clinical results and to increase the number of individuals who can benefit from colorectal cancer immunotherapy.

Papillary thyroid carcinoma prevalence and its predictors in patients with primary hyperparathyroidism

Aim: Papillary thyroid carcinoma (PTC) and primary hyperparathyroidism (PHPT) are among the most common endocrine diseases. Although it has been shown that hyperparathyroidism may be associated with various cancers, the question of whether there is an association between hyperparathyroidism and PTC remains controversial. To evaluate the incidence of concomitant PTC among patients with PHPT and to identify possible risk factors for the development of PTC in these patients.&#x0D; Material and Method: The data of 543 patients who had been operated on due to PHPT in our institution were reviewed retrospectively. Patients who underwent thyroid surgery in conjunction with parathyroidectomy and patients whose diagnosis of PTC was confirmed histopathologically were compared in terms of their clinical, biochemical, and histopathological features. The prevalence of PTC found in patients with PHPT was compared with national rates to estimate standardized incidence ratios (SIRs).&#x0D; Results: Of the 456 PHPT patients enrolled in the study, 281 (61.6%) had concomitant thyroid nodules on thyroid ultrasonography, and PTC was detected in 53 (11.6%) patients during their thyroid surgeries. Compared to the general population, the incidence of papillary thyroid cancer was increased in both women and men with PHPT (SIR: 272.2, 95% CI: 201.6-360.0, p

Acute fulminant rhino-orbito-cerebral mucormycosis: Our experience with open approach in the COVID era

Objectives: Rhino-orbito-cerebral mucormycosis (ROCM) is a quite rare and an extremely aggressive infection which can cause profound destruction of tissues. A high index of suspicion is required to diagnose and treat this infection. Although mostly occurring in diabetic or immunosuppressed patients, a sudden surge of these patients has been observed in the COVID era. Mortality is extremely high in neglected cases and can range from 40%–85% or even more. In this article, we aim to highlight patient demographics, clinical features, diagnosis, management, and outcome of fulminant ROCM in patients managed jointly by plastic surgeons and maxillofacial surgeons by the open approach. Materials and Methods: Between May 2021 and August 2021, there was a sudden upsurge of mucormycosis patients admitted in our institute (IPGME and R, Kolkata). Less severe fulminant forms of the disease were managed by the department of otorhinolaryngology by endoscopy, whereas fulminant cases with extensive involvement were managed by the department of plastic surgery in conjunction with the department of maxillofacial surgery. The surgical management involved open access to the involved tissues and resection under direct vision combined with appropriate medical management. Results: In total, we operated on eight cases of fulminant ROCM of which 4 patients were male and 4 females. Apart from this, two male patients and one female patient were also planned for extensive debridement surgery but the same could not be performed because of poor anesthetic risk. Biopsies were taken in all of these patients. Therefore, out of a total of 11 patients with fulminant ROCM, 9 patients did not survive taking the mortality rate in fulminant cases to 82%. Conclusion: ROCM can be an extremely difficult disease to treat and is associated with a very high mortality rate in fulminant cases. Early diagnosis coupled with adequate debridement and systemic amphotericin B has the prospect of salvaging patients with this dreaded disease.