The effect of smoking and elderly age on digital replantation - a multivariate analysis.

INTRODUCTION: It is often questioned whether to perform replantation or revision amputation for amputation injuries in elderly patients and smokers. According to the current indication criteria, neither old age nor smoking in the absence of other risk factors are considered to be risk factors for replantation failure. However, many microsurgeons still may make the decision not to perform digital replantation based solely on these factors. MATERIAL AND METHODS: In order to evaluate the influence of both factors, we provided univariate and multivariate analyses of patients who underwent replantation at our centre during a 10-year period. We divided patients in two groups according to age (< and ≥ 60 years) and smoking status. RESULTS: In the univariate analysis, there were no differences in immediate results between the two age groups. In the multivariate analysis, no statistical difference was found in neither long-term nor short-term results between the two age groups and between smokers and non-smokers. CONCLUSION: Smoking and age should not be considered the only risk factors when deciding whether to perform digital replantation.

Analysis of postoperative complications after open scar hernia hernioplasty - a retrospective analysis of a patient cohort.

INTRODUCTION: The aim of this study was to analyse complications associated with inicisional hernia repair surgery and to assess individual risk factors for surgical site infections occurring at the Department of Surgery of the University Hospital Kralovske Vinohrady in 2015. METHODS: We analysed 138 patients with a focus on risk factors that potentially increase the risk of postoperative infectious complications such as mesh implantation, smoking, diabetes mellitus, ischemic heart disease, malignancies, immunosuppressive therapy and urgency of the procedure. RESULTS: Based on multivariate logistic regression analysis, acute surgery proved to be a risk factor for infection, and in the ad hoc Fisher test, the ratio was 2.73. Diabetes mellitus as a risk factor reached the limit of significance (p=0.071). No other variables were associated with an increased risk of surgical site infections. CONCLUSION: Acute surgery was assessed as a significant risk factor for postoperative wound infection. On the contrary, mesh repair was not associated with an increased risk of infection.

Intrahepatic cholangiocarcinoma: risk factors affecting survival of operated patients.

INTRODUCTION: The aim of this study was to evaluate the results of surgical treatment of intrahepatic cholangiocarcinoma (IHCHCA) in terms of overall survival and disease-free survival, and to analyse and find potential prognostic factors affecting overall survival and disease-free survival. METHODS: Retrospective evaluation was performed of consecutively enrolled patients operated for IHCHCA from January 2005 to January 2022 (17 years) had undergone surgery. During the monitored period, 38 surgical procedures were performed, of which liver resection was done in 25 cases (65.8%). RESULTS: The 5-year survival in the radically resected group was 44%, and the 5-year disease-free survival was 32%. Based on univariate and multivariate analysis, radicality of surgery (p=0.01116) and lymph node involvement (p=0.00576) were assessed as negative prognostic factors for overall survival. Radicality of surgery (p=0.018) and administration of adjuvant chemotherapy (p=0.044) were significant negative prognostic factors affecting disease-free survival. However, they lost their significance in the multivariate analysis. CONCLUSION: Radical surgical resection of the liver remains an essential treatment option for intrahepatic cholangiocarcinoma aimed at achieving a radical procedure with microscopically negative margins. KEY WORDS: cholangiocarcinoma, resection, recurrence, survival.

Does Convergent Placement of Interlocking Iliosacral Screws into the Body of Vertebra S1 Prevent Screw Migration?

PURPOSE OF THE STUDY To compare the outcomes of parallel and convergent iliosacral screw insertion into the body of vertebra S1 in the treatment of posterior pelvic arch injuries. MATERIAL AND METHODS Radiographs of 120 patients (43 women, 77 men), aged between 14-79 years, treated with iliosacral screw fixation for posterior pelvic ring fractures between 1.1.2009 and 31.12.2019 were reviewed for inclusion in the study. In each case two screws were inserted into the body of vertebra S1. The screws were inserted in either parallel or convergent orientation. Convergent orientation allows the threads of both screws to be interconnected. In this technique, the first screw is inserted into the centre of the body of vertebra S1 as a compression screw. The second screw is inserted as a positioning screw and is placed so that the threads of both screws lock together. We believe that the interlocking of the threads of both screws and contact of the second screw with three cortices (two of the iliac bone and one of the sacrum) increase the stability of the fixation. Migration of loosened screws was measured on radiographs of the pelvis obtained at six weeks and at three, six and twelve months postoperatively. Migration of five millimetres or more within the first six weeks was considered to be clinically significant. Only patients after primary fracture treatment and with a complete one-year follow-up were included in the study. Cases of non-union and failure of osteosynthesis of the anterior pelvic arch and patients with incomplete follow-up were excluded. The incidence of significant screw migration between the two techniques was compared using Fisher's exact test with a 5% level of significance. RESULTS Sixty-three patients (23 women, 40 men) aged 17 to 79 years were included in the study. Parallel screws were used in 24 patients (8 women, 16 men) and convergent screws were used in 39 patients (15 women, 24 men). Clinically significant migration occurred in nine (38%) patients after parallel insertions. In two of these cases there was unstable fixation of the anterior pelvic arch. Migration of convergently placed iliosacral screws occurred in four (10%) cases. In three of these cases this was due to unstable fixation of the anterior pelvic arch. The difference in screw migration between the two groups was shown to be significant (p = 0.0219). DISCUSSION Iliosacral screws ensure sufficient stability of the posterior arch in type B and C pelvic fractures provided that the anterior pelvic arch is stable. Convergent insertion of iliosacral screws may increase the stability of fixation. Minimally invasive surgery with sufficient stability may be advantageous for early treatment of patients after multiple trauma and in elderly patients. The weaknesses of this study are its relatively small number of patients, which prevented reliable statistical analysis of screw migration according to the type of pelvic fractures. The second main limitation is the failure to perform densitometric examination of the skeleton in patients with X-ray proven screw migration for confirmation of osteoporosis as one of the possible causes of fixation failure. CONCLUSIONS The results of the study suggest that convergent insertion of iliosacral screws into S1 is associated with a lower risk of screw migration and subsequent failure of fixation of the posterior pelvic arch. Key words: pelvic fracture, pelvic injury, iliosacral screw, parallel screws, convergent screws, migration of iliosacral screws.

Log-Transformed Electromyography Amplitude Power Output Relationship: Nondominant vs. Dominant Limb.

ABSTRACT: Boccomino, HL, Daoud, BT, Hudas, A, North, WA, and Malek, MH. Log-transformed electromyography amplitude power output relationship: nondominant vs. dominant limb. J Strength Cond Res 36(3): 851-856, 2022-Findings from studies that examine bilateral differences between the nondominant and dominant limb during whole-body (i.e., cycle ergometry) are equivocal. This may, in part, be because of the mode of exercise (i.e., whole-body) and how the data are analyzed. Surface electromyography (EMG) is a noninvasive method of examining motor unit recruitment and activation during exercise. The log-transformed electromyography amplitude power output relationship provides y-intercept and slope terms on a subject-by-subject basis that can therefore be statistically analyzed. The purpose of this study, therefore, was to identify potential differences in the muscle for the nondominant and dominant limb using the log-transformed EMG amplitude power output relationship for continuous exercise that isolates the quadricep femoris muscles. Nine healthy college-aged men (mean ± SEM: age, 22.6 ± 1.2 years; mass, 68.6 ± 10.4 kg; and height, 1.76 ± 0.03 m) volunteered as subjects for the current study. Each subject visited the laboratory on a single occasion, had EMG electrodes placed on their rectus femoris muscle for their nondominant and dominant limb, and performed an incremental double-leg knee-extensor ergometry to voluntary exhaustion. The subjects achieved a mean power output (75 ± 8 W) for the exercise test. In addition, a mean end-exercise heart rate (155 ± 8 b·min-1) corresponded to 79 ± 4% of the age-predicted heart rate using the formula 220-age. Separate paired t tests for the slope (t[8] = 0.929 p = 0.38) and y-intercept (t[8] = 0.368, p = 0.72) terms revealed no significant mean differences between the 2 limbs. The results of the present study indicate that there are no differences in muscle activation between the nondominant and dominant limbs for continuous exercise that isolates the muscle.

Monitoring EBV infection, MSI, PDL-1 expression, Her-2/neu amplification as a biomarker for PD-1 inhibition in gastric cancer.

BACKGROUND: The anti-PD-1 monoclonal antibody pembrolizumab has been shown to be associated with a good response in patients with metastatic gastric cancer. Excellent therapeutic results of pembrolizumab have been shown in patients with tumours showing a high microsatellite instability (MSI) and Epstein-Barr virus (EBV) positivity. GOAL: This is a retrospective study of 40 bioptic specimens from the patients, who underwent gastrectomy for gastric carcinoma. The goal of the study was to identify biomarkers (EBV, MLH-1, PDL-1 expression) that are potentially relevant for selecting the patients, who may benefit from PD-1 inhibition therapy. METHODS: Immunohistochemical (IHC) expression of PDL-1 and MSI, cytogenetic FISH amplification of the HER-2/neu gene and polymerase chain reaction of EBV RNA, including charge quantification, were performed in selected patients with metastatic or advanced gastric cancer. RESULTS: EBV-encoded RNA was detected in nine patients. None of them exhibited Her-2 overexpression or CMV infection. PD-L1 was detected in twelve patients. Ten patients were MLH1 positive. All nine cases of EBV infection showed a high expression of PD-L1 and MLH-1 (Tab. 1, Ref. 14).

Autoimmune pancreatitis ­ a surgical mistake?

Autoimmune pancreatitis is a specific type of chronic pancreatitis. Its clinical manifestation mimics pancreatic cancer. A multidisciplinary approach is necessary to establish the correct diagnosis. Autoimmune pancreatitis can be diagnosed on the basis of symptomatology, imaging methods, endoscopy, serology and histopathological examination. There are two different forms of autoimmune pancreatitis ­ type 1 and type 2. Type 1 is lymphoplasmacytic sclerosing pancreatitis and type 2 is idiopathic centroductal sclerosing pancreatitis. The disease most often takes a chronic form with acute exacerbations. In this paper we present two case reports of patients operated on for suspected malignancy of the pancreas, who were subsequently diagnosed with autoimmune pancreatitis based on histopathological examination. The aim of this communication is to point out the diagnostic pitfalls of this disease. Surgical treatment is not considered as a standard therapeutic method according to the current guidelines.

Enhanced recovery after surgery and mini-invasive approaches in rectal cancer surgery - short-term outcomes.

INTRODUCTION: The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. METHODS: A prospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. RESULTS: A total of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. A significantly lower incidence of paralytic ileus (20.9% vs. 3%) and a shorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. CONCLUSIONS: Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

Executive Functioning Predicts Academic But Not Social Adjustment to University.

Objective: Adjusting well academically and socially has been associated with enhanced academic performance and student retention. The purpose of this study was to examine subthreshold levels of ADHD symptoms such as inattention, hyperactivity, and executive functioning as potential predictors of academic and social adjustment in a healthy sample of university students. Method: Participants were 135 undergraduate university students who completed self-report questionnaires. Results: Hierarchical regression analyses revealed that metacognition (an aspect of executive function), gender, and age were significant predictors of academic adjustment beyond hyperactivity, inattention, and depression. Depression was the only significant predictor of social adjustment. Conclusion: The BASC-College form may identify depression symptoms predictive of social adjustment, but symptoms of inattention or hyperactivity are not sufficiently sensitive to predict academic adjustment. Measures of executive function that include metacognition such as the BRIEF-A may be most promising in identifying skills predictive of academic adjustment.

Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit.

OBJECTIVES: Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. DESIGN: A prospective, observational study. SETTING: Two GEM units at St Vincent's Hospital Melbourne, Australia. PARTICIPANTS: Patients admitted to the GEM units who stayed longer than 21 days were included in the study. MEASUREMENTS: Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). RESULTS: Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001). CONCLUSION: On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

Biomarkers to assess the targeting of DNA repair pathways to augment tumor response to therapy.

Hyper-activation of DNA repair pathways can enable tumor cells to survive DNA damage. Therefore, targeting specific DNA repair pathways might prove efficacious for cancer therapy. The advent of personalized therapy necessitates novel biomarkers to assess tumor response to therapy. Biological indicators are vital in the field of cancer research and treatment. The focus of this review is on the DNA repair machinery as an emerging target for enhancement of therapy. Additionally, DNA damage and repair biomarkers for prognosis in different types of cancer will be discussed. The application of biomarkers to assess tumor response to therapy based on targeting DNA repair pathways can potentially improve patient quality of life and aid in treatment design.

SU-E-T-434: Use of Deformable Registration for Cumulated Dose Calculation in Image-Guided Intracavitary Bracytherapy for Cervical Cancer.

PURPOSE: The minimum dose to 2 cc of tissue receiving the highest dose (D2cc) has been suggested as a surrogate measurement for risk of developing toxicity in organs at risk (OARs) in patients receiving image-guided cervical intracavitary brachytherapy. Conventional D2cc is typically calculated by simple summation, assuming the locations of the hot spots do not vary substantially. This study explores the effect of deformable image registration in determining a more accurate D2cc of rectum, sigmoid colon, bladder and small bowel. METHODS: Five patients, with 2 pelvic CT scans each performed at the time of brachytherapy planning, were evaluated. The first scan was performed with an empty bladder (an indwelling catheter was in place) and the second with a full bladder (with 180-cc sterile water). OARs were contoured on each scan. A symmetric demons algorithm with weighted sub-area approach was used to register images from different fractions. A pelvic prostate phantom was used to verify the method. After registration, the cumulated D2cc (ND2cc) was compared to the conventional D2cc (OD2cc) without deformable registration. RESULTS: In all cases, the ND2cc was lower than the OD2cc. For full bladder scans, the average difference (range) for rectum, sigmoid colon, bladder and small bowel between ND2cc and OD2cc were 28.9 (1.6 - 56.6)%, 34.7 (5.7 -68.4)%, 12.1 (0.0 -27.7)%, 7.2 (1.1 -22)% respectively. For empty bladder scans, the average differences (range) for the above organs between the ND2cc and the OD2cc were 30.7 (0.75-56.3%, 20.6 (6.3-39.6)%, 7.5 (0.88-13.1)%, 12.2(0.0-22.2)% respectively. CONCLUSIONS: A significant difference was observed between the ND2cc and the OD2cc with rectum and sigmoid being the most variable and bladder the least variable. While further studies are needed to evaluate which D2cc method is more useful in predicting late toxicity, we found the conventional method often overestimates dose to OARs.

Dysphagia lusoria: a case study.

Dysphagia lusoria is described in the literature as difficulty swallowing because of a "jest of nature." The "jest of nature" is a birth defect encompassing any aortic root vascular anomaly that causes esophageal dysphagia. Persons with dysphagia lusoria can be categorized according to their specific subclavian anomaly (ie, depending on the presence of an aneurysm, occlusive disease, or esophageal compression). All patients with this anomaly have an aberrant subclavian artery in a transposed position that courses posterior to the esophagus. The operative approach to repair this condition has been controversial. An extrathoracic approach is documented as superior to a repair involving thoracotomy because there is decreased rate of complications that may be associated with a thoracotomy and greater visibility of the subclavian and carotid artery. This case study describes a 25-year-old woman with dysphagia lusoria related to an aberrant right subclavian artery. The report includes a literature review and describes the perioperative approach and nursing care. The use of the preadmission and same-day admission services are supported as is an extrathoracic surgical approach. At follow-up this patient reported no symptoms of dysphagia and showed no evidence of esophageal compression confirming that persons with symptomatic dysphagia lusoria can be managed with positive long-term results.

Raman scattering as a characterization tool for epitaxial GaN thin films grown on sapphire by turbo disk metal-organic chemical vapor deposition.

Thin layers of GaN, a few micrometers thick, grown on sapphire substrate, are the basic structure in the rapidly developing GaN-based blue optoelectronics devices. We are looking for nondestructive, effective, and convenient characterization tools for GaN/sapphire. Ordinary Raman scattering measurements have limited use because strong Raman signals from the sapphire substrate overwhelm the GaN Raman features. We describe two techniques for making commercial laser Raman systems serve as convenient characterization tools for GaN/sapphire. One uses a near right-angle laser beam incidence, and the other uses microscope lens focusing. In these two ways the detected GaN Raman signals are much stronger than sapphire features, and correct assignments can be made quickly.

Purple urine bags.

Purple urine drainage bags were found in 7 of 71 chronically catheterized elderly women. The purple staining of the bags is due to a violet discoloration (indirubin) of the plastic of the catheter bag and fine blue crystals of indigo in the urine. The colors are formed from the substrate indoxyl sulfate (indican) and all 7 patients had bacteria in the urine that would produce blue colonies on agar enriched with the urine (filter sterilized) of the patients involved. Organisms identified were Providencia or Klebsiella species. Indican excretion was higher in patients with purple urinary catheter bags than in controls.

Plasma and leucocyte zinc concentrations and their response to zinc supplementation in an elderly population.

Plasma, mononuclear cell and granulocyte zinc were assessed in a group of 15 institutionalised elderly female patients, and the effect of different levels of zinc supplements (50, 100, 150 mg elemental zinc/day) on these parameters was measured. Plasma but not cellular zinc was lower in the elderly compared with a young control group, but a diminished serum albumin may explain the plasma results. Plasma zinc increased with supplementation, but only when the daily intake was 100 or 150 mg/day; the greatest response was with the higher dose. Mononuclear cell zinc did not respond to zinc supplements. There was a decrease in granulocyte zinc at all levels of zinc supplements, the greatest decrease being found with the highest dose (150 mg/day). The decrease in granulocyte zinc at high intakes may have implications in phagocytosis and chemotaxis.