The efficacy of the American College of Surgeons Surgical Risk Calculator in the prediction of postoperative complications in oncogeriatric patients after curative surgery for abdominal tumors.

BACKGROUND: The American College of Surgeons (ACS) has developed a Surgical Risk Calculator (SRC) to predict postoperative surgical complications. No studies have reported the performance of the ACS-SRC in oncogeriatric patients. Our objective was to evaluate the predictive performance of the ACS-SRC in these patients, treated with curative surgery for an abdominal malignancy. METHODS: This is a retrospective study including 136 patients who underwent elective abdominal oncological surgery, between 2017 and 2019, at our institution. Postoperative complications were classified according to the ACS-SRC, and its predictive performance was analyzed by assessing discrimination and calibration and using receiver operating characteristics and area under the curve (AUC). RESULTS: Discrimination was adequate with AUC of 0.7113 (95% confidence interval [CI]: 1.062-1.202, p = 0.0001; Brier 0.198) for serious complications and 0.7230 (95% CI: 1.101-1.756, p = 0.0057; Brier 0.099) for pneumonia; and poor for sepsis, surgical site infection (SSI), and urinary tract infection (UTI) with AUCs of 0.6636 (95% CI: 1.016-1.353, p = 0.0299; Brier 0.142), 0.6167 (95% CI: 1.003-1.266, p = 0.0450; Brier 0.175), and 0.6598 (95% CI: 1.069-2.145, p = 0.0195; Brier 0.082), respectively. CONCLUSION: The ACS-SRC is an adequate predictor for serious complications and pneumonia in oncogeriatric patients treated surgically for abdominal cancer. However, the predictive power of the calculator appears to be low for sepsis, UTI, and SSI.

Hip fractures re-operation compared with death at two year in elderly patients: lowest risk of revision with dual mobility total hip arthroplasty than with bipolar hemiarthroplasty or internal fixation of Garden I and II.

PURPOSE: This study determined at two year follow-up the lifetime risk of re-operation for elderly patients with hip fractures undergoing internal fixation, dual mobility total hip arthroplasty, or bipolar hemiarthroplasty, using death of the patient as a competing risk. MATERIALS AND METHODS: With the hypothesis that arthroplasties may have less complications without increasing mortality even for Garden I and Garden II fractures, we retrospectively reviewed 317 hips with femoral neck fractures operated between January 2015 and August 2019. The mean age at time of surgical intervention was 82.4 years (range 65 to 105). Sixty patients presented a nondisplaced hip fracture (Garden I or II) treated by internal fixtion (I-F), and 257 were treated by hip arthroplasty: 118 dual mobility total hip arthroplasty (DM-THA) and 139 with a bipolar hemiarthroplaty (B-H). Demographics, surgical and complications data, and mortality were collected and compared for each group. RESULTS: The overall mortality rate was 22.4% at two years, and similar (p = 0.98) in all groups, respectively 22%, 22%, and 23% for DM-THA, B-H, and I-F groups. With dual mobility THA, the cumulative incidence of re-operations for any reason was (lower (9%) than with internal fixation (22%) or bipolar hemiarthroplasties (19%). CONCLUSION: Using a double mobility total prosthesis does not increase the post-operative mortality of the patients, nor does it increase their survival. But, reducing the risk of complications certainly improves their quality of life during the little time they have left .

The significance of nanoparticles in brain cancer diagnosis and treatment: modeling and simulation.

A numerical analysis of specific absorption rate (SAR) and temperature distributions in a realistic human head model is presented in this study. The key challenge is to rise cancer temperature to an optimal temperature without heating nearby healthy tissues. The model's uniqueness is that it captures the effect of nanoparticles on both brain cancer diagnosis and treatment. A realistic human head model with a cancerous brain segmented from 2D magnetic resonance imaging (MRI) gained from an actual patient using 3D Slicer, modeled, and simulated using CST-Microwave Studio, and illuminated by Archimedes spiral antenna. At frequencies of 2450 MHz and 915 MHz, the model simulated the absence and presence of various nanoparticles. The obtained results suggest that when using nanoparticles, it is possible to achieve sufficient energy deposition and temperature rise to therapeutic values (greater than 42 °C) in brain cancers using the proposed noninvasive hyperthermia system at 915 MHz frequency, especially for gold nanoparticles, without harming surrounding healthy tissue. Our research might pave the way for a clinical applicator prototype that can heat brain cancer.