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Welch Alexandersen posted an update 6 months, 1 week ago
86, 95% CI 0.73-1.01, p=0.07). Shorter length of stay (LOS) (WMD-5.07, 95% CI-6.71 to-3.43, p<0.001) was noted in ERAS group, without increasing 30-day readmission (RR 1.03, 95% CI 0.86-1.24, p=0.71) and mortality (RR 0.70, 95% CI 0.41-1.21, p=0.20).
ERAS significantly reduced overall and minor morbidity, incidences of DGE, incisional and intra-abdominal infections, and shortened LOS in PD, without increasing 30-day readmission and mortality. However, more large-scale randomized controlled trials are still needed to confirm the findings.
ERAS significantly reduced overall and minor morbidity, incidences of DGE, incisional and intra-abdominal infections, and shortened LOS in PD, without increasing 30-day readmission and mortality. https://www.selleckchem.com/products/frax597.html However, more large-scale randomized controlled trials are still needed to confirm the findings.
A single-institution study demonstrated robotic pancreaticoduodenectomy (RPD) was protective against clinically-relevant postoperative pancreatic fistula (CR-POPF) compared to open pancreaticoduodenectomy (OPD). We sought to compare the national rate of CR-POPF by approach.
Procedure-targeted pancreatectomy Participant User Data File was queried from 2014 to 2017 for all patients undergoing pancreaticoduodenectomy. A modified fistula risk score was calculated and patients were stratified into risk categories. Multivariate logistic regression and propensity score matching was used.
The rate of CR-POPF (15.6% vs. 11.9%; p=0.026) was higher in OPD compared to RPD. On subgroup analysis, OPD had higher CR-POPF in high risk patients (32.9% vs. 19.4%; p=0.007). On multivariable analysis OPD was a predictor of increased CR-POPF (Odds Ratio =1.61 ; p=0.005). Other operative factors associated with increased CR-POPF included soft pancreatic texture (OR=2.65 ; p<0.001) and concomitant visceral resection (OR=1.41 ; p=0.031). Increased duct size (reference <3mm) was predictive of decreased CR-POPF 3-6mm (OR=0.70 ; p<0.001) and ≥6mm (OR=0.47 ; p<0.001). Following propensity score matching, RPD continued to be protective against the occurrence of CR-POPF (OR=1.54 ; p=0.013).
This is the largest multicenter study to evaluate the impact of RPD on POPF. It suggests that RPD can be protective against POPF, especially for high risk patients.
This is the largest multicenter study to evaluate the impact of RPD on POPF. It suggests that RPD can be protective against POPF, especially for high risk patients.
The incidence of primary hepatic malignancies including Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is on the rise. (i) Surgery remains the mainstay of potential curative treatment, however the vast majority of patients will recur and not be amenable to curative therapy. (ii) Inflammation has been associated with poor prognosis, however there is no preoperative marker that can predict recurrence-free- or overall survival. Our aim is to correlate inflammation measured as neutrophil extracellular traps (NETs) with survival.
A retrospective analysis was performed using sera/tissue from patients with hepatic malignancies. NET levels were measured in the serum (MPO-DNA) or tumor (Cit-H3). Log rank analysis for RFS/OS was performed.
Cancer patients had higher pre-surgery MPO-DNA levels compared to healthy individuals (healthy vs cancer 2.6±1.0ng/ml vs 34.7±2.13ng/ml; p<0.0001). High pre-surgery serum NET levels were associated with shorter RFS/OS compared to those with low levels(RFS-HCC HR 2.91, 95% CI 1.61-5.26, p<0.0001, RFS-CC HR 3.22, 95% CI 1.33-7.77 p<0.0093). High Cit-H3 tumor levels similarly predicted shorter RFS/OS.
The current study shows a correlation between pre-operative NET levels and survival. Studying NET formation as a biomarker pre-surgery can help identify patients that could benefit from closer follow-up due to higher risk for recurrence.
The current study shows a correlation between pre-operative NET levels and survival. Studying NET formation as a biomarker pre-surgery can help identify patients that could benefit from closer follow-up due to higher risk for recurrence.
The timing of protein intake over the day on muscle mass and strength gains have received interest in the literature. Thus, the aim of this systematic review is to analyze clinical studies that evaluated the acute effects of pre-sleep protein consumption on overnight muscle protein synthesis and the chronic effects on muscle mass and strength.
Systematic review.
A literature search was conducted up to June 2020 according to PRISMA statement and nine articles were included to analyze.
The consumption of 20-40 g of casein approximately 30 min before sleep stimulates whole-body protein synthesis rates over a subsequent overnight period in young and elderly men (preceded or not by resistance exercise, respectively). In addition, pre-sleep protein consumption can augment the muscle adaptive response (muscle fiber cross-sectional area, strength and muscle mass) during 10-12 weeks of resistance exercise in young, but not in elderly men.
Based on current evidence, the consumption of 20-40 g of casein approxthe initial evidence regarding the pre-sleep protein enhances overnight muscle protein synthesis rates, the current available evidence is limited precluding to conclude about the chronic effects on skeletal muscle mass or strength. These conclusions need to be taken with caution due to uneven protein intakes between experimental groups. Therefore, more data are needed before further considering pre-sleep protein as an effective nutritional intervention.
Brachytherapy (BT) after surgical resection of keloids reduces the risk of local recurrence, but standardization of dose/technique is lacking. Typical keloid BT treatment utilizes a single-channel source prescribed to 5-mm depth. We investigated the dosimetry of a volume-based target definition for interstitial high-dose-rate BT treatment of keloids.
We retrospectively identified consecutive 14 patients who had a total of 20 keloids treated with interstitial high-dose-rate BT for keloids at our institution between 2004 and 2014. Keloids were treated with a single 8Gy fraction prescribed to 5mm beneath the scar within 36h of surgery. Retrospectively, a 3-mm skin high-risk clinical target volume (HR-CTV) was contoured under the scar for volume-based dose calculations.
Mean (SD) HR-CTV was 3.91cm
(3.1) and mean (SD) HR-CTV dose was 11.3Gy (3.6). Mean D
(SD) was 62.9% (25.8) and mean V
(SD) was 56.5% (26.4). The mean V
(SD), V
(SD), and V
(SD) were as follows 37.6% (19.9), 25.1% (14.4), and 11.3% (6.