Introduction: The better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR. Material and methods: A multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders. Results: In total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women. Conclusions: Long-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.
Objective: Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. Materials and Methods: Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR.Results: From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% con-
Background: During extracorporeal life support (ECLS), bleeding is one of the most frequent complications, associated with high morbidity and increased mortality, despite continuous improvements in devices and patient care. Risk factors for bleeding complications in veno-venous (V-V) ECLS applied for respiratory support have been poorly investigated.We aim to develop and internally validate a prediction model to calculate the risk for bleeding complications in adult patients receiving V-V ECLS support.Methods: Data from adult patients reported to the extracorporeal life support organization (ELSO) registry between the years 2010 and 2020 were analyzed.The primary outcome was bleeding complications recorded during V-V ECLS.
Background Total ankle arthroplasty is increasingly used as a treatment for end stage ankle arthropathy. The aim of this study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence. Methods Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27–99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and reoperations were recorded for all patients. Results Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p < 0.001), while the mean AOFAS gradually increased during follow-up postoperative from a mean of 40.9 points preoperative to an average of 82.5 but shows a small decline towards the end of follow-up (p < 0.001). During follow-up we recorded 8 failures (12.3%) resulting in a Kaplan-Meier survival analysis of 87.7% with a median follow-up of 85.2 months. Conclusion We observed excellent clinical results and survival after TAA with the CCI implant with only a low mid-term complication rate. Level of evidence Level III, prospective cohort study.
Background The aims of this study were to assess whether sensory nerve coaptation in free flap breast reconstruction is subject to learning, and to elucidate challenges of this technique. Methods In this single-center retrospective cohort study, we reviewed consecutive free flap breast reconstructions performed between March 2015 and August 2018. Data were extracted from medical records, and missing values imputed. We assessed learning by exploring associations between case number and probability of successful nerve coaptation using a multivariable mixed-effects model. Sensitivity analysis was performed in a subgroup of cases with evidence of attempted coaptation. Recorded reasons for failed coaptation attempts were grouped into thematic categories. Multivariable mixed-effects models were used to examine associations between case number and postoperative mechanical detection threshold. Results Nerve coaptation was completed in 250 of 564 (44%) included breast reconstructions. Success rates varied considerably between surgeons (range 21-78%). In the total sample, the adjusted odds of successful nerve coaptation increased 1.03-fold for every unit increase in case number (95% confidence interval 1.01 – 1.05, p < .05), but sensitivity analysis refuted this apparent learning effect (adjusted odds ratio 1.00, 95% confidence interval 1.00 – 1.01, p = .34). The most frequently recorded reasons for failed nerve coaptation attempts were inability to locate a donor or recipient nerve. Postoperative mechanical detection thresholds showed a negligible, positive association with case number (estimate 0.00, 95% confidence interval 0.00 – 0.01, p < .05). Conclusions This study does not provide evidence in support of a learning process for nerve coaptation in free flap breast reconstruction. Nevertheless, the identified technical challenges suggest that surgeons may benefit from training visual search skills, familiarizing with relevant anatomy, and practicing techniques for achieving tensionless coaptation. This study complements prior studies exploring therapeutic benefit of nerve coaptation by addressing technical feasibility.
Genomic profiling has shown that not all cancer patients who share similar macro- and microscopical features harbour the same underlying molecular mechanism. This suggests the urge for matching patients to mechanism-based cancer therapies, independent of their primary tumour location and histology (Bashraheel et al. 2020). Currently, precision oncology trials provide personalised treatments based on the druggable variants found in a patient genetic makeup. Typically, those trials target single genetic variants (Schmidt et al. 2016; Murciano-Goroff et al. 2020) or provide combination therapies targeting single, mechanistically unrelated proteins which have been proven to be ineffective and or insufficient (Choobdar et al. 2019; Lazareva et al. 2021). In parallel, these variants are allocated to so-called canonical signalling pathways, e.g., KEGG pathways, Wiki Pathways. However, these are rather curated mind maps only combining similar signalling proteins or messengers. They do not represent true cellular signalling entities. Alternatively, signalling modules can be constructed in an unbiased manner from the interactome using validated seed proteins, also termed cancer driver genes, resulting in fragments and often mixtures of the above curated pathways (Nogales et al. 2022). These modules likely represent the true cancer mechanism and concerted network modulation with multiple mechanistically related drugs all acting on the same module i.e., network pharmacology, promise to be much more effective than targeting single unrelated variants (Cheng et al. 2019). As complex tumours will require multiple drugs targeting several modules (Sanchez-Vega et al. 2018), we start with low complexity tumours with a low mutational burden, e.g., thyroid cancer and diffuse intrinsic pontine gliomas (DIPG) (Vogelstein et al. 2013). Here, we (i) construct de-novo disease modules to identify drug targets and repurposable drugs, (ii) apply diagnostic assays to detect the patient-specific perturbed modules and (iii) decide on the therapeutic strategy to correct the modules using network pharmacology. Repurposable drugs are ranked based on clinical feasibility and other parameters. This allows a fundamentally new approach to cancer therapy often using low-side effect drugs acting in concert to improve patient survival and quality of life by implementing biology-informed drug interventions.
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