Perfusion-related complications remain the most common concern in DIEP flap breast reconstruction. Indocyanine green-based fluorescence angiography can be used for the real-time intra operative ...assessment of flap perfusion. The SPY Elite system is the most widely used device in this setting. The main objective was to describe the use of SPY-Q proprietary software to perform qualitative and quantitative analysis of flap perfusion.
This retrospective cohort study was performed at the Curie Institute between 2013 and 2017. We included patients undergoing unilateral DIEP flap breast reconstruction for whom indocyanine green-based angiography videos were of sufficient quality for analysis. Videos were recorded with the SPY Elite System and analyzed with SPY-Q proprietary software.
We included 40 patients. We used real-time dynamic color analysis to describe three different patterns of flap perfusion. SPY-Q proprietary software provides quantitative flap perfusion parameters. Our quantitative analysis confirmed that zone I is the best perfused part of the flap and zone IV the less perfused one. There was no significant association between flap perfusion pattern and perforator anatomy, patients' clinical characteristics or postoperative outcomes. After exploratory univariate analysis, quantitative perfusion parameters were significantly impaired in young patients with diabetes mellitus or under hormone therapy by tamoxifen.
We here describe a new approach to assess DIEP flap perfusion using the SPY Elite System proprietary software. It provides interesting qualitative and quantitative analysis that can be used in further studies to precisely assess DIEP flap perfusion.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Survival disparities persist in ovarian cancer and may be linked to the environments in which patients live. The main objective of this study was to analyze the global impact of the area of residence ...of ovarian cancer patients on overall survival. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. We included all the patients with epithelial ovarian cancers diagnosed between 2010 and 2016. The areas of residence were analyzed by the hierarchical clustering of the principal components to group similar counties. A multivariable Cox proportional hazards model was then fitted to evaluate the independent effect of each predictor on overall survival. We included a total of 16,806 patients. The clustering algorithm assigned the 607 counties to four clusters, with cluster 1 being the most disadvantaged and cluster 4 having the highest socioeconomic status and best access to care. The area of residence cluster remained a statistically significant independent predictor of overall survival in the multivariable analysis. The patients living in cluster 1 had a risk of death more than 25% higher than that of the patients living in cluster 4. This study highlights the importance of considering the sociodemographic factors within the patient's area of residence when developing a care plan and follow-up.
The three different breast cancer subtypes (Luminal,
positive, and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual ...axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype.
We retrospectively evaluated the axillary involvement (0, 1 to 3 positive nodes, ≥4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into three classes (0; 1 to 3; 4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes.
1197 patients were included in the analysis (luminal (
= 526, 43.9%), TNBCs (
= 376, 31.4%),
-positive BCs (
= 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype (
= 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR 2.8; 95% CI 1.93; 4.06,
< 0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR = 1.24, 95% CI = 0.86; 1.79). In patients with TNBC, both 1-3N+ and ≥4 N+ classes were associated with a decreased RFS (HR = 3.19, 95% CI = 2.05; 4.98 and HR = 4.83, 95% CI = 3.06; 7.63, respectively
ypN0,
< 0.001). Similar decreased prognosis were observed among patients with
-positive BC (1-3N +: HR = 2.7, 95% CI = 1.64; 4.43 and ≥4 N +: HR = 2.69, 95% CI = 1.24; 5.8 respectively,
= 0.003).
The prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.
Breast cancer (BC) is the most commonly diagnosed type of cancer and the leading cause of cancer deaths in women. Smoking is the principal modifiable risk factor for cancers and has a negative ...influence on long-term survival. We conducted a retrospective study on consecutive BC survivors seen at follow-up consultations between 3 June and 30 October 2019 at Institut Curie, Paris, France. Smoking behaviors were evaluated prospectively via interviewer-administered questionnaires. The aim of this study was to describe smoking-related patient care at diagnosis and smoking cessation patterns in women with a history of BC. A total of 1234 patients were included in the study. Smoking status at diagnosis was missing from electronic health records in 32% of cases, including 13% of patients who smoke. Only 20% of the 197 patients currently smoking at diagnosis recalled having a discussion about smoking with a healthcare professional. Radiotherapists and surgeons were more likely to talk about complications than other practitioners. The main type of information provided was general advice to stop smoking (n = 110), followed by treatment complications (n = 48), while only five patients were referred to tobaccologists. Since diagnosis, 33% (n = 65) of the patients currently smoking had quit. Patients who quit had a lower alcohol consumption, but no other factor was associated with smoking cessation. The main motivation for tobacco withdrawal was the fear of BC relapse (63%). This study highlights room for improvement in the assessment of smoking behavior. Our data raise important perspectives for considering BC treatment and follow-up as a window of opportunity for smoking cessation.
Abstract Objective Examine the predictive value for maternal-fetal infection of routine bedside tests detecting the proinflammatory cytokines, TNFα and IL-6, in the vaginal secretions of women with ...premature rupture of the membranes (PROM). Study Design This prospective two-center cohort study included all women hospitalized for PROM over a 2-year period. A bedside test assessed IL-6 and TNFα in vaginal secretions. Both centers routinely tested CRP and leukocytes, assaying both in maternal serum, and analyzed vaginal bacterial flora; all samples were repeated twice weekly until delivery. Results The study included 689 women. In cases of preterm PROM (PPROM) before 37 weeks (n = 184), a vaginal sample positive for one or more bacteria was the only marker associated with early neonatal infection (OR 5.6, 95%CI; 2.0-15.7). Its sensitivity was 82% (95%CI; 62-94) and its specificity 56% (95%CI; 47-65). All positive markers of infection were associated with the occurrence of chorioamnionitis. In cases of PROM from 37 weeks onward (n = 505), only CRP > 5 mg/dL was associated with early neonatal infection (OR = 8.3, 95%CI; 1.1-65.4) or clinical chorioamnionitis (OR = 6.8, 95%CI; 1.5-30.0). The sensitivity of CRP > 5 mg/dL was 91% (95%CI; 59-100) and its specificity 45% (95%CI; 40-51) for predicting early neonatal infection, and 89% (95%CI; 65-99) and 46% (95%CI; 41-51), respectively, for predicting clinical chorioamnionitis. Conclusion The association of vaginal cytokines with maternal-fetal infection is weak and thus prevents their use as a good predictor of maternal-fetal infection. CRP and vaginal samples may be useful for identifying a group of women at low risk of infection.
Background
The respiratory consequences of daily nursing care interventions in patients with acute respiratory distress syndrome (ARDS) are not clearly established.
Aims and objectives
The main ...objective of this study was to assess the feasibility of alveolar collapse analysis by the measurement of lung impedance distribution technique during nursing care in patients with ARDS.
Design
Prospective observational pilot physiologic study in a surgical intensive care unit of a tertiary care hospital including adult intubated patients with moderate‐to‐severe ARDS.
Methods
Each patient was monitored for 12 hours using a chest impedance device. Daily care interventions studied were as follows: endotracheal suctioning, mouth care, bed‐bathing, and blood sampling. The primary endpoint was the variation in end‐expiratory lung impedance (reflecting functional residual capacity) before and 1, 5, 15, and 30 minutes after nursing care interventions. Data are presented as median (interquartile‐range).
Results
One hundred and eight events were collected in 18 patients. Endotracheal suctioning (n = 42), mouth care (n = 26), and bed‐bathing (n = 23) induced a significant decrease in lung impedance after care: endotracheal suctioning (−40.0 −53.8; −28.6% at 1 minute P < .001, −10.4 −27.9; 1.8% at 30 minutes P = .03; mouth care −17.9 −45.4; −14.6% at 1 minute P < .001, −10.4 −21.3; 3.4% at 30 minutes P = .01; bed‐bathing −40.2 −53.5; −14.3% at 1 minute P < .001, −10.6 −36.4; 1.6% at 30 minutes P = .01). Blood sampling (n = 17) did not induce significant changes in lung impedance.
Conclusions
The lung impedance distribution technique during nursing care appears feasible in the majority of patients with ARDS. Some daily nursing care in ARDS patients (including bed‐bathing and mouth care) resulted in a prolonged decrease in lung functional residual capacity and therefore could be associated with pulmonary de‐recruitment.
Relevance to clinical practice
A caregiver who has to assess the functional residual capacity of these patients should probably be informed of the schedules of the nursing care interventions.
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