Background
Seroma after mastectomy and/or axillary lymph node dissection (ALND) is among the most common issue surgeons have to face in the early postoperative management of breast cancer. Using ...quilting sutures (QS) to aid in tissue approximation and decrease dead space is proposed as a simple technique to reduce seroma rate. We aimed to perform a systematic review, and analyse, in a meta-analytical model, the role of QS in improving wound outcomes and decrease volume, duration of drainage, and length of stay in hospital.
Methods
The study was registered with PROSPERO. A systematic search of the PubMed, EMBASE, and SCOPUS databases was performed for all comparative studies examining surgical outcomes in patients who underwent QS versus conventional closure (CC) after mastectomy ± ALND.
Results
Twenty-one studies with a total of 3473 patients (1736 in the study group and 1737 in the control group) were included based on the selection criteria. The study group showed significantly lower rates of seroma (
p
< 0.00001), total volume of drainage (
p
< 0.0001), days to drain removal (
p
< 0.00001), and length of stay (
p
< 0.00001) compared with the control group, while wound complication rates (surgical site infection, flap necrosis, hematoma, skin dimpling) were comparable between the two groups.
Conclusions
QS are a reliable intraoperative technique that decrease seroma formation, volume of postoperative drainage, duration of drainage and length of hospital stay, and should be considered in mastectomies with or without ALND.
Mesh fixation is one of the most important steps in laparoscopic inguinal hernia repair. Tacks are often used and provide reliable fixation but they increase the risk of bleeding and chronic pain. To ...decrease chronic pain, absorbable tacks have been more recently developed. Another method is fixation via glue, which is the most minimally invasive approach, but it may theoretically lead to higher rates of fixation failure.
To analyse the intraoperative mesh fixation success rate and postoperative outcomes between cyanoacrylate and absorbable tacks in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.
Adult patients who underwent TAPP hernia repair were included prospectively. Patients were split into two groups: the study group (LB) in which the mesh was fixed with cyanoacrylate glue and the control group (AT) in which absorbable tacks were used. Main outcomes were fixation success rate, early postoperative pain, chronic pain, patient reported outcomes and recurrence rate.
The mesh fixation success rate when using LB was 96.70% (n = 88), while in the AT group, the mesh fixation success rate was 100% (n = 120). Patients in the AT group had significantly higher pain scores than patient in the LB group (p < 0.001, 95% CI). There was no significant difference in chronic pain, patient reported outcomes or recurrences between the two groups.
Cyanoacrylate glue is a safe option for mesh fixation in transabdominal preperitoneal laparoscopic inguinal hernia repair with improved early postoperative pain and similar chronic pain, patient reported outcomes and recurrence when compared to absorbable tack fixation.
Background and objectives: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional ...outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. Materials Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. Results: Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea–hypopnea index (p = 0.009) and enlarge the superior posterior airway space (p = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO2 (p = 0.80). Conclusions: This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea–hypopnea index.
(1) Background: In recent years, several studies have described various and heterogenous methods to sensitize nanoparticles (NPs) to pH changes; therefore, in this current scoping review, we aimed to ...map current protocols for pH functionalization of NPs and analyze the outcomes of drug-loaded pH-functionalized NPs (pH-NPs) when delivered in vivo in tumoral tissue. (2) Methods: A systematic search of the PubMed database was performed for all published studies relating to in vivo models of anti-tumor drug delivery via pH-responsive NPs. Data on the type of NPs, the pH sensitization method, the in vivo model, the tumor cell line, the type and name of drug for targeted therapy, the type of in vivo imaging, and the method of delivery and outcomes were extracted in a separate database. (3) Results: One hundred and twenty eligible manuscripts were included. Interestingly, 45.8% of studies (n = 55) used polymers to construct nanoparticles, while others used other types, i.e., mesoporous silica (n = 15), metal (n = 8), lipids (n = 12), etc. The mean acidic pH value used in the current literature is 5.7. When exposed to in vitro acidic environment, without exception, pH-NPs released drugs inversely proportional to the pH value. pH-NPs showed an increase in tumor regression compared to controls, suggesting better targeted drug release. (4) Conclusions: pH-NPs were shown to improve drug delivery and enhance antitumoral effects in various experimental malignant cell lines.
Background and Objectives: The objective of this study was to investigate quantitative changes in cell-free DNA (cfDNA) found in the bloodstream of patients with locally advanced rectal cancer who ...received neoadjuvant long-course chemoradiation, assuming a change in DNA fragments release during therapeutic stress. Materials and Methods: This was a prospective observational study that involved 49 patients who had three distinct pathologies requiring neoadjuvant chemoradiation: 18 patients with breast cancer, 18 patients with cervical cancer, and 13 patients with rectal cancer. Both breast cancer and cervical cancer patients were used as a control groups. Breast cancer patients were used as a control group as irradiation targeted healthy tissue after the tumor resection (R0), while cervical cancer patients were used as a control group to evaluate the effect of chemoradiation regarding cfDNA in a different setting (squamous cell carcinomas) and a different tumor burden. Rectal cancer patients were the study group, and were prospectively evaluated for a correlation between fragmentation of cfDNA and late response to chemoradiation. Blood samples were collected before the initiation of treatment and after the fifth radiation dose delivery. cfDNA was quantified in peripheral blood and compared with the patients’ clinicopathological characteristics and tumor volume. Conclusion: Thirteen patients with locally advanced rectal cancer (T3/T4/N+/M0) were included in the study, and all of them had their samples analyzed. Eight were male (61.54%) and five were female (38.46%), with an average age of 70.85 years. Most of the patients had cT3 (53.85%) or cT4 (46.15%) tumors, and 92.31% had positive lymph nodes (N2–3). Of the thirteen patients, only six underwent surgery, and one of them achieved a pathological complete response (pCR). The mean size of the tumor was 122.60 mm3 35.33–662.60 mm3. No significant correlation was found between cfDNA, tumor volume, and tumor regression grade. cfDNA does not seem to predict response to neoadjuvant chemoradiotherapy and it is not correlated to tumor volume or tumor regression grade.
Obstructive sleep apnea syndrome (OSAS) is a relatively common condition and the cause of neurocognitive and cardiovascular morbidity in children. The aim of this study was to demonstrate if there is ...a correlation between upper airway volume and area and mandibular dimensions and the presence of OSA in children. We retrospectively analyzed 82 patients (43 diagnosed with OSA and 29 healthy ones) using CBCT images and calculated the upper airway volume and area and 3 mandibular parameters. There were statistically significant differences between group 0 (control) and group 1 (OSA patients) with smaller upper airway volume and area and antero-posterior diameter of cross-sectional minimal airway area in OSA patients, but no significant differences regarding the mandibular measurements between the two groups. In conclusion, the impact of pediatric OSA on health and well-being underscores the importance of early identification and appropriate management.
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