The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

A Stable Open-Shell Conjugated Diradical Polymer with Ultra-High Photothermal Conversion Efficiency for NIR-Ⅱ Photo-Immunotherapy of Metastatic Tumor

Massive efforts have been concentrated on the advance of eminent near-infrared(NIR) photothermal materials(PTMs) in the NIR-Ⅱ window(1000–1700 nm), especially organic PTMs because of their intrinsic biological safety compared with inorganic PTMs. However, so far, only a few NIR-Ⅱresponsive organic PTMs was explored, and their photothermal conversion efficiencies(PCEs) still remain relatively low. Herein, donor–acceptor conjugated diradical polymers with open-shell characteristics are explored for synergistically photothermal immunotherapy of metastatic tumors in the NIR-Ⅱ window. By employing side-chain regulation, the conjugated diradical polymer TTB-2 with obvious NIR-Ⅱ absorption was developed, and its nanoparticles realize a record-breaking PCE of 87.7% upon NIR-Ⅱ light illustration. In vitro and in vivo experiments demonstrate that TTB-2 nanoparticles show good tumor photoablation with navigation of photoacoustic imaging in the NIR-Ⅱ window, without any side-effect. Moreover, by combining with PD-1 antibody,the pulmonary metastasis of breast cancer is high-effectively prevented by the efficient photo-immunity effect. Thus, this study explores superior PTMs for cancer metastasis theranostics in the NIR-Ⅱ window, offering a new horizon in developing radical-characteristic NIR-Ⅱ photothermal materials.

Free radicals trigger the closure of open pores in lignin-derived hard carbons toward improved sodium-storage capacity

The chemical activation of various precursors is effective for creating additional closed pores in hard carbons for sodium storage.However,the formation mechanism of closed pores under the influence of pore-forming agents is not well understood.Herein,an effective chemical activation followed by a high-temperature self-healing strategy is employed to generate interconnected closed pores in lignin-derived hard carbon(HCs).By systematic experimental design combined with electron paramagnetic res-onance spectroscopy,it can be found that the content of free radicals in the carbon matrix influences the closure of open pores at high temperatures.Excessively high activation temperature(>700 C)leads to a low free radical concentration,making it difficult to achieve self-healing of open pores at high tempera-tures.By activation at 700°C,a balance between pore making and self-healing is achieved in the final hard carbon.A large number of free radicals triggers rapid growth and aggregation of carbon microcrys-tals,blocking pre-formed open micropores and creating additional interconnected closed pores in as-obtained hard carbons.As a result,the optimized carbon anode(LK-700-1300)delivers a high reversible capacity of 330.8 mA h g^(-1) at 0.03 A g^(-1),which is an increase of 86 mA h g^(-1) compared to the pristine lignin-derived carbon anode(L-700-1300),and exhibits a good rate performance(202.1 mA h g^(-1) at 1 A g^(-1)).This work provides a universal and effective guidance for tuning closed pores of hard carbons from otherprecursors.

Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Influence of humanistic care-based operating room nursing on safety,recovery,and satisfaction after radical surgery for colorectal carcinoma

BACKGROUND Radical surgery is a preferred treatment for colorectal carcinoma,wherein nursing intervention is essential for postoperative recovery and prevention of complications.Recently,the application of humanistic care in medical care has attracted attention.Humanistic care emphasizes comprehensive care,with importance attached to patients’physical needs as well as psychological and emotional support to provide more humane and personalized care services.However,no clinical reports have examined the use of humanistic care in patients undergoing radical surgery for colorectal carcinoma.AIM To investigate the influence of humanistic care-based operating room nursing on the safety,postoperative recovery,and nursing satisfaction of patients who have undergone radical surgery for colorectal carcinoma.METHODS In total,120 patients with rectal cancer who underwent surgery in Zhongnan Hospital of Wuhan University between August 2023 and March 2024 were selected and grouped based on the nursing methods employed.Of these patients,55 were treated with routine nursing intervention(control group)and 65 were provided humanistic care-based operating room nursing(research group).The patients’vital signs were recorded,including systolic/diastolic blood pressure(SBP/DBP)and heart beats per minute(BPM),as well as serum stress indices,including norepinephrine(NE),adrenal hormone(AD),and cortisol(Cor).Postoperative recovery and complications were also recorded.Patients’negative emotions,life hope,and nursing satisfaction were evaluated using the Self-rating Depression/Anxiety Scale(SDS/SAS),Herth Hope Index(HHI),and self-deve-loped nursing satisfaction questionnaire,respectively.RESULTS During emergence from anesthesia,SBP,DBP,and BPM levels were found to be lower in the research group than those in the control group,also serum Cor,AD,and NE levels were lower.In addition,the research group had shorter operative,awakening,anal exhaust,first postoperative ambulation,drainage tube removal,intestinal recovery,and hospital times.The total complication rate and the SDS and SAS scores were lower in the research group than those in the control group.The HHI and nursing satisfaction scores were higher in the research group.CONCLUSION Humanistic care-based operating room nursing can mitigate physiological stress responses,reduce postoperative complications,promote postoperative recovery,relieve adverse psychological emotions,and enhance life hope and nursing satisfaction in patients undergoing radical surgery for colorectal carcinoma,which can be popularized in clinical practice.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in China.Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.RESULTS The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished group.The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed discharge.CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy.Low PNI is an independent risk factor associated with delay discharge.More strategies are needed to improve the clinical outcome of these patients.

Effects of psychological intervention on negative emotions and psychological resilience in breast cancer patients after radical mastectomy

Breast cancer(BC)is the most common malignant tumor in women,and the treatment process not only results in physical pain but also significant psychological distress in patients.Psychological intervention(PI)has been recognized as an important approach in treating postoperative psychological disorders in BC patients.It has been proven that PI has a significant therapeutic effect on postoperative psychological disorders,improving patients'negative emotions,enhancing their psychological resilience,and effectively enhancing their quality of life and treatment compliance.

Tumor recurrence and survival prognosis in patients with advanced gastric cancer after radical resection with radiotherapy and chemotherapy

BACKGROUND Advanced gastric cancer is a common malignancy that is often diagnosed at an advanced stage and is still at risk of recurrence after radical surgical treatment.Chemoradiotherapy,as one of the important treatment methods for gastric cancer,is of great significance for improving the survival rate of patients.However,the tumor recurrence and survival prognosis of gastric cancer patients after radio-therapy and chemotherapy are still uncertain.AIM To analyze the tumor recurrence after radical radiotherapy and chemotherapy for advanced gastric cancer and provide more in-depth guidance for clinicians.METHODS A retrospective analysis was performed on 171 patients with gastric cancer who received postoperative adjuvant radiotherapy and chemotherapy in our hospital from 2021 to 2023.The Kaplan-Meier method was used to calculate the recurrence rate and survival rate;the log-rank method was used to analyze the single-factor prognosis;and the Cox model was used to analyze the prognosis associated with multiple factors.RESULTS The median follow-up time of the whole group was 63 months,and the follow-up rate was 93.6%.Stage II and III patients accounted for 31.0%and 66.7%,respec-tively.The incidences of Grade 3 and above acute gastrointestinal reactions and hematological adverse reactions were 8.8%and 9.9%,respectively.A total of 166 patients completed the entire chemoradiotherapy regimen,during which no adverse reaction-related deaths occurred.In terms of the recurrence pattern,17 patients had local recurrence,29 patients had distant metastasis,and 12 patients had peritoneal implantation metastasis.The 1-year,3-year,and 5-year overall survival(OS)rates were 83.7%,66.3%,and 60.0%,respectively.The 1-year,3-year,and 5-year disease-free survival rates were 75.5%,62.7%,and 56.5%,respectively.Multivariate analysis revealed that T stage,peripheral nerve invasion,and the lymph node metastasis rate(LNR)were independent prognostic factors for OS.CONCLUSION Postoperative intensity-modulated radiotherapy combined with chemotherapy for gastric cancer treatment is well tolerated and has acceptable adverse effects,which is beneficial for local tumor control and can improve the long-term survival of patients.The LNR was an independent prognostic factor for OS.For patients with a high risk of local recurrence,postoperative adjuvant chemoradiation should be considered.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

Radical Hysterectomy in Cervical Cancer: Patients’ Epidemiological and Clinical Profiles and Perioperative Outcome in Two Referral Hospitals in Cameroon

Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.

Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy:A single center analysis

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

Laparoscopic vs open radical resection in management of gallbladder carcinoma:A systematic review and meta-analysis

BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma(GBC)above the T1b stage.However,whether it should be performed under laparoscopy for GBC is still controversial.AIM To compare laparoscopic radical resection(LRR)with traditional open radical resection(ORR)in managing GBC.METHODS A comprehensive search of online databases,including Medline(PubMed),Cochrane Library,and Web of Science,was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023.A meta-analysis was subsequently performed.RESULTS A total of 18 retrospective studies were identified.In the long-term prognosis,the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival(TFS).LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis(TNM)Ⅱstage subgroup vs the ORR group(P=0.04).In the short-term prognosis,the LRR group had superiority over the ORR group in the postoperative length of stay(POLS)(P<0.001).The sensitivity analysis showed that all pooled results were robust.CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNMⅡdisease and POLS.Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.

Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer

BACKGROUND Radical surgery is the most commonly used treatment for hepatocellular carcinoma(HCC).However,the surgical effect remains not ideal,and prognostic evaluation is insufficient.Furthermore,clinical intervention is rife with uncertainty and not conducive to prolonging patient survival.AIM To explore correlations between the systemic immune inflammatory index(SII)and geriatric nutritional risk index(GNRI)and HCC operation prognosis.METHODS This retrospective study included and collected follow up data from 100 HCC.Kaplan–Meier survival curves were used to analyze the correlation between SII and GNRI scores and survival.SII and GNRI were calculated as follows:SII=neutrophil count×platelet count/lymphocyte count;GNRI=[1.489×albumin(g/L)+41.7×actual weight/ideal weight].We analyzed the predictive efficacy of the SII and GNRI in HCC patients using receiver operating characteristic(ROC)curves,and the relationships between the SII,GNRI,and survival rate using Kaplan–Meier survival curves.Cox regression analysis was utilized to analyze independent risk factors influencing prognosis.RESULTS After 1 year of follow-up,24 patients died and 76 survived.The area under the curve(AUC),sensitivity,specificity,and the optimal cutoff value of SII were 0.728(95%confidence interval:0.600-0.856),79.2%,63.2%,and 309.14,respectively.According to ROC curve analysis results for predicting postoperative death in HCC patients,the AUC of SII and GNRI combination was higher than that of SII or GNRI alone,and SII was higher than that of GNRI(P<0.05).The proportion of advanced differentiated tumors,tumor maximum diameter(5–10 cm,>10 cm),lymph node metastasis,and TNM stage III-IV in patients with SII>309.14 was higher than that in patients with SII≤309.14(P<0.05).The proportion of patients aged>70 years was higher in patients with GNRI≤98 than that in patients with GNRI>98(P<0.05).The 1-year survival rate of the SII>309.14 group(compared with the SII≤309.14 group)and GNRI≤98 group(compared with the GNRI>98 group)was lower(P<0.05).CONCLUSION The prognosis after radical resection of HCC is related to the SII and GNRI and poor in high SII or low GNRI patients.

An efficient electrocatalytic system composed of nickel oxide and nitroxyl radical for the oxidation of bio-platform molecules to dicarboxylic acids

Selective oxidation of biomass and its derivatives to dicarboxylic acids represents a promising route for biomass valorization.However,the co-presence of multiple functional groups in biomass molecules makes the selective oxidation of particular functional a challenging task.Here,we demonstrate an efficient electrocatalytic system consisting of nickel oxide(NiO)and a nitroxyl radical,i.e.,2,2,6,6-tetrame thylpiperidine-1-oxyl(TEMPO)or 4-acetamido-TEMPO(ACT),for the selective oxidation of key bioplatform molecules including glucose,xylose and 5-hydroxymethylfurfural(HMF)into corresponding dicarboxylic acids,i.e.,glucaric acid,xylaric acid,and 2,5-furandicarboxylic acid(FDCA).NiO is clarified as the active catalyst for the oxidation of aldehyde in bio-platform molecules to carboxylic acid,while TEMPO or ACT is responsible for the oxidation of primary alcohol to aldehyde.The combination of NiO and TEMPO or ACT significantly accelerated the tandem oxidation of aldehyde and hydroxyl groups in glucose,xylose and HMF,thus achieving excellent yields(83%-99%)of dicarboxylic acids.Moreover,the combination catalyst enables the selective oxidation of glucose and xylose with high concentrations(e.g.,20 wt%),which offers a promising strategy for biomass valorization.

Primary Treatment for Clinically Early Cervical Cancer with Lymph Node Metastasis:Radical Surgery or Radiation?

Objective To compare survival outcomes between primary radical surgery and primary radiation in early cervical cancer.Methods Patient information was extracted from the Surveillance,Epidemiology,and Results database.Patients diagnosed with early cervical cancer of stage T1a,T1b,and T2a(American Joint Committee on Cancer,7th edition)from 1998 to 2015 were included in this study after propensity score matching.Overall survival(OS)was analyzed using the Kaplan-Meier method.Results Among the 4964 patients included in the study,1080 patients were identified as having positive lymph nodes(N1),and 3884 patients were identified as having negative lymph nodes(N0).Patients with primary surgery had significantly longer 5-year OS than those with primary radiotherapy in both the N1 group(P<0.001)and N0 group(P<0.001).In the subgroup analysis,similar results were found in patients with positive lymph nodes of stage T1a(100.0%vs.61.1%),T1b(84.1%vs.64.3%),and T2a(74.4%vs.63.8%).In patients with T1b1 and T2a1,primary surgery resulted in longer OS than primary radiation,but not in patients with T1b2 and T2a2.In multivariate analysis,the primary treatment was identified as an independent prognostic factor in both N1 and N0 patients(HR_(N1)=2.522,95%CI=1.919–3.054,PN1<0.001;HR_(N0)=1.895,95%CI=1.689–2.126,PN0<0.001).Conclusion In early cervical cancer stage T1a,T1b1,and T2a1,primary surgery may result in longer OS than primary radiation for patients with and without lymph node metastasis.

Decontamination of Cr(Ⅵ) from water using sewage sludge-derived biochar: Role of environmentally persistent free radicals

Biochar is a well-known material for pollutant removal owing to its low cost and rich surface functionality. A kind of highly active substance, called environmentally persistent free radicals(EPFRs), can be produced in the preparation process of biochar, playing an important role in the removal of pollutants.In this study, sludge-derived biochars(SBC_(120) and SBC_(270)) were prepared by the hydrothermal carbonization under two temperatures(120℃ and 270℃) to investigate their removal abilities of Cr(Ⅵ). The maximum removal amounts of Cr(Ⅵ) by SBC_(120) and SBC_(270) were 16.58 and 22.93 mg·g^(-1), respectively. It was further revealed that the appearance of Cr(Ⅲ), as a result of EPFRs on sludge-derived biochar(SBC) transferred electrons to Cr(Ⅵ) in neutral solutions. That is to say, oxygen-centered(O-centered) EPFRs on SBC_(120) and carbon-centered(C-centered) EPFRs on SBC_(270) all could be used as electron donors to Cr(Ⅵ) to make it become Cr(Ⅲ). This study not only provides a theoretical basis for the mechanism of pollutants removal by sludge-derived biochar but also offers a new perspective on the direct effect of EPFRs on pollutants.