The impact of hepatitis B and C diagnoses on surgical outcomes following mastectomy and breast reconstruction

We sought to determine the differences in surgical outcomes associated with adjuvant radiation versus no radiation in patients undergoing concurrent breast oncologic and reconstructive operations. A retrospective review of patients who underwent combined oncologic and plastic surgeries for breast diseases from January 2005 to June 2010 was compared for demographic factors and outcomes by receipt of radiation therapy. During the study period, 175 patients were identified; 25.7 per cent received radiation therapy. Mean patient age was 51 years and median follow-up was 355 days. Overall, 80.2 per cent of patients underwent mastectomy; 19.8 per cent partial mastectomy; 42.1 per cent autologous tissue reconstruction; and 54.8 per cent implant-based reconstruction. There were no significant differences between radiated and nonradiated patients in rates of overall or oncoplastic-specific complications. Lymphedema was the only complication seen more frequently in the radiated arm ( P = 0.03). In our series of carefully selected patients undergoing a variety of reconstructive techniques for repair of partial or total mastectomy defects, radiation was not associated with worse outcomes in patients undergoing immediate breast reconstruction. With careful collaboration among plastic surgeons, breast surgeons, and radiation oncologists, patients requiring breast surgery may safely be considered for reconstruction of partial or total mastectomy defects when adjuvant radiation is required.

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The impact of prepectoral implant positioning in breast reconstruction on the technical delivery of postmastectomy radiotherapy

10.1055/s-0040-1710617 ◽

2020 ◽

Author(s):

C Deutschmann ◽

J Knoth ◽

D Gschwantler-Kaulich ◽

CF Singer ◽

C Leser ◽

...

Keyword(s):

Breast Reconstruction ◽

Postmastectomy Radiotherapy ◽

Implant Positioning ◽

The Impact

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Hepatitis B virus (HBV) viral load, liver and renal function in adults treated with tenofovir disoproxil fumarate (TDF) vs. untreated: a retrospective longitudinal UK cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06226-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tingyan Wang ◽

David A. Smith ◽

Cori Campbell ◽

Jolynne Mokaya ◽

Oliver Freeman ◽

...

Keyword(s):

Viral Load ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Renal Impairment ◽

Clinical Guidelines ◽

Untreated Group ◽

Liver Inflammation ◽

B Virus ◽

The Impact

Abstract Background Current clinical guidelines recommend treating chronic hepatitis B virus (HBV) infection in a minority of cases, but there are relatively scarce data on evolution or progression of liver inflammation and fibrosis in cases of chronic HBV (CHB) that do not meet treatment criteria. We aimed to assess the impact of TDF on liver disease, and the risk of renal impairment in treated CHB patients in comparison to untreated patients. Methods We studied a longitudinal ethnically diverse CHB cohort in the UK attending out-patient clinics between 2005 and 2018. We examined TDF treatment (vs. untreated) as the main exposure, with HBV DNA viral load (VL), ALT, elastography scores and eGFR as the main outcomes, using paired tests and mixed effects model for longitudinal measurements. Additionally, decline of eGFR during follow-up was quantified within individuals by thresholds based on clinical guidelines. Baseline was defined as treatment initiation for TDF group and the beginning of clinical follow-up for untreated group respectively. Results We included 206 adults (60 on TDF, 146 untreated), with a median ± IQR follow-up duration of 3.3 ± 2.8 years. The TDF group was significantly older (median age 39 vs. 35 years, p = 0.004) and more likely to be male (63% vs. 47%, p = 0.04) compared to the untreated group. Baseline difference between TDF and untreated groups reflected treatment eligibility criteria. As expected, VL and ALT declined significantly over time in TDF-treated patients. Elastography scores normalised during treatment in the TDF group reflecting regression of inflammation and/or fibrosis. However, 6/81 (7.4%) of untreated patients had a progression of fibrosis stage from F0-F1 to F2 or F3. There was no evidence of difference in rates or incidence of renal impairment during follow-up in the TDF vs. untreated group. Conclusions Risk of liver inflammation and fibrosis may be raised in untreated patients compared to those receiving TDF, and TDF may benefit a larger percentage of the CHB population.

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Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

Global Spine Journal ◽

10.1177/2192568221996300 ◽

2021 ◽

pp. 219256822199630

Author(s):

Narihito Nagoshi ◽

Kota Watanabe ◽

Masaya Nakamura ◽

Morio Matsumoto ◽

Nan Li ◽

...

Keyword(s):

Multicenter Study ◽

Surgical Outcomes ◽

Hemoglobin A1c ◽

Perioperative Complications ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Asia Pacific ◽

C5 Palsy ◽

Significant Difference ◽

The Impact

Study Design: Retrospective multicenter study. Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients. Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation. Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; P = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; P = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; P = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty. Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.

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Hepatitis B Virus Infection in Pregnancy: Immunological Response, Natural Course and Pregnancy Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10132926 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2926

Author(s):

Sirinart Sirilert ◽

Theera Tongsong

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Pregnancy Outcomes ◽

Natural Course ◽

Hbv Infection ◽

Chronic Hbv Infection ◽

B Virus ◽

Chronic Hbv ◽

Adverse Pregnancy ◽

The Impact

This review aimed to provide an update on the impact of pregnancy on the natural course of hepatitis B virus (HBV) infection and also on the impact of HBV infection on adverse pregnancy outcomes, including mother-to-child transmission (MTCT). For the literature review, original research articles, review articles, and guidelines were narratively reviewed and comprehensively validated. The databases of PubMed, EMBASE, and CINAHL were carefully searched for articles in English on topics related to HBV infection, pregnancy, and vertical transmission from 1960 to May 2021. Immunological changes during pregnancy such as suppression of Th1 response and induction of Th2 immunity lead to an impaired immune reaction to HBV and stimulate viral activity along with the reduction of CD8 T cells to escape immune detection. The impact of pregnancy on the natural course of chronic HBV infection seems to be minimal, while pregnancy can increase morbidity and mortality in the case of advanced HBV hepatitis or cirrhosis. Importantly, hepatitis flare or alanine aminotransferase (ALT) flare can occur during pregnancy and is more common during the postpartum period due to the interaction between HBV and the immune response. Interestingly, the impact of HBV infection on adverse pregnancy outcomes is more serious than ever thought. Updated evidence indicates that pregnancies with chronic HBV infection increase the risk of preterm birth and gestational diabetes, especially in cases of positive hepatitis e antigen (HBeAg).

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The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective

Plastic Surgery ◽

10.1177/22925503211030017 ◽

2021 ◽

pp. 229255032110300

Author(s):

Caroline F. Illmann ◽

Christopher Doherty ◽

Margaret Wheelock ◽

Joshua Vorstenbosch ◽

Joan E. Lipa ◽

...

Keyword(s):

Breast Reconstruction ◽

Care Delivery ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based ◽

Reconstructive Procedures ◽

Surgical Access ◽

Canadian Perspective ◽

Canadian Provinces ◽

The Impact

Background: The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers’ perspective. Methods: This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons’ breast reconstruction practice patterns and opinions on strategies for resource utilization. Results: Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted. Conclusion: This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers’ perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.

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Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

European Radiology ◽

10.1007/s00330-021-07873-2 ◽

2021 ◽

Author(s):

Carlos Canelo-Aybar ◽

Alvaro Taype-Rondan ◽

Jessica Hanae Zafra-Tanaka ◽

David Rigau ◽

Axel Graewingholt ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Surgical Outcomes ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Conserving Surgery ◽

Cochrane Library ◽

Treatment Change ◽

The Impact

Abstract Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

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