Preoperative Predictors of Lymph Node Invasion and Biochemical Recurrence in High-risk Prostate Cancer

Aim: To evaluate the preoperative predictors of pathological lymph node (LN) metastasis and prognostic factors for postoperative biochemical recurrence (BCR) in robot-assisted radical prostatectomy with extended pelvic LN dissection in patients with D'Amico high-risk prostate cancer (PCa). Patients and Methods: Overall, 107 patients with D'Amico high-risk PCa underwent robot-assisted radical prostatectomy with extended pelvic LN dissection without neoadjuvant or adjuvant therapy. BCR was defined as a prostate-specific antigen (PSA) level ≥0.2 ng/ml. Moreover, BCR-free survival rates were determined using Kaplan-Meier analysis. Logistic regression analysis was used to evaluate preoperative predictors of pathological LN metastasis. Cox regression analysis was used to evaluate the effects of preoperative and pathologic variables on BCR. Results: The median follow-up was 21 months, and the 5-year BCR-free survival rate was 59.8%. The positive LN rate was 21.5%. In multivariate analysis, the percentage of positive cores was a significant preoperative predictor of positive LNs. Patients with >50% positive cores (p=0.004) and PSA density (PSAD) >0.5 ng/ml/cc (p=0.005) had a high risk of having ≥3 positive LNs. In multivariate analysis, PSAD >0.5% was a significant preoperative predictor of BCR. Among the postoperative predictors, the number of positive LNs was significantly associated with BCR. Patients with ≥3 positive LNs (n=7) had significantly lower BCR-free survival rates than patients with one or two positive LNs (n=16) (p<0.001). Patients with >50% positive cores and PSAD >0.5 ng/ml/cc had a risk for a high number of positive LNs (≥3) that was strongly associated with shorter BCR-free survival (p<0.001). Conclusion: The percentage of positive cores may be useful as a preoperative predictor of pathological LN metastasis in patients with high-risk PCa. Patients with >50% positive cores and PSAD >0.5 ng/ml/cc were found to have a high risk for ≥3 positive LNs and shorter BCR-free survival.

Preoperative predictors for a successful return to sport following anterior cruciate ligament reconstruction (ACLR): a protocol for a systematic review and meta-analysis

IntroductionReturn to sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is the primary goal for most patients. However, the decision of when to RTS is difficult for patients and clinicians as it is based on limited available evidence. Over the past decade, a number of predictor variables have been associated with RTS after ACLR. We present a Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of preoperative predictors for RTS/preinjury levels of physical activity following ACLR.Methods and analysisA literature search will be performed in six electronic databases (CINAHL, AMED, MEDLINE, SPORTDiscus and PsycINFO via EBSCOhost and Web of Science) from inception to December 2020. Prospective, retrospective and cross-sectional study designs will be included. To be included, studies will need to identify at least one preoperative predictor and identify the relationship between the predictor(s) and RTS/preinjury levels of physical activity following ACLR. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction, risk of bias assessment using the Quality in Prognostic Studies tool and the Grading of Recommendations Assessment, Development and Evaluation framework. If data allows and studies are considered homogeneous, data will be pooled through a meta-analysis. If heterogenous, a narrative synthesis will be completed. Subgroup and sensitivity analyses will be completed, where appropriate.Ethics and disseminationEthical permission is not required for this study. The results will be published in a peer-reviewed journal and presented at national and international conferences.PROSPERO registration numberCRD42020222567.

Preoperative Predictors of Prolonged Hospital Stay in Accelerated Rehabilitation for Patients Undergoing Orthopedic Surgery

In this study, we performed a retrospective and prospective study of preoperative predictors of the length of stay (LOS) in three groups of surgical patients and conducted a clinical retrospective study of the current research status of preoperative predictors of LOS prolongation in three groups of patients under ERAS (enhanced recovery after surgery) mode, such as patient characteristics and comorbidities. Information such as patients’ exercise preferences, exercise time, frequency and duration, footwear, location of knee osteoarthritis, whether there is a past history of knee injury, and smoking and drinking history was collected, and the research data of 312 patients undergoing the three operations were analyzed by SPSS. Meniscal injury-knee arthroscopy sample included a total of 104 people. Surgical sample for anterior cruciate ligament reconstruction included a total of 100 subjects. Knee osteoarthritis-knee replacement surgery sample included 148 people who were divided into two groups in a ratio of 1 : 1: one group used Mailuo Shutong pills during hospitalization (intervention group) and the other group did not (control group). The research conclusions are as follows. Meniscal Knee Arthroscopy. (1) Samples from different causes of injury showed significant differences for all injured sites. (2) Samples with different smoking and drinking histories all showed significant differences for the causes of injury. (3) Exercise hobby, exercise frequency, duration of each exercise and duration of exercise, and warm-up time before exercise all showed positive correlation. Anterior Cruciate Ligament Reconstruction Surgery. (4) Samples from different causes of injury showed significant differences for all the injured sites. (5) Age has a significant negative influence on the wearing of shoes at ordinary times. (6) Exercise hobby: the warm-up time before exercise had a significant negative influence on the injured area. (7) Two groups of analysis items of exercise frequency, exercise duration and exercise duration, preexercise warm-up time, and exercise hobby were typically positively correlated. Total Knee Arthroplasty. (8) There was a significant difference of 0.01 between the hospitalization days of the intervention group and the control group ( p < 0.01 ), and the hospitalization days of the intervention group were significantly lower than those of the control group. These results indicated that Mailuo Shutong pills were of great significance for the treatment of orthopedic patients during the operation period in that it could effectively shorten the hospital stay of all orthopedic patients and strengthen the accelerated rehabilitation. (9) There was a significant positive correlation between the history of knee joint surgery and the use time of Mailuo Shutong pills. (10) There was a markable positive correlation between occupation and sports hobbies, sports time, frequency and duration, and footwear. There was a significant negative correlation between occupation and preexercise warm-up. (11) Exercise time, frequency, and duration have significant positive influence on BMI.

The Failed Bidirectional Glenn Shunt: Risk Factors for Poor Outcomes and the Role of Early Reoperation

Background: Bidirectional Glenn shunt (BDG) failure carries high morbidity and mortality but the clinical factors associated with failure and the optimal management strategy are understudied. Methods: A total of 217 patients undergoing BDG at our institution between 1989 and 2020 were retrospectively reviewed and categorized as success or failure. Failure was defined as the need for reoperation (BDG takedown, reoperation for correction of cardiac defect, and/or transplantation) at any time postoperatively; operative mortality (death attributable to BDG malfunction occurring during the index hospitalization for BDG or within 30 days of discharge); or late mortality (death directly attributable to BDG malfunction occurring prior to Fontan or next-stage palliation). Univariate and binary logistic regression analyses were performed. Results: BDG failure occurred in 14 (6.5%) patients. Univariate predictors were: hypoplastic left heart syndrome ( P = .037), right ventricular (RV) dominance ( P = .010), greater pre-BDG pulmonary vascular resistance (PVR) ( P = .012), concomitant atrioventricular valve repair ( P = .020), prolonged pleural drainage ( P = .001), intensive care unit ( P<.001) and hospital ( P = .002) stays, and extracorporeal membrane oxygenation (ECMO) requirement ( P<.001). Multivariate predictors were: RV dominance ( P = .002), greater PVR ( P = .041), ICU ( P<.001) and hospital ( P = .020) stays, and need for ECMO ( P<.001). As many as 10 of 14 (71%) patients with BDG failure died. Reoperation was performed for 10 patients with BDG failure. Five reoperation patients survived until discharge, with four patients alive at last follow-up (mean 7.9 years). Survivors underwent reoperation earlier than nonsurvivors (36 vs. 94 days). Conclusions: BDG failure carries high mortality, but preoperative predictors and postoperative indicators of failure exist. Early BDG takedown and insertion of aorta-pulmonary shunt may allow survival.

Predictors for dementia during long-term follow-up after aortic valve replacement in an elderly population

Introduction Patients undergoing surgical aortic valve replacement (SAVR) with a biological prosthesis usually receive this type of valve because higher age and comorbid conditions. This is the type of patient for whom transcatheter valve implantation (TAVI) has been developed and applied as a mean for less invasive treatment. However, this is also the age group at risk for dementia, a condition which severely reduces the quality of life. Purpose The predictors for the development of dementia during long-term follow-up after SAVR need identification. Methods From January 2008 to June 2017, 1305 patients underwent SAVR with a biological valve. Of these patients, 1221 left the hospital alive (93.6%). In a retrospective file study, the effect of age, gender, preoperative comorbid condition (chronic renal or pulmonary disease, diabetes, treated or treatable cancer, hypertension, stroke) and cardiac status (left ventricular function, coronary artery disease, myocardial infarction, prior CABG or PCI, severity of symptoms, atrial fibrillation, ventricular arrhythmias, conduction defects with or without a need for permanent pacemaker), operative data (bypass time&gt;120 minutes, concomitant CABG, mitral valve repair, maze procedure, procedure on the ascending aorta) and in-hospital postoperative complications (endocarditis, thromboembolism, bleeding, atrial fibrillation, heart failure, pulmonary and renal complications) on the development of dementia was studied. Factors with an effect in a univariate Kaplan-Meier survival analysis were entered in a Cox' proportional hazard analysis. Results There was a follow-up of 7726 patient-years (mean 5.9y). Five-year survival was 78.8±1.3%. At 10 year, this was 50.7±2.1%. Dementia during long-term follow-up was diagnosed in 162/1080 patients (15%). Predictors for the development of dementia are grouped as 1) preoperative, 2) operative and 3) postoperative, and ranked according the p-value. 1) Preoperative predictors – Age &gt;75 years: Odds ratio: 2.89, with 95% Confidence interval between 2.02–4.14 and p&lt;0.001 – Need for emergent surgery: OR=2.84 (1.56–5.19), p=0.001 – Coronary artery disease: OR=1.57 (1.12–2.21), p=0.009 – Diabetes mellitus: OR=1.56 (1.08–2.24), p=0.017 – Atrial fibrillation: OR=1.51 (1.07–2.15), p=0.020 2) Operative predictors – Bypass time &gt;120 minutes: OR=1.40 (1.01–1.94), p=0.043 3) Postoperative predictors – Delirium: OR=3.35 (2.26–4.97), p&lt;0.001 – Acute renal injury: OR=1.98 (1.39–2.81),p&lt;0.001 – Thromboembolism: OR=2.10 (1.02–4.30), p=0.043 Conclusions Development of dementia during long-term follow-up after SAVR in elderly is not uncommon. High age and need for emergent surgery are the dominant preoperative predictors. Long cardiopulmonary bypass, which is usually a marker for more complex procedures is the only operative predictor. Postoperative delirium during hospital stay is a warning sign. The only modifiable factor is need for emergent surgery. FUNDunding Acknowledgement Type of funding sources: None.