Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival

xlomafota13 shared this article with you from Inoreader Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 9:S1748-6815(21)00295-3. doi: 10.1016/j.bjps.2021.05.043. Online ahead of print. ABSTRACT BACKGROUND: The role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS. METHODS: A systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise he terogeneity. RESULTS: Six studies (n = 4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and p = 0.05). Combined HRs for disease-free (1.25 and p = 0.22) and disease-specific (1.06 and p = 0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and p = 0.01), disease-free (OR 1.19 and p = 0.01) and disease-specific (OR 1.19 and p = 0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and p = 0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001). CONCLUSIONS: Pooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further l arge multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS. PMID:34266806 | DOI:10.1016/j.bjps.2021.05.043 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of local tranexamic acid on septoplastic surgery quality

xlomafota13 shared this article with you from Inoreader Evaluation of local tranexamic acid on septoplastic surgery quality Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 24:S1748-6815(21)00097-8. doi: 10.1016/j.bjps.2021.03.008. Online ahead of print. ABSTRACT BACKGROUND: Even a small amount of bleeding during nose surgery can impair the surgeon's vision, prolong the duration of operation, and affect surgery quality; therefore, various techniques have been proposed to control the bleeding. The aim of this study was to compare the efficacy of the local use of tranexamic acid (TXA) in the dry field of surgery. METHOD: This randomized, double-blinded, controlled trial was conducted in the operation room of Imam Reza Hospital, Tehran, Iran, from January 10, 2016 to February 8, 2017. Sixty patients with age range from 20 to 60 years and the American Society of Anesthesiologists physical status classes I candidates who require septoplasty enrolled. Patients were randomized through white and black cards to receive either syringes. Thirty patients in the interventi on group received lidocaine + adrenaline + TXA and 30 patients in the control group received lidocaine + adrenaline. Bleeding volume accumulated in the suction chamber, the nasopharyngeal pack, and hemodynamic variations were measured. Surgeon's satisfaction scores and suitability of operation field were obtained from the surgeon by using the Likert scale and Boezaart grading scale, respectively. RESULTS: The intervention group had a higher score of surgeon satisfaction [4.1 vs 3.16 in the control group (P = 0.001)] and fewer hemodynamic variations. The mean bleeding volume in the intervention was 187.23 ± 54.61 mL and in the control group was 341.22 ± 49.17 mL (P = 0.001). The mean Boezaart score (suitability of operation field) in the intervention group was 1.8 (score range: 1-3) and in the control group was 2.53 (score range: 2-4) and it was statistically significant (P = 0.001). CONCLUSION: The local use of TXA + lidocaine + adrenaline is associated with reduced bl eeding, greater surgeon satisfaction, reduced need for Karpol injection, and better hemodynamic stability. PMID:34266802 | DOI:10.1016/j.bjps.2021.03.008 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cost of peripheral facial palsy treatment with Botulinum Toxin type A

xlomafota13 shared this article with you from Inoreader Cost of peripheral facial palsy treatment with Botulinum Toxin type A Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 23:S1748-6815(21)00336-3. doi: 10.1016/j.bjps.2021.06.003. Online ahead of print. ABSTRACT INTRODUCTION: Facial palsy (FP) is one of the most common neuropathies. Overall, 15%-30% of patients develop chronic sequelae. Several studies support the use of botulinum toxin A (BoNT-A) in the treatment of FP sequelae. No studies have analyzed the cost of treating FP with BoNT-A. METHODS: A retrospective review of data from all clinical records of consultations and procedures that took place at the FP Treatment Unit clinic throughout 2017. Type of BoNT-A used, total dose used, unilateral or bilateral injection, date of consultation, and gender were collected. The price of expendable materials, BoNT-A, and the 2017 salary scale was obtained to establish costs. RESULTS: During 2017, 605 clinical procedures were conducted in 240 patients. The mean number of procedures was 2.5 (0.80). The average time between procedures was 124(28.72) days. The total annual cost was 34.155,10€. The average annual cost of BoNT-A for each procedure was 39,93€, and the total annual cost of BoNT-A was 24.160,58€. On average, more units of IncotoxA were injected. This difference is not reflected in the final cost of each BoNT-A. For patients who achieved treatment stability, the average annual cost per patient was 106,6€ (OnatoxA) and 100,6€ (IncotoxA). CONCLUSION: In our unit, treatment with BoNT-A in FP sequelae had an average annual cost of 124,31€ per patient, requiring a visit to the hospital to receive treatment every 124 days. Given the functional and quality of life improvements, we should consider that it is a beneficial treatment at an acceptable cost. PMID:34266804 | DOI:10.1016/j.bjps.2021.06.003 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of lower lid tightening surgery with lateral tarsal strip on intraocular pressure

xlomafota13 shared this article with you from Inoreader Effect of lower lid tightening surgery with lateral tarsal strip on intraocular pressure Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 20:S1748-6815(21)00340-5. doi: 10.1016/j.bjps.2021.06.006. Online ahead of print. ABSTRACT AIM: To determine whether lower lid tightening surgery with the lateral tarsal strip (LTS) technique can lead to a significant increase in intraocular pressure. This could have implications in the management of lower lid laxity in patients with glaucoma. METHODS: Prospective observational study of patients undergoing unilateral LTS for lower lid laxity. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry in the operative and fellow eye immediately preop and post-op, and at 2 weeks and 3 months post-operatively. Results were analysed for a statistically significant change in IOP following surgery. RESULTS: Thirty-seven patients underwent LTS (mean age 76). Mean preoperative IOP in the operative eye was 13.59 mmHg and 13.89 mmHg in the fellow eye. Mean immediate post-opera tive IOP was 15.41 mmHg in the operative eye and 14.53 mmHg in the fellow eye. There was a statistically significant increase between immediate pre- and post-operative IOP in the operative eye (P = 0.02), but not in the fellow eye. There was also a statistically significant difference found at 3 months post-operatively. CONCLUSION: Lower lid tightening with LTS was associated with a statistically significant increase in IOP immediately post-operatively. In some patients, IOP remained elevated at 3 months after surgery. Lower lid laxity can occur with increasing age and in older patients frequently present with ocular comorbidities, including glaucoma. The results suggest that lower lid tightening surgery in patients with glaucoma or glaucoma suspects, requires careful consideration. PMID:34266805 | DOI:10.1016/j.bjps.2021.06.006 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of multiple lymphatic basin drainage in truncal melanoma patients

xlomafota13 shared this article with you from Inoreader Impact of multiple lymphatic basin drainage in truncal melanoma patients Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 18:S1748-6815(21)00334-X. doi: 10.1016/j.bjps.2021.06.001. Online ahead of print. ABSTRACT INTRODUCTION: In many patients with cutaneous melanoma that affects the trunk area, there is lymphatic drainage to multiple basins (MLBD). This study aimed to examine whether MLBD is associated with disease outcomes. METHODS: Lymphatic mapping and sentinel lymph node (SLN) biopsy were performed in 161 patients with truncal melanoma. The number and location of draining nodal basins were established during the preoperative lymphoscintigraphy using technetium-99 m rhenium sulphide nanocolloid. RESULTS: MLBD was present in 59 (37%) patients, and single lymphatic basin drainage (SLBD) in 102 (63%) patients. Patients with MLBD showed no increased risk for SLN metastasis compared to patients with SLBD (27% versus 29%, respectively). There was no significant difference in disease-free survival (DFS) bet ween patients with MLBD and those with SLBD. Five-year DFS was 64% for patients with MLBD and SLBD. Multivariate analysis showed that the presence of ulceration (p = 0.01) was an independent predictor of SLN metastasis, while melanoma thickness (p = 0.01) and SLN metastasis (p = 0.01) were independent predictors of DFS. In patients with a negative SLN, five-year DFS was 74% for patients with MLBD and 73% for those with SLBD. Multivariate analysis showed that melanoma thickness (p = 0.00) was an independent predictor of DFS. CONCLUSION: MLBD does not negatively impact the disease outcome in patients with truncal melanoma. PMID:34266803 | DOI:10.1016/j.bjps.2021.06.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian

xlomafota13 shared this article with you from Inoreader Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian Via Polyps Vestn Otorinolaringol. 2021;86(3):20-27. doi: 10.17116/otorino20218603120. ABSTRACT Purpose of the study is to assess the internal consistency, reliability of retesting and clinical reliability of the Russian version of the Voice Handicap Index (VHI)-30 questionnaire. MATERIAL AND METHODS: It is prospective observational study. The original English version of the VHI-30 questionnaire was translated into Russian by two independent researchers (professional translators). The final Russian version (VHI-30rus) was formulated by a third researcher (otorhinolaryngologist) on the basis of these two translations, and then translated back into English. The 181 participants were included in this study. The main group patients (n=91) were additionally divided into subgroups in accordance with the form of dysphonia: 65 (71.4%) patients had functional and organic dysphonia, 8 (8.8%) had chronic inflammatory diseases of the larynx, 7 (7.7%) - benign neoplasms of the larynx (singing nodules, polyps, cysts), 11 (12.1%) - unilateral laryngeal paralysis. The control group consisted of 90 people without voice disorders. Internal consistency (Cronbach's α coefficient), retest reliability (intraclass correlation coefficient (ICC) VHI-30, comparison of VHI-30 indicators of patients and studied control group (Mann-Whitney U-test, Kruskal-Wallis test) and correlation with the overall severity of dysphonia (Spearman's ρ rank correlation coefficient) were determined. RESULTS: In the patient group, we observed excellent internal consistency for VHI-30rus (α=0.95) and good internal consistency for all VHI-30rus subscales: physical (α=0.88), functional (α=0.88), and emotional (α=0.88). The intraclass correlation coefficient (ICC) indicated high retest reliability for patients (0.99) and control group subjects (0.84). The 30-item mean total values for patients with dysphonia were statistically significantly higher tha n for control group participants (p<0.001). A correlation was found between the overall VHI-30rus value and the overall severity of dysphonia (ρ=0.748, p<0.001). In the patient's group, female and male participants showed a statistically insignificant difference in the total value of VHI-30rus (Mann-Whitney U-test, p<0.001). There was a correlation in terms of VHI-30rus indicators in different subgroups of the patient group and the control group (Spearman's correlation coefficient: functional dysphonia - 0.942; chronic laryngitis - 0.756; unilateral laryngeal paralysis - 0.888; benign neoplasms - 0.982; control group studied - 0.882). CONCLUSION: As a result of this study, the VHI-30 questionnaire was translated from English into Russian for use in the Russian-speaking environment. The study showed good internal consistency, retest reliability, and clinical validity for the Russian version of the VHI-30rus questionnaire. The VHI-30rus ques tionnaire can be recommended for use in clinical practice for patients with dysphonia. PMID:34269019 | DOI:10.17116/otorino20218603120 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of three-dimensional-printed template-guided and traditional implantation of 125I seeds for gynecological tumors: A dosimetric and efficacy study

xlomafota13 shared this article with you from Inoreader Comparison of three-dimensional-printed template-guided and traditional implantation of <sup>125</sup>I seeds for gynecological tumors: A dosimetric and efficacy study Via radioactive iodine J Cancer Res Ther. 2021 Jul;17(3):688-694. doi: 10.4103/jcrt.JCRT_1565_20. ABSTRACT OBJECTIVE: The objective of the study was to compare the dose parameter and clinical efficacy of three-dimensional-printed template (3D-PT)-guided and traditional 125I seed implantation in treatment of gynecological tumors. MATERIALS AND METHODS: A total of 28 patients with gynecological tumors treated with radioactive seed implantation in Hebei General Hospital from January 2016 to December 2018 were retrospectively analyzed. Twelve patients (template group) were guided by 3D-PT and the remaining 16 patients (traditional group) were guided by computed tomography (CT) with traditional technique. Preoperative treatment plan (preplan) was completed through a treatment planning system. In the template group, 3D-PT was printed according to preplan and seeds were implanted under the guidance of 3D-PT and CT. In the traditional group, seeds were implanted under the guidance of single CT directly according to the preplan. Postoperative verification plan (post-plan) was completed. Dose-volume histogram (DVH) was calculated and D80, D90, V90, V100, and V150 were obtained according to DVH. Then, deviation of the dosimetric parameters D80, D90, V90, V100, and V150 between the preplan and postplan were compared within the two groups. The difference and percentage of difference of the above dosimetric parameters between the preplan and postplan within the two groups were c alculated using the formula Xd = Xpost-plan- Xpre-plan, and Xd% = (Xpost-plan- Xpre-plan)/Xpre-plan × 100%. Doses were calculated to determine whether the differences there were statistically significant. Efficacy evaluation was completed according to RECISIT 1.1. Local control rate and effective rate of 2-months postplan were compared between the two groups. Survival analysis was completed by the Kaplan-Meier method. The patients were followed up for 12 months, and their survival rate was calculated and compared. RESULTS: There was no significant difference between the two groups for all the parameters, except for D80 of the preplan and postplan in the traditional group (P = 0.000). All the differences and percentage of difference were calculated and it was found that the Xd difference of D80 (P = 0.035), D90 (P = 0.023), V90 (P = 0.047), V100 (P = 0.032), and V150 (P = 0.031), as well as the Xd% difference of D80 (P = 0.032), D90 (P = 0.034), V90 (P = 0.042), V100 (P = 0.036), and V150 (P = 0.044) of the two groups was statistically significant, thus indicating that the dosimetric parameter fluctuation in the template group was more stable. The result of the curative effect after 2 months were as follows: the local control rate and effective rate of the template group were 100% (12/12) and 83.3% (10/12), while those of the traditional group were 100% (16/16) and 81.2% (13/16). There was no statistically significant difference in the curative effect between the two groups. After 6-27 months (median = 12 months) of follow-up, the median survival time of the template group and traditional group were 17 (10-23) and 16 (11-20) months, respectively, and the 1-year overall survival rate was 63% and 79% (P = 0.111), respectively, with no statistically significant difference observed. CONCLUSION: 3D-PT-guided 125I seed implantation is safe and ef fective in the treatment of gynecological tumors. PMID:34269300 | DOI:10.4103/jcrt.JCRT_1565_20 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.