Background: s/Aims: The role of surgery for pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastases remains controversial. Previous studies assessing the outcomes of combined surgery for primary PDAC and liver metastases have been limited by the inconsistent application of neoadjuvant chemotherapy (NAC). Methods: We identified patients with PDAC and fewer than three liver metastases who received at least six months of NAC and underwent simultaneous pancreas and liver resection between January 2018 and March 2023 at a single institution. Additionally, we queried the National Cancer Database (NCDB) from 2010 to 2019 to identify patients with synchronous metastatic PDAC to the liver who received NAC before simultaneous resection, serving as a comparison group. Results: Ten patients met the inclusion criteria for the institutional case series, with seven ultimately undergoing simultaneous resection. Among 224 patients in the NCDB who underwent simultaneous pancreas and liver resection, 70 patients (31.2%) received NAC.After a median follow-up of 59 months in the institutional cohort, five patients experienced recurrence, resulting in a median disease-free survival of four months (95% confidence interval [CI] 3, not reached). After controlling for confounding factors in the NCDB cohort, the administration of NAC was associated with improved survival (hazard ratio: 0.44, 95% CI 0.29–0.65, p < 0.001) compared to those who underwent upfront surgery. Conclusions Neoadjuvant therapy followed by simultaneous liver and pancreas resection for metastatic PDAC is safe and feasible, and it may provide a survival benefit in carefully selected patient populations.

Objective: Oral anticoagulant (OAC) use increases the risk of death in conditions like hemorrhagic stroke, trauma, and traumatic brain injury. Early identification of OAC use is critical for timely interventions to mitigate hemorrhage risk and improve survival. We aimed to identify emergency medical services (EMS) care characteristics associated with patients using an OAC. Methods: We analyzed prehospital data (2018–2020) from the ESO Data Collaborative, focusing on adult (≥18 years) 911 EMS calls. The administered OACs were warfarin, dabigatran, rivaroxaban, and apixaban. We compared EMS call characteristics, patient demographics, response times, and interventions between OAC and non-OAC users. We used univariate logistic regression to identify independent predictors of OAC use. Results: Of 16,244,550 adult 911 EMS events, 906,575 involved OAC users (56 of 1,000 calls). Those using OAC were older (73.6 years vs. 56.9 years) and more often from nursing homes or long-term care facilities (17.0% vs. 9.2%) but less likely to have trauma (14.7% vs. 18.1%) or cardiac arrest (1.2% vs. 1.4%). The most common EMS primary clinical impressions for OAC users were chest pain (7.4%), altered mental status (7.3%), injury (6.5%), abdominal pain (4.3%), and brain injury (2.8%). Conclusion OAC users accounted for 1 in 18 adult EMS encounters. Specific patient and call characteristics were associated with OAC use. These findings should be incorporated into EMS training to facilitate recognition and appropriate management of OAC-related emergencies.

Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient’s age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients’ vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients’ responsiveness to stimuli.

Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient’s age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients’ vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients’ responsiveness to stimuli.

Background: Sedation remains a subject of contention and anxiety for many interventional teams. We reviewed our outcomes of electroencephalographic (EEG) bi-spectral index sensor (BIS) guidance, which allowed us to transfer the role of the sedation practitioner to the interventional radiology nurses. Methods: In total, 150 consecutive cancer-related interventional procedures were collected prospectively at a tertiary center. All patients were given 4 L oxygen via a nasal cannula and had conscious sedation administered by two trained interventional nurses. In addition to standard monitoring, frontal lobe EEG BIS monitoring was used. The initial amount of midazolam or fentanyl administered were dependant on the patient’s age and American Society of Anesthesiologists classification score. Thereafter, conscious sedation was maintained by titrating small incremental doses to maintain BIS between 80 and 85. The patients’ vitals were monitored at 5-minute intervals and recorded along with the Ramsay sedation scale and tolerance score. Results: The three most common procedures were: radiologically inserted gastrostomy (48%), percutaneous transhepatic cholangiography (35%), and esophageal stenting (11%). All procedures were completed without disruption or unexpected patient movements. No reversal agents or airway management were required and no incidences of hypoxia occurred. Conclusion BIS monitoring is an invaluable tool that has successfully allowed the role of the sedation practitioner to be transferred to the interventional nurses. It allows sedation to be personalized to each patient and their individual susceptibility to combination sedation and represents a vast improvement over interval clinical assessment of patients’ responsiveness to stimuli.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: “(laparoscopic OR endoscopic) AND (anterior AND lumbar).” Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio’s “metafor” package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6–43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9–90.4). Complications occurred in 19.2% (95% CI, 13.4–27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6–11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.

Methods: Patients undergoing primary, elective 1–3 level ACDF for radiculopathy at a single academic center between 2015 and 2021 were identified retrospectively. Cervical FS was evaluated using axial T2-weighted MRI images via a validated grading scale. The maximum degree of stenosis was used for multilevel disease. Motor symptoms were classified using encounters at their final preoperative and first postoperative visits, with examinations ≤3/5 indicating weakness. PROMs were obtained preoperatively and at 1-year follow-up. Bivariate analysis was used to compare outcomes based on stenosis severity, followed by multivariable analysis. Results: This study included 354 patients, 157 with moderate stenosis and 197 with severe stenosis. Overall, 58 patients (16.4%) presented with upper extremity weakness ≤3/5. A similar number of patients in both groups presented with baseline motor weakness (13.5% vs. 16.55, p =0.431). Postoperatively, 97.1% and 87.0% of patients with severe and moderate FS, respectively, experienced full motor recovery (p =0.134). At 1-year, patients with severe neuroforaminal stenosis presented with significantly worse 12-item Short Form Survey Physical Component Score (PCS-12) (33.3 vs. 37.3, p =0.049) but demonstrated a greater magnitude of improvement (Δ PCS-12: 5.43 vs. 0.87, p =0.048). Worse stenosis was independently associated with greater ΔPCS-12 at 1-year (β =5.59, p =0.022). Conclusions Patients with severe FS presented with worse preoperative physical health. While ACDF improved outcomes and conferred similar motor recovery in all patients, those with severe FS reported much better improvement in physical function.

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and prospective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the international collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.

PURPOSE: The selective elimination of cancer stem cells (CSCs) in tumor patients is a crucial goal because CSCs cause drug refractory relapse. To improve the current conventional bispecific immune-engager platform, a 16133 bispecific natural killer (NK) cell engager (BiKE), consisting of scFvs binding FcγRIII (CD16) on NK cells and CD133 on carcinoma cells, was first synthesized and a modified interleukin (IL)-15 crosslinker capable of stimulating NK effector cells was introduced. MATERIALS AND METHODS: DNA shuffling and ligation techniques were used to assemble and synthesize the 1615133 trispecific NK cell engager (TriKE). The construct was tested for its specificity using flow cytometry, cytotoxic determinations using chromium release assays, and lytic degranulation. IL-15–mediated expansion was measured using flow-based proliferation assays. The level of interferon (IFN)-γ release was measured because of its importance in the anti-cancer response. RESULTS: 1615133 TriKE induced NK cell–mediated cytotoxicity and NK expansion far greater than that achieved with BiKE devoid of IL-15. The drug binding and induction of cytotoxic degranulation was CD133+ specific and the anti-cancer activity was improved by integrating the IL-15 cross linker. The NK cell–related cytokine release measured by IFN-γ detection was higher than that of BiKE. NK cytokine release studies showed that although the IFN-γ levels were elevated, they did not approach the levels achieved with IL-12/IL-18, indicating that release was not at the supraphysiologic level. CONCLUSION: 1615133 TriKE enhances the NK cell anti-cancer activity and provides a self-sustaining mechanism via IL-15 signaling. By improving the NK cell performance, the new TriKE represents a highly active drug against drug refractory relapse mediated by CSCs.
Antibody-Dependent Cell Cytotoxicity ; Chromium ; DNA Shuffling ; Flow Cytometry ; Humans ; Interferons ; Interleukin-15 ; Interleukins ; Killer Cells, Natural ; Ligation ; Neoplastic Stem Cells ; Recurrence ; Sensitivity and Specificity

In recent, distraction osteogenesis has been used to correct skeletal malformations and discrepancies in the craniofacial area. It also seems to be considered as an alternative in the treatment of severe midfacial hypoplasia. There are some types of distractors for midfacial distraction such as subcutaneous distractors and rigid external distractors. We used a rigid external distractor for correction (RED) of craniofacial hypoplasia. Seven patients underwent a midfacial distraction osteogenesis with a rigid external distractor between April 2000 and July 2001. Three patients suffered from Apert's syndrome, three patients from Crouzon's syndrome, and one patient suffered from midfacial hypoplasia due to midfacial radiotheraphy during childhood. On average, the mean distance of distraction was 19.8mm (10~25mm) and the distraction lasted for 24 days. The patients showed no severe complications like infections, optic disturbance, or wrong distraction vectors. One patient complained pain on the site of the occipital fixation of the distractor. In one patient who underwent subtotal craniectomy 3 months before Le Fort III distraction, the distractor was dislocated as the cranial bone was too weak to support the distractor. This report reveals that the application of rigid external distractor and transfacial pull results in an exact control of the distraction vectors and an excellent correction of midfacial hypoplasia without any severe complications.
Humans ; Osteogenesis, Distraction*