Introduction: Surgery in patients with head and neck cancers is frequently complicated by multiple stages of procedure that includes significant surgical removal of all or part of an organ with cancer, tissue reconstruction, and extensive neck dissection. Postoperative wound infections, termed ‘surgical site infections’ (SSIs) are a significant impediment to head-and-neck cancer surgery and recovery, and need to be addressed.
Areas covered: Approximately 10–45% of patients undergoing head-and-neck cancers surgery develop SSIs. SSIs can lead to delayed wound healing, increased morbidity and mortality as well as costs. Consequently, SSIs need to be avoided where possible, as even the surgery itself impacts on patients’ subsequent activities and their quality of life, which is exacerbated by SSIs. Several risk factors for SSIs need to be considered to reduce future rates, and care is also needed in the selection and duration of antibiotic prophylaxis.
Expert commentary: Head and neck surgeons should give personalized care especially to patients at high risk of SSIs. Such patients include those who have had chemoradiotherapy and need reconstructive surgery, and patients from lower and middle-income countries and from poorer communities in high income countries, who often have high levels of co-morbidity because of resource constraints. 相似文献
We have recently shown that human epididymis protein 4 (HE4) levels correlate with the severity of cystic fibrosis (CF) lung disease. However, there are no data on how HE4 levels alter in patients receiving CFTR modulating therapy.
Methods
In this retrospective clinical study, 3 independent CF patient cohorts (US-American: 29, Australian: 12 and Irish: 19 cases) were enrolled carrying at least one Class III CFTR CF-causing mutation (p.Gly551Asp) and being treated with CFTR potentiator ivacaftor. Plasma HE4 was measured by immunoassay before treatment (baseline) and 1–6?months after commencement of ivacaftor, and were correlated with FEV1 (% predicted), sweat chloride, C-reactive protein (CRP) and body mass index (BMI).
Results
After 1?month of therapy, HE4 levels were significantly lower than at baseline and remained decreased up to 6?months. A significant inverse correlation between absolute and delta values of HE4 and FEV1 (r?=??0.5376; P?<?.001 and r?=??0.3285; P?<?.001), was retrospectively observed in pooled groups, including an independent association of HE4 with FEV1 by multiple regression analysis (β?=??0.57, P?=?.019). Substantial area under the receiver operating characteristic curve (ROC-AUC) value was determined for HE4 when 7% mean change of FEV1 (0.722 [95% CI 0.581–0.863]; P?=?.029) were used as classifier, especially in the first 2?months of treatment (0.806 [95% CI 0.665–0.947]; P?<?.001).
Conclusions
This study shows that plasma HE4 levels inversely correlate with lung function improvement in CF patients receiving ivacaftor. Overall, this potential biomarker may be of value for routine clinical and laboratory follow-up of CFTR modulating therapy. 相似文献
ObjectiveThis guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care.Intended UsersAll health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity.Target PopulationWomen with obesity who are pregnant or planning pregnancies.EvidenceLiterature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.Validation MethodsThe content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care.Benefits, Harms, and CostsImplementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity.Guideline UpdateSOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter.SponsorsThis guideline was developed with resources funded by the SOGC.Summary Statements
1Maternal obesity carries both maternal and fetal risks (II-2).
2There are limited options for weight loss and management during pregnancy (II-2).
3Guidelines can assist with individualized recommendations regarding maternal gestational weight gain and calorie and nutrient intake during pregnancy (II-2).
4Maternal obesity is a risk factor for fetal macrosomia (II-2).
5The accuracy of fetal imaging for pregnancy dating, anatomical assessment, and fetal weight estimates is reduced in the setting of maternal obesity (II-2).
6Stillbirth is more common with maternal obesity (II-1).
7Multiple gestations carry additional risks in pregnancies complicated by maternal obesity (II-2).
8Weight loss surgery before pregnancy, while generally conferring benefits to mother and fetus, also carries rare and serious morbidity during gestation (II-1).
Recommendations
1Weight management strategies prior to pregnancy may include dietary, exercise, medical, and surgical approaches. When pursued before pregnancy, health benefits may carry forward into future pregnancies (III B).
2As obesity carries many medical risks, assessment for conditions of the cardiac, pulmonary, renal, endocrine, and skin systems, as well as obstructive sleep apnea, is warranted in the pre-pregnancy period (II-3 B).
3Folic acid supplementation in the 3 months prior to conception is warranted given the increased risks of congenital abnormalities of the fetal heart and neural tube related to maternal obesity (II-2 A).
4It is recommended that both monitoring of gestational weight gain and approaches for gestational weight gain management be formally integrated into routine prenatal care (III A).
5There is good evidence to support the role of exercise in pregnancy (I A).
6There is good evidence to support supplementation with folic acid (at least 0.4 mg) and vitamin D (400 IU) during pregnancy (II-2 A).
7Fetal macrosomia may be altered by well-controlled maternal gestational weight gain (II-2 A).
8Increased fetal surveillance for well-being is suggested in the third trimester if the reduced fetal movements are reported, given the increased rate of stillbirth (II-3).
9Aspirin prophylaxis can be recommended for women with obesity when other risk factors are present for the prevention of preeclampsia (I A).
10It is recommended that delivery be considered at 39–40 weeks gestation for women with a body mass index of 40 kg/m2 or greater given the increased rate of stillbirth (II-2 A).
11Multiple gestations in women with obesity require increased surveillance and may benefit from consultation with a Maternal-Fetal Medicine consultant, especially in the setting of monochorionic gestations (II-2 A).
12Pregnancy after weight loss surgery may benefit from Maternal-Fetal Medicine consultation given the potential for significant albeit rare maternal morbidity (III B).
Robotic approaches have been steadily replacing laparoscopic approaches in metabolic and bariatric surgeries (MBS); however, their superiority has not been rigorously evaluated. The main goal of the study was to evaluate the 5-year utilization trends of robotic MBS and to compare to laparoscopic outcomes.
Methods
Retrospective analysis of 2015–2019 MBSAQIP data. Kruskal-Wallis test/Wilcoxon and Fisher’s exact/chi-square were used to compare continuous and categorical variables, respectively. Generalized linear models were used to compare surgery outcomes.
Results
The use of robotic MBS increased from 6.2% in 2015 to 13.5% in 2019 (N= 775,258). Robotic MBS patients had significantly higher age, BMI, and likelihood of 12 diseases compared to laparoscopic patients. After adjustment, robotic MBS patients showed higher 30-day interventions and 30-day readmissions alongside longer surgery time (26–38 min).
Conclusion
Robotic MBS shows higher intervention and readmission even after controlling for cofounding variables.
