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Wang P, Hou Z, Wang Z, Luo X. Multifunctional Therapeutic Nanodiamond Hydrogels for Infected-Wound Healing and Cancer Therapy. ACS APPLIED MATERIALS & INTERFACES 2024; 16:9656-9668. [PMID: 38377529 DOI: 10.1021/acsami.3c13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Wound infection and tumor recurrence are the two main threats to cancer patients after surgery. Although researchers have developed new treatment systems to address the two significant challenges simultaneously, the potential side effects of the heavy-metal-ion-based treatment systems still severely limit their widespread application in therapy. In addition, the wounds from tumor removal compared with general operative wounds are more complex. The tumor wounds mainly exhibit more hemorrhage, larger trauma area, greater vulnerability to bacterial infection, and residual tumor cells. Therefore, a multifunctional treatment platform is urgently needed to integrate rapid hemostasis, sterilization, wound healing promotion, and antitumor functions. In this work, nanodiamonds (NDs), a material that has been well proven to have excellent biocompatibility, are added into a solution of acrylic-grafted chitosan (CEC) and oxidized hyaluronic acid (OHA) to construct a multifunctional treatment platform (CEC-OHA-NDs). The hydrogels exhibit rapid hemostasis, a wound-healing-promoting effect, excellent self-healing, and injectable abilities. Moreover, CEC-OHA-NDs can effectively eliminate bacteria and inhibit tumor proliferation by the warm photothermal effect of NDs under tissue-penetrable near-infrared laser irradiation (NIR) without cytotoxicity. Consequently, we adopt a simple and convenient strategy to construct a multifunctional treatment platform using carbon-based nanomaterials with excellent biocompatibility to promote the healing of infected wounds and to inhibit tumor cell proliferation simultaneously.
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Affiliation(s)
- Peiwen Wang
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Zishuo Hou
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Zizhen Wang
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
| | - Xianglin Luo
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, People's Republic of China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, People's Republic of China
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Kristjansen KA, Engel Krag A, Schmidt H, Hölmich LR, Bønnelykke-Behrndtz ML. Perioperative treatment with tranexamic acid in melanoma (PRIME): protocol for a Danish multicentre randomised controlled trial investigating the prognostic and treatment-related impact of the plasminogen-plasmin pathway. BMJ Open 2024; 14:e077012. [PMID: 38309757 PMCID: PMC10840044 DOI: 10.1136/bmjopen-2023-077012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Inflammation is a hallmark of cancer and is involved in tumour growth and dissemination. However, the hallmarks of cancer are also the hallmarks of wound healing, and modulating the wound inflammatory response and immune contexture in relation to cancer surgery may represent effective targets of therapies.Repurposing anti-inflammatory drugs in a cancer setting has gained increasing interest in recent years. Interestingly, the known and thoroughly tested antifibrinolytic drug tranexamic acid reduces the risk of bleeding, but it is also suggested to play important roles in anti-inflammatory pathways, improving wound healing and affecting anti-carcinogenic mechanisms.As a novel approach, we will conduct a randomised controlled trial using perioperative treatment with tranexamic acid, aiming to prevent early relapses by >10% for patients with melanoma. METHODS AND ANALYSIS Design: investigator-initiated parallel, two-arm, randomised, blinded, Danish multicentre superiority trial. PATIENTS ≥T2 b melanoma and eligible for sentinel lymph node biopsy (n=1204).Project drug: tranexamic acid or placebo. TREATMENT before surgery (intravenous 15 mg/kg) and daily (peroral 1000 mg x 3) through postoperative day 4. PRIMARY OUTCOME relapse within 2 years after surgery.Primary analysis: risk difference between the treatment arms (χ2 test). SECONDARY OUTCOMES postoperative complications, adverse events and survival.Inclusion period: summer 2023 to summer 2026. ETHICS AND DISSEMINATION The trial will be initiated during the summer of 2023 and is approved by the National Committee on Health Research Ethics, the Danish Medicine Agency, and registered under the Data Protection Act. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Patients included in the study will adhere to normal Danish treatment protocols and standards of care, and we expect only mild and temporary side effects. Positive and negative results will be published in peer-reviewed journals, with authorships adhering to the Vancouver rules. TRIAL REGISTRATION NUMBER NCT05899465; ClinicalTrials.gov Identifier.
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Affiliation(s)
- Karoline Assifuah Kristjansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Engel Krag
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark
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Duranti E, Cordani N, Villa C. Edaravone: A Novel Possible Drug for Cancer Treatment? Int J Mol Sci 2024; 25:1633. [PMID: 38338912 PMCID: PMC10855093 DOI: 10.3390/ijms25031633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Despite significant advancements in understanding the causes and progression of tumors, cancer remains one of the leading causes of death worldwide. In light of advances in cancer therapy, there has been a growing interest in drug repurposing, which involves exploring new uses for medications that are already approved for clinical use. One such medication is edaravone, which is currently used to manage patients with cerebral infarction and amyotrophic lateral sclerosis. Due to its antioxidant and anti-inflammatory properties, edaravone has also been investigated for its potential activities in treating cancer, notably as an anti-proliferative and cytoprotective drug against side effects induced by traditional cancer therapies. This comprehensive review aims to provide updates on the various applications of edaravone in cancer therapy. It explores its potential as a standalone antitumor drug, either used alone or in combination with other medications, as well as its role as an adjuvant to mitigate the side effects of conventional anticancer treatments.
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Affiliation(s)
| | | | - Chiara Villa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (E.D.); (N.C.)
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Duran Ramirez JM, Gomez J, Hanson BM, Isa T, Myckatyn TM, Walker JN. Staphylococcus aureus Breast Implant Infection Isolates Display Recalcitrance To Antibiotic Pocket Irrigants. Microbiol Spectr 2023; 11:e0288422. [PMID: 36507629 PMCID: PMC9927092 DOI: 10.1128/spectrum.02884-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022] Open
Abstract
Breast implant-associated infections (BIAIs) are the primary complication following placement of breast prostheses in breast cancer reconstruction. Given the prevalence of breast cancer, reconstructive failure due to infection results in significant patient distress and health care expenditures. Thus, effective BIAI prevention strategies are urgently needed. This study tests the efficacy of one infection prevention strategy: the use of a triple antibiotic pocket irrigant (TAPI) against Staphylococcus aureus, the most common cause of BIAIs. TAPI, which consists of 50,000 U bacitracin, 1 g cefazolin, and 80 mg gentamicin diluted in 500 mL of saline, is used to irrigate the breast implant pocket during surgery. We used in vitro and in vivo assays to test the efficacy of each antibiotic in TAPI, as well as TAPI at the concentration used during surgery. We found that planktonically grown S. aureus BIAI isolates displayed susceptibility to gentamicin, cefazolin, and TAPI. However, TAPI treatment enhanced biofilm formation of BIAI strains. Furthermore, we compared TAPI treatment of a S. aureus reference strain (JE2) to a BIAI isolate (117) in a mouse BIAI model. TAPI significantly reduced infection of JE2 at 1 and 7 days postinfection (dpi). In contrast, BIAI strain 117 displayed high bacterial burdens in tissues and implants, which persisted to 14 dpi despite TAPI treatment. Lastly, we demonstrated that TAPI was effective against Pseudomonas aeruginosa reference (PAO1) and BIAI strains in vitro and in vivo. Together, these data suggest that S. aureus BIAI strains employ unique mechanisms to resist antibiotic prophylaxis treatment and promote chronic infection. IMPORTANCE The incidence of breast implant associated infections (BIAIs) following reconstructive surgery postmastectomy remains high, despite the use of prophylactic antibiotic strategies. Thus, surgeons have begun using additional antibiotic-based prevention strategies, including triple antibiotic pocket irrigants (TAPIs). However, these strategies fail to reduce BIAI rates for these patients. To understand why these therapies fail, we assessed the antimicrobial resistance patterns of Staphylococcus aureus strains, the most common cause of BIAI, to the antibiotics in TAPI (bacitracin, cefazolin, and gentamicin). We found that while clinically relevant BIAI isolates were more susceptible to the individual antibiotics compared to a reference strain, TAPI was effective at killing all the strains in vitro. However, in a mouse model, the BIAI isolates displayed recalcitrance to TAPI, which contrasted with the reference strain, which was susceptible. These data suggest that strains causing BIAI may encode specific recalcitrance mechanisms not present within reference strains.
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Affiliation(s)
- Jesus M. Duran Ramirez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Jana Gomez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Blake M. Hanson
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Taha Isa
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer N. Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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Cui W, Xie Y. Oncological results in women with wound complications following mastectomy and immediate breast reconstruction: A meta‐analysis. Int Wound J 2022; 20:1361-1368. [PMID: 36336978 PMCID: PMC10088858 DOI: 10.1111/iwj.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
We performed a meta-analysis to evaluate the oncological results in women with wound complications following mastectomy and immediate breast reconstruction. A systematic literature search up to August 2022 was performed and 1618 subjects with mastectomy and immediate breast reconstruction at the baseline of the studies; 443 of them were with wound complications, and 1175 were with no wound complications as a control. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the oncological results in women with wound complications following mastectomy and immediate breast reconstruction using dichotomous or contentious methods with a random or fixed-effect model. The wound complications had a significantly longer length of time to adjuvant therapy (MD, 9.44; 95% CI, 4.07-14.82, P < .001) compared with no wound complications in subjects with mastectomy and immediate breast reconstruction. However, no significant difference was found between wound complications and no wound complications in subjects with mastectomy and immediate breast reconstruction in breast cancer recurrence (OR, 1.96; 95% CI, 0.95-4.06, P = .07), death rates (OR, 1.95; 95% CI, 0.89-4.27, P = .09), and kind of immediate breast reconstruction (OR, 1.01; 95% CI, 0.53-1.92, P = .98). The wound complications had a significantly longer length of time to adjuvant, however, no significant difference was found in breast cancer recurrence, death rates, and kind of immediate breast reconstruction. The analysis of outcomes should be done with caution even though no low sample size was found in the meta-analysis but a low number of studies was found in certain comparisons.
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Affiliation(s)
- Wenting Cui
- Department of Breast Surgery, Huangpu Branch, Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai People's Republic of China
| | - Yiqun Xie
- Department of Breast Surgery, Huangpu Branch, Ninth People's Hospital Shanghai Jiaotong University School of Medicine Shanghai People's Republic of China
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Balvardi S, Kammili A, Hanson M, Mueller C, Vassiliou M, Lee L, Schwartzman K, Fiore JF, Feldman LS. The association between video-based assessment of intraoperative technical performance and patient outcomes: a systematic review. Surg Endosc 2022; 36:7938-7948. [PMID: 35556166 DOI: 10.1007/s00464-022-09296-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Efforts to improve surgical safety and outcomes have traditionally placed little emphasis on intraoperative performance, partly due to difficulties in measurement. Video-based assessment (VBA) provides an opportunity for blinded and unbiased appraisal of surgeon performance. Therefore, we aimed to systematically review the existing literature on the association between intraoperative technical performance, measured using VBA, and patient outcomes. METHODS Major databases (Medline, Embase, Cochrane Database, and Web of Science) were systematically searched for studies assessing the association of intraoperative technical performance measured by tools supported by validity evidence with short-term (≤ 30 days) and/or long-term postoperative outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results were appraised descriptively as study heterogeneity precluded meta-analysis. RESULTS A total of 11 observational studies were identified involving 8 different procedures in foregut/bariatric (n = 4), colorectal (n = 4), urologic (n = 2), and hepatobiliary surgery (n = 1). The number of surgeons assessed ranged from 1 to 34; patient sample size ranged from 47 to 10,242. High risk of bias was present in 5 of 8 studies assessing short-term outcomes and 2 of 6 studies assessing long-term outcomes. Short-term outcomes were reported in 8 studies (i.e., morbidity, mortality, and readmission), while 6 reported long-term outcomes (i.e., cancer outcomes, weight loss, and urinary continence). Better intraoperative performance was associated with fewer postoperative complications (6 of 7 studies), reoperations (3 of 4 studies), and readmissions (1 of 4 studies). Long-term outcomes were less commonly investigated, with mixed results. CONCLUSION Current evidence supports an association between superior intraoperative technical performance measured using surgical videos and improved short-term postoperative outcomes. Intraoperative performance analysis using video-based assessment represents a promising approach to surgical quality-improvement.
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Affiliation(s)
- Saba Balvardi
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Anitha Kammili
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Melissa Hanson
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Carmen Mueller
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Melina Vassiliou
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Kevin Schwartzman
- Respiratory Division, Department of Medicine, McGill University, Montreal, QC, Canada
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Department of Surgery, McGill University, 1650 Cedar Ave, D6-136, Montreal, QC, H3G 1A4, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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Gilbert TM, Hackett J, Holt L, Bird N, Quinn M, Gordon-Weeks A, Diaz-Nieto R, Fenwick SW, Malik HZ, Jones RP. Long-term morbidity after surgery for perihilar cholangiocarcinoma: A cohort study. Surg Oncol 2022; 45:101875. [DOI: 10.1016/j.suronc.2022.101875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
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de Boniface J, Szulkin R, Johansson ALV. Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women. Br J Surg 2022; 109:977-983. [PMID: 35929050 PMCID: PMC10364684 DOI: 10.1093/bjs/znac275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/06/2022] [Accepted: 07/15/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Postoperative complications may activate prometastatic systemic pathways through tissue damage, wound healing, infection, and inflammation. Postoperative complications are associated with inferior survival in several types of cancer. The aim was to determine the association between postoperative complications and survival in breast cancer. METHODS This population-based cohort included women operated for T1-3 N0-3 M0 invasive breast cancer in Sweden from 2008 to 2017. Only major surgical postoperative complications leading to readmission and/or reoperation within 30 days were considered. Main outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Prospectively collected nationwide register data were used. Multivariable Cox models were adjusted for clinical and socioeconomic confounders and co-morbidity. RESULTS Among 57 152 women, major surgical postoperative complications were registered for 1854 patients. Median follow-up was 6.22 (0.09-11.70) years. Overall, 9163 patients died, and 3472 died from breast cancer. Major surgical postoperative complications were more common after mastectomy with or without immediate reconstruction (7.3 and 4.3 per cent respectively) than after breast-conserving surgery (2.3 per cent). Unadjusted 5-year OS and BCSS rates were 82.6 (95 per cent c.i. 80.8 to 84.5) and 92.1 (90.8 to 93.5) per cent respectively for women with a major surgical postoperative complication, and 88.8 (88.6 to 89.1) and 95.0 (94.8 to 95.2) per cent for those without a complication (P < 0.001). After adjustment, all-cause and breast cancer mortality rates remained higher after a major surgical postoperative complication (OS: HR 1.32, 95 per cent c.i. 1.15 to 1.51; BCSS: HR 1.31, 1.04 to 1.65). After stratification for type of breast surgery, this association remained significant only for women who had mastectomy without reconstruction (OS: HR 1.41, 1.20 to 1.66; BCSS: HR 1.36, 1.03 to 1.79). CONCLUSION Major surgical postoperative complications are associated with inferior survival, especially after mastectomy. These results underline the importance of surgical de-escalation.
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Affiliation(s)
- Jana de Boniface
- Correspondence to: Jana de Boniface, Department of Surgery, Breast Centre, Capio St Göran’s Hospital, 11219 Stockholm, Sweden (e-mail: )
| | - Robert Szulkin
- SDS Life Science, Danderyd, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Oslo, Norway
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Fotakis G, Trajanoski Z, Rieder D. Computational cancer neoantigen prediction: current status and recent advances. IMMUNO-ONCOLOGY TECHNOLOGY 2021; 12:100052. [PMID: 35755950 PMCID: PMC9216660 DOI: 10.1016/j.iotech.2021.100052] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the last few decades, immunotherapy has shown significant therapeutic efficacy in a broad range of cancer types. Antitumor immune responses are contingent on the recognition of tumor-specific antigens, which are termed neoantigens. Tumor neoantigens are ideal targets for immunotherapy since they can be recognized as non-self antigens by the host immune system and thus are able to elicit an antitumor T-cell response. There are an increasing number of studies that highlight the importance of tumor neoantigens in immunoediting and in the sensitivity to immune checkpoint blockade. Therefore, one of the most fundamental tasks in the field of immuno-oncology research is the identification of patient-specific neoantigens. To this end, a plethora of computational approaches have been developed in order to predict tumor-specific aberrant peptides and quantify their likelihood of binding to patients' human leukocyte antigen molecules in order to be recognized by T cells. In this review, we systematically summarize and present the most recent advances in computational neoantigen prediction, and discuss the challenges and novel methods that are being developed to resolve them. Tumors have the ability to acquire immune escape mechanisms. Tumor-specific aberrant peptides (neoantigens) can elicit an immune response by the host immune system. The identification of neoantigens is one of the most fundamental tasks in the field of immuno-oncology research. A plethora of computational approaches have been developed in order to predict patient-specificneoantigens.
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Affiliation(s)
- G Fotakis
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Z Trajanoski
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - D Rieder
- Institute of Bioinformatics, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
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Fleming CA, O’Connell EP, Kavanagh RG, O’Leary DP, Twomey M, Corrigan MA, Wang JH, Maher MM, O’Connor OJ, Redmond HP. Body Composition, Inflammation, and 5-Year Outcomes in Colon Cancer. JAMA Netw Open 2021; 4:e2115274. [PMID: 34459908 PMCID: PMC8406082 DOI: 10.1001/jamanetworkopen.2021.15274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Obesity, particularly visceral obesity and sarcopenia, are poor prognostic indicators in colon cancer. OBJECTIVES To explore the association between body composition profiles and 5-year colon cancer outcomes and delineate the associated underlying inflammatory processes. DESIGN, SETTING, AND PARTICIPANTS This multicenter translational cohort study included patients with nonmetastatic colon cancer who did not have underlying chronic inflammatory disorders and were not receiving anti-inflammatory drugs referred to tertiary cancer centers from 2009 to 2015. Preoperative acute phase proteins (white cell count, C-reactive protein, and albumin), cytokines (interleukin [IL]-1b, IL-2, IL-6, IL-10, interferon γ, and tumor necrosis factor α), vascular endothelial growth factor (VEGF), and cell surface receptor expression levels (CD11b and CD14) were measured. All patients underwent follow-up for at least 5 years. Data were analyzed in December 2020. EXPOSURE Nonmetastatic colon cancer. MAIN OUTCOMES AND MEASURES The associations of body composition profiles with 5-year cancer recurrence and disease-specific mortality were analyzed using Mantel Cox log-rank test and Kaplan-Meier curves. RESULTS A total of 28 patients were included (median [interquartile range] age, 67 [58-72] years; 22 [78.6%] men). Low skeletal muscle area (SMA) and high visceral to total fat ratio were associated with poor clinical and oncological outcomes, including increased 5-year recurrence (low SMA: hazard ratio [HR], 2.30 [95% CI, 1.41-2.89]; P = .04; high visceral to total fat ratio: HR, 5.78 [95% CI, 3.66-7.95]; P = .02). High visceral to total fat ratio was associated with increased 5-year disease-specific mortality (HR, 5.92 [95% CI, 4.04-8.00]; P = .02). Patients with low SMA who developed a cancer recurrence, compared with those who did not, had higher C-reactive protein (mean [SD], 31.24 [6.95] mg/dL vs 8.11 [0.58] mg/dL; P = .003), IL-6 (mean [SD], 1.93 [1.16] ng/mL vs 0.88 [0.14] ng/mL; P = .004), VEGF (mean [SD], 310.03 [122.66] ng/mL vs 176.12 [22.94] ng/mL; P = .007), and CD14 (mean [SD], 521.23 [302.02] ng/mL vs 322.07 [98.35] ng/mL; P = .03) expression and lower albumin (mean [SD], 3.8 [0.6] g/dL vs 43.50 [3.69] g/dL; P = .01), IL-2 (mean [SD], 0.45 [0.25] ng/mL vs 0.94 [0.43] ng/mL; P < .001), IL-10 (mean [SD], 8.15 [1.09] ng/mL vs 16.32 [4.43] ng/mL; P = .004), and interferon γ (mean [SD], 2.61 [1.36] ng/mL vs 14.87 [3.43] ng/mL; P = .02) levels. Patients with high visceral to total fat ratio who developed recurrence had higher levels of IL-6 (mean [SD], 5.26 [7.05] ng/mL vs 2.76 [3.11] ng/mL; P = .03) and tumor necrosis factor α (mean [SD], 5.74 [4.53] ng/mL vs 4.50 [1.99] ng/mL; P = .03). CONCLUSIONS AND RELEVANCE These findings suggest that low SMA and high visceral to total fat ratio were associated with worse colon cancer outcomes and with increased expression of proinflammatory cytokines and VEGF and inhibition of anti-inflammatory cytokines.
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Affiliation(s)
- Christina A. Fleming
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
| | - Emer P. O’Connell
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
- Department of Colorectal Surgery, Cork University Hospital, Cork, Ireland
| | | | - Donal P. O’Leary
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Mark A. Corrigan
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Jiang H. Wang
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J. O’Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Henry P. Redmond
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
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Grzeczkowicz A, Drabik M, Lipko A, Bącal P, Kwiatkowska A, Kazimierczak B, Granicka LH. A Composite Membrane System with Gold Nanoparticles, Hydroxyapatite, and Fullerenol for Dual Interaction for Biomedical Purposes. MEMBRANES 2021; 11:565. [PMID: 34436328 PMCID: PMC8398639 DOI: 10.3390/membranes11080565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Background: Wound dressing plays a vital role in post-operative aftercare. There is the necessity to develop dressings for application on the border of soft and hard tissue. This study aimed to develop multifunctional polyelectrolyte layers enhanced by hydroxyapatite nanoparticles, gold nanoparticles (AuNPs), and/or fullerenol nanocomposites to achieve a wound dressing that could be applied on the bone-skin interface. Methods: Constructed shells were examined using TEM, STEM, and EDX techniques. The human osteoblasts or fibroblasts were immobilized within the shells. The systems morphology was assessed using SEM. The functioning of cells was determined by flow cytomery. Moreover, the internalization of AuNPs was assessed. Results: Involvement of fullerenol and/or hydroxyapatite nanoparticles influenced the immobilized cell systems morphology. Membranes with fullerenol and hydroxyapatite nanoparticles were observed to block the internalization of AuNPs by immobilized hFOB cells. Conclusions: The designed bilayer membranes incorporating fullerenol, and bacteriostatic elements, prevented the internalization of AuNPs by hFOB cells and ensured the proper counts and morphology of eukaryotic cells. The developed material can be recommended for dressings at the bone-skin interface.
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Affiliation(s)
- Anna Grzeczkowicz
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
| | - Monika Drabik
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
| | - Agata Lipko
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
| | - Paweł Bącal
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
- Institute of Paleobiology, Polish Academy of Sciences, Twarda 51/55 St., 02-109 Warsaw, Poland
| | - Angelika Kwiatkowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
| | - Beata Kazimierczak
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
| | - Ludomira H. Granicka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Trojdena 4 St., 02-109 Warsaw, Poland; (A.G.); (M.D.); (A.L.); (P.B.); (A.K.); (B.K.)
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4-1BBL as a Mediator of Cross-Talk between Innate, Adaptive, and Regulatory Immunity against Cancer. Int J Mol Sci 2021; 22:ijms22126210. [PMID: 34207500 PMCID: PMC8227424 DOI: 10.3390/ijms22126210] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/25/2023] Open
Abstract
The ability of tumor cells to evade the immune system is one of the main challenges we confront in the fight against cancer. Multiple strategies have been developed to counteract this situation, including the use of immunostimulant molecules that play a key role in the anti-tumor immune response. Such a response needs to be tumor-specific to cause as little damage as possible to healthy cells and also to track and eliminate disseminated tumor cells. Therefore, the combination of immunostimulant molecules and tumor-associated antigens has been implemented as an anti-tumor therapy strategy to eliminate the main obstacles confronted in conventional therapies. The immunostimulant 4-1BBL belongs to the tumor necrosis factor (TNF) family and it has been widely reported as the most effective member for activating lymphocytes. Hence, we will review the molecular, pre-clinical, and clinical applications in conjunction with tumor-associated antigens in antitumor immunotherapy, as well as the main molecular pathways involved in this association.
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13
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Ramos-Zayas A, López-Medrano F, Urquiza-Fornovi I, Zubillaga I, Gutiérrez R, Sánchez-Aniceto G, Acero J, Almeida F, Galdona A, Morán MJ, Pampin M, Cebrián JL. The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study. Cancers (Basel) 2021; 13:cancers13092109. [PMID: 33925543 PMCID: PMC8123773 DOI: 10.3390/cancers13092109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Healthcare-associated infections (HAIs) result in an increased morbidity and a delay in adjuvant therapy—thus increasing the cancer recurrence rates—in patients undergoing oncological microvascular head and neck reconstruction. HAIs also result in a cost increase for the Health System. We prospectively analysed the incidence, clinical characteristics, risk factors and impacts of these infections in 65 patients undergoing head and neck free-flap reconstruction in three third-level university hospitals in Madrid (Spain). The three of them implemented the same antibiotic prophylactic regimen for surgical interventions. The rate of HAIs was 61.54%. The following complications were significantly more frequent in patients with HAIs: need to reoperate (p = 0.009), duration of hospital admission (p < 0.001) and delay in starting radiotherapy (p = 0.009). This manuscript aims to point out the importance of preventing HAIs in head and neck cancer patients, as they have shown a higher risk of postoperative complications. Abstract (1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39–21.10), anaemia (OR: 8.00; 95% CI, 0.96–66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01–8.14), surgery duration (OR: 1.01; 95% CI, 1.00–1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42–33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06–1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72–47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.
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Affiliation(s)
- Ana Ramos-Zayas
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
- Correspondence: ; Tel.: +34-617955504
| | - Francisco López-Medrano
- Unit of Infectious Diseases, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Department of Medicine, School of Medicine, Universidad Complutense, 28041 Madrid, Spain;
| | - Irene Urquiza-Fornovi
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Ignacio Zubillaga
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Ramón Gutiérrez
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Gregorio Sánchez-Aniceto
- Oral and Maxillofacial Surgery Department, “12 de Octubre” University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain; (I.U.-F.); (I.Z.); (R.G.); (G.S.-A.)
| | - Julio Acero
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - Fernando Almeida
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - Ana Galdona
- Oral and Maxillofacial Surgery Department, “Ramón y Cajal” University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain; (J.A.); (F.A.); (A.G.)
| | - María José Morán
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
| | - Marta Pampin
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
| | - José Luis Cebrián
- Oral and Maxillofacial Surgery Department, “La Paz” University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain; (M.J.M.); (M.P.); (J.L.C.)
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Kadomatsu Y, Tsubouchi H, Nakanishi K, Sugiyama T, Ueno H, Goto M, Ozeki N, Nakamura S, Fukui T, Chen-Yoshikawa TF. Differential impacts of postoperative complications on patients' survival in completely resected non-small-cell lung cancer. Gen Thorac Cardiovasc Surg 2021; 69:1283-1290. [PMID: 33687642 DOI: 10.1007/s11748-021-01619-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of inflammatory respiratory complications on long-term survival in patients with resected non-small cell lung cancer. We defined inflammatory respiratory complications to include the following six conditions: pneumonia, empyema, bronchial fistula, respiratory dysfunction, acute interstitial pneumonia, and atelectasis. METHODS Part of the National Clinical Database was linked to our prospective database from 2014 to 2017. Linkage was achieved for 866 patients. The Kaplan-Meier method was used to evaluate the overall, relapse-free, and cancer-related survival. The Cox proportional hazard model was used to analyze the impact of each complication. RESULTS Of the 736 patients included in the study, 149 had complications. The 5-year overall and cancer-specific survival rates were significantly lower in patients with inflammatory respiratory complications. The Cox proportional hazard model showed that the inflammatory respiratory complications had a significant impact on overall survival (hazard ratio 2.48, 95% confidence interval 1.41-4.38) but not air leak (hazard ratio 1.38, 95% confidence interval 0.70-2.70). CONCLUSIONS Our study shows the differential impact of each complication on the survival of patients with non-small cell lung cancer. The presence of inflammatory respiratory complications was the only predictor of poor overall survival.
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Affiliation(s)
- Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hideki Tsubouchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Nakanishi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Mc Geehan G, Edelduok IM, Bucholc M, Watson A, Bodnar Z, Johnston A, Sugrue M. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement. Life (Basel) 2021; 11:life11020138. [PMID: 33670186 PMCID: PMC7916918 DOI: 10.3390/life11020138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. METHODS An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included "emergency surgery", "laparotomy", "surgical site infection", "midline incision" and "wound bundle". Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. RESULTS This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39-1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57-1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. CONCLUSIONS This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle's ability to potentially improve outcome after emergency laparotomy.
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Affiliation(s)
- Gearóid Mc Geehan
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- School of Medicine, University of Limerick, V94T9PX Limerick, Ireland
| | - Itoro M Edelduok
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (Magee Campus), Northern Ireland BT48 7JL, UK
| | - Angus Watson
- Raigmore Hospital, NHS-Highland, Inverness IV2 3DZ, UK
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Alison Johnston
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
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16
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Balasubramanian I, Harding T, Boland MR, Ryan EJ, Geraghty J, Evoy D, McCartan D, McDermott EW, Prichard RS. The Impact of Postoperative Wound Complications on Oncological Outcomes Following Immediate Breast Reconstruction for Breast Cancer: A Meta-analysis. Clin Breast Cancer 2020; 21:e377-e387. [PMID: 33451964 DOI: 10.1016/j.clbc.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 12/21/2022]
Abstract
The association between immediate breast reconstruction (IBR)-related wound complications and breast cancer recurrence (BCR) remains uncertain. This study aimed to investigate the oncological outcomes in patients with wound complications following mastectomy and IBR. A comprehensive search was undertaken for all studies describing complications in patients with breast cancer following IBR. Studies were included if they reported on complications and investigated their relationship with BCR. A meta-analysis was performed using a random-effects model, with data presented as odds ratios and 95% confidence intervals. A total of 1418 patients from five studies were included in the final analysis. The mean age of patients included was 47.2 years. A total of 382 (26.9%) patients had postoperative complications following a majority of implant-based IBR (929/1418). A total of 158 (11.1%) recurrences, which included 63 locoregional and 106 distant recurrences, was noted at a mean follow-up of 66 months. Although there was an increase in recurrence rates in the complication group (n = 66/382; 17.3% vs. n = 92/1036; 8.9%), there was no significant association between complications and BCR (17.3% vs. 8.9%; P = .18) or mortality (3.6% vs. 2.3%; P = .15). Time to adjuvant therapy was significantly increased in patients with complications (mean difference, 8.69 days; range, 1.18-16.21 days; P = .02; I2 = 0.02). This meta-analysis demonstrated a higher incidence of wound complications following IBR and a statistically significant increased time to adjuvant therapy. However, this did not translate into adverse oncological outcomes in patients with breast cancer undergoing IBR.
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Affiliation(s)
| | - Tim Harding
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Eanna J Ryan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - James Geraghty
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Denis Evoy
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Damian McCartan
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Enda W McDermott
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
| | - Ruth S Prichard
- Department of Surgery, St Vincents University Hospital, Dublin, Ireland
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17
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Savioli F, Edwards J, McMillan D, Stallard S, Doughty J, Romics L. The effect of postoperative complications on survival and recurrence after surgery for breast cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 155:103075. [PMID: 32987333 DOI: 10.1016/j.critrevonc.2020.103075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND This systematic review investigated the impact of complications on long term outcomes for patients with primary invasive operable breast cancer. METHODS A systematic review was performed using appropriate keywords, and meta-analysis using a random effects model completed. RESULTS Ten retrospective cohort studies, including 37,657 patients were included. Five studies identified a relationship between wound complications, infection and pyrexia and recurrence or recurrence-free survival. Risk of recurrence, 1-year and 5-year recurrence-free survival and overall survival were related to complications, particularly for patients with poor Nottingham Prognostic Index. Five studies failed to demonstrate a relationship between complications and prognosis. Complication was found to significantly affect 5-year recurrence-free survival (HR 1.48 95 % CI 1.02-2.14, p = 0.04) but not recurrence (HR 2.39, 95 %CI 0.94-6.07, p = 0.07), with a high degree of heterogeneity amongst analysed studies (I2 = 95 %). DISCUSSION Further research is needed to quantify the effects of postoperative complication on prognosis following surgery for breast cancer.
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Affiliation(s)
- F Savioli
- Clinical Research Fellow, Specialty Trainee (General Surgery), Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2 New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom.
| | - J Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, Glasgow, G61 1QH, United Kingdom
| | - D McMillan
- Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2 New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - S Stallard
- Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - J Doughty
- Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom
| | - L Romics
- New Victoria Hospital, 52 Grange Road, Glasgow G42 9LF, United Kingdom; Academic Unit of Surgery, School of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2 New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
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18
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O'Connor RÍ, Kiely PA, Dunne CP. The relationship between post-surgery infection and breast cancer recurrence. J Hosp Infect 2020; 106:522-535. [PMID: 32800825 DOI: 10.1016/j.jhin.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI). The aim of this review was to critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these. This systematic review adopted two approaches: to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery; and, secondly, to examine breast cancer recurrence following SSI occurrence. Ninety-nine studies with 484,605 patients were eligible in the SSI-focused searches, and 53 studies with 17,569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. Six-hundred and thirty-eight Gram-positive and 442 Gram-negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (11.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist. In conclusion, there is association between SSI and adverse cancer outcomes, but the cellular link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardized prospective study with appropriate statistical power is justified.
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Affiliation(s)
- R Í O'Connor
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland
| | - P A Kiely
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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19
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Lawler J, Choynowski M, Bailey K, Bucholc M, Johnston A, Sugrue M. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open 2020; 4:737-747. [PMID: 32525280 PMCID: PMC7528523 DOI: 10.1002/bjs5.50302] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/26/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. METHODS An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. RESULTS Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1·37, 95 per cent c.i. 1·28 to 1·46) and cancer-specific survival (HR 2·58, 2·15 to 3·10). Anastomotic leakage occurred in 7·4 per cent and had a significant negative impact on disease-free survival (HR 1·14, 1·09 to 1·20), overall survival (HR 1·34, 1·28 to 1·39), cancer-specific survival (HR 1·43, 1·31 to 1·55), local recurrence (HR 1·18, 1·06 to 1·32) and overall recurrence (HR 1·46, 1·27 to 1·68). CONCLUSION This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.
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Affiliation(s)
- J Lawler
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Choynowski
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - K Bailey
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Bucholc
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
| | - A Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland.,EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
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Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications. Ann Surg 2019; 272:81-91. [DOI: 10.1097/sla.0000000000003644] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Valente SA, Liu Y, Upadhyaya S, Tu C, Pratt DA. The effect of wound complications following mastectomy with immediate reconstruction on breast cancer recurrence. Am J Surg 2019; 217:514-518. [DOI: 10.1016/j.amjsurg.2018.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
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Redmond HP, Neary PM, Jinih M, O'Connell E, Foley N, Pfirrmann RW, Wang JH, O'Leary DP. RandomiSed clinical trial assessing Use of an anti-inflammatoRy aGent in attenUating peri-operatiVe inflAmmatioN in non-meTastatic colon cancer - the S.U.R.G.U.V.A.N.T. trial. BMC Cancer 2018; 18:794. [PMID: 30081854 PMCID: PMC6091184 DOI: 10.1186/s12885-018-4641-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background Peri-operative inflammation has been extensively highlighted in cancer patients as detrimental. Treatment strategies to improve survival for cancer patients through targeting peri-operative inflammation have yet to be devised. Methods We conducted a multi-centre, randomised controlled clinical trial using Taurolidine in non-metastatic colon cancer patients. Patients were randomly assigned to receive Taurolidine or a placebo. The primary endpoint for the study was the mean difference in day 1 IL-6 levels. Secondary clinical endpoints included rates of post-operative infections and tumor recurrence. Results A total of 293 patients were screened for trial inclusion. Sixty patients were randomised. Twenty-eight patients were randomised to placebo and 32 patients to Taurolidine. IL-6 levels were equivalent on day 1 post-operatively in both groups. However, IL-6 levels were significantly attenuated over the 7 day study period in the Taurolidine group compared to placebo (p = 0.04). In addition, IL-6 levels were significantly lower at day 7 in the Taurolidine group (p = 0.04). There were 2 recurrences in the placebo group at 2 years and 1 in the Taurolidine group. The median time to recurrence was 19 months in the Placebo group and 38 months in the Taurolidine group (p = 0.27). Surgical site infection was reduced in the Taurolidine treated group (p = 0.09). Conclusion Peri-operative use of Taurolidine significantly attenuated circulating IL-6 levels in the initial 7 day post-operative period in a safe manner. Future studies are required to establish the impact of IL-6 attenuation on survival outcomes in colon cancer. Trial registration The trial was registered with EudraCT (year = 2008, registration number = 005570–12) and ISRCTN (year = 2008, registration number = 77,829,558).
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Affiliation(s)
- H Paul Redmond
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Peter M Neary
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Marcel Jinih
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Emer O'Connell
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Niamh Foley
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Rolf W Pfirrmann
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - Jiang H Wang
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland
| | - D Peter O'Leary
- Surguvant Research Centre, Cork University Hospital, Cork, Ireland.
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