Early to midterm survival of patients with deep sternal wound infection managed with laparoscopically harvested omentum.

OBJECTIVE: The optimal management of deep sternal wound infection (DWSI) remains controversial. Our objective was to evaluate outcomes of patients with DSWI managed with transposition of laparoscopically harvested omentum (LHO). METHODS: Between 2000 and 2020, a total of 38,623 adult patients who underwent full median sternotomy for cardiac surgery were analyzed retrospectively at our institution. DSWI occurred in 455 (1.2%), of whom 364 (93.2%) were managed with pectoralis myocutaneous flap (PMF) and 33 (7.2%) with LHO. Univariate and multivariate analysis models were used to determine predictors of cumulative late mortality and adjusted survival curves were generated. RESULTS: Among patients who received LHO, average age was 65.7 ± 9.7 years and a larger proportion of patients were male. A majority of patients (88%) had coronary bypass surgery, with bilateral internal mammary arteries use in only 21.2%. Mean length of stay (LOS) was 58.90 days and early hospital mortality occurred in 4 patients (12.1%). Patients who received LHO compared to only PMF had larger body mass index and had more heart failure. Furthermore, the hospital LOS was also significantly prolonged in the LHO group (58.9 vs. 27.4 days, p = .002), with a slightly higher in-hospital mortality (12.1% vs. 3.3%, p = .03). Late survival for LHO patients at 5 and 10 years was 71.9% and 44.8%, respectively. CONCLUSION: Use of LHO is a safe and viable alternative to traditional myocutaneous flaps to manage complex DSWI. Early and late survival were favorable in this high-risk population.

The modulation of locomotor speed is maintained following partial denervation of ankle extensors in spinal cats.

Speed modulation requires spatiotemporal adjustments and altered neural drive to different muscles. The loss of certain muscles produces changes in the locomotor pattern and functional compensation. However, how the loss of specific muscles affects speed modulation has not been specifically investigated. Here, we denervated the lateral gastrocnemius and soleus muscles unilaterally in seven cats that had recovered hindlimb locomotion following complete spinal transection (spinal cats). Hindlimb locomotion was tested at 10 speeds, from 0.1 to 1.0 m/s, before, 1-2 days, and 1-8 wk after denervation. Six of seven cats performed hindlimb locomotion 1-2 days postdenervation at all speeds, with the exception of two out of those six cats that did not perform stable stepping at 0.9 and 1.0 m/s. All seven cats performed hindlimb locomotion 1-8 wk postdenervation at all speeds. In some cats, at 1-2 days postdenervation, the ipsilateral hindlimb performed more steps than the contralateral hindlimb, particularly at slow speeds. This 2:1 coordination disappeared over time. In three cats, the linear increase in the amplitude of the electromyography of the ipsilateral medial gastrocnemius was reduced with increasing speed early after denervation before recovering later on. Overall, the results indicate that spinal circuits interacting with sensory feedback from the hindlimbs compensate for the partial loss of ankle extensors, retaining the ability to modulate locomotor speed. NEW & NOTEWORTHY We investigated speed modulation after denervating 2 ankle extensors unilaterally at 10 treadmill speeds in spinal-transected cats. Although we observed new forms of left-right coordination and changes in muscle activity of a remaining synergist, modulation of spatiotemporal variables with increasing speed was largely maintained after denervation. The results indicate that spinal locomotor centers interacting with sensory feedback compensate for the loss of ankle extensors, allowing speed modulation.

Transforming pancreaticobiliary cancer treatment: Exploring the frontiers of adoptive cell therapy and cancer vaccines.

Pancreaticobiliary cancer, encompassing malignancies of both the pancreatic and biliary tract, presents a formidable clinical challenge marked by a uniformly bleak prognosis. The asymptomatic nature of its early stages often leads to delayed detection, contributing to an unfavorable 5-year overall survival rate. Conventional treatment modalities have shown limited efficacy, underscoring the urgent need for alternative therapeutic approaches. In recent years, immunotherapy has emerged as a promising avenue in the fight against pancreaticobiliary cancer. Strategies such as therapeutic vaccines and the use of tumor-infiltrating lymphocytes have garnered attention for their potential to elicit more robust and durable responses. This review seeks to illuminate the landscape of emerging immunotherapeutic interventions, offering insights from both clinical and research perspectives. By deepening our understanding of pancreaticobiliary cancer and exploring innovative treatment modalities, we aim to catalyze improvements in patient outcomes and quality of life.

Perioperative oncolytic virotherapy to counteract surgery-induced immunosuppression and improve outcomes in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is a high fatality cancer with one of the worst prognoses in solid tumors. Most patients present with late stage, metastatic disease and are not eligible for potentially curative surgery. Despite complete resection, the majority of surgical patients will recur within the first two years following surgery. Postoperative immunosuppression has been described in different digestive cancers. While the underlying mechanism is not fully understood, there is compelling evidence to link surgery with disease progression and cancer metastasis in the postoperative period. However, the idea of surgery-induced immunosuppression as a facilitator of recurrence and metastatic spread has not been explored in the context of pancreatic cancer. By surveying the existing literature on surgical stress in mostly digestive cancers, we propose a novel practice-changing paradigm: alleviate surgery-induced immunosuppression and improve oncological outcome in PDAC surgical patients by administering oncolytic virotherapy in the perioperative period.