Lymph Node Positivity of Axillary Reverse Mapping Lymph Nodes at the Time of Axillary Lymph Node Dissection: Two-Site Prospective Trial.

BACKGROUND: Axillary reverse mapping (ARM) was introduced in 2007 to identify and selectively preserve upper-extremity lymphatics during axillary lymph node surgery to decrease the risk of lymphedema. The patient population in which an ARM lymph node (LN) can be preserved during an axillary lymph node dissection (ALND) has not been established to date. This study aimed to determine the frequency of metastatic involvement of an ARM LN among patients undergoing ALND. METHODS: Patients undergoing ALND with or without immediate lymphatic reconstruction (ILR) were enrolled in a prospective trial at two institutional sites between April 2018 and Decemeber 2022. This report analyzes the ARM node positivity and total LN positivity rates during ALND for the cohort of patients enrolled in the ILR intervention arm of the study. RESULTS: The inclusion criteria were met by 139 patients, who made up the study population (133 with breast cancer and 6 with other disease). Of the breast cancer patients, 99.2% were female, 35.3% (47/133) were cT3 or greater, and 96.2% (128/133) had cN1 or greater disease. For 55 of the 133 patients (41.4%), the ARM nodes were marked and specified in the pathology report. Of the 55 patients, 39 (70.9%) had a positive LN at ALND. Of these 55 patients, 11 (20%) had positive ARM nodes. The ARM LN was the only positive node in 3 of the 11 patients. CONCLUSION: In the contemporary patient population undergoing ALND, the positivity rate of the ARM LN was relatively high, suggesting that leaving ARM LNs in patients undergoing ALND may not be oncologically safe.

Preoperative and Intraoperative Blood Pressure Variability Independently Correlate with Outcomes.

BACKGROUND: Blood pressure variability (BPV) describes visit-to-visit blood pressure (BP) changes independent of hypertension. Preoperative BPV and intraoperative BPV are associated with increased postoperative outcomes. We investigated the impact of both preoperative BPV and intraoperative BPV on elective surgical outcomes, specifically whether preoperative BPV and intraoperative BPV were independent risk factors for surgical complications. MATERIALS AND METHODS: We investigated 600 patients undergoing elective surgery lasting more than two h and who had ≥8 outpatient BP recordings over three preoperative years. Age, sex, ethnicity, BMI, current medical problems, and medications at time of surgery were recorded. BPV was calculated as the standard deviation (SD) of systolic or diastolic BP for the 369 valid patients. Average BPV were compared between adverse outcomes of readmission, wound infection, acute kidney injury, death, myocardial infarction, and cerebral vascular accident. RESULTS: Three-hundred-sixty-nine (52.6% male, 47.4% female, 98.1% non-Hispanic) patients (mean age 62.5) were included in the study. Preoperative systolic (P = 0.043) and diastolic (P = 0.009) BPV were higher for patients with the combined endpoint of all adverse events. Preoperative systolic BPV was correlated with intraoperative BPV (P = 0.010). Both systolic and diastolic preoperative BPV was found to be independent from intraoperative BPV. Otolaryngology procedures were associated with less adverse outcomes (P = 0.034), whil antimicrobials (P = 0.022), autonomic drugs (P < 0.001), or respiratory drugs (P = 0.032) was associated with an increased likelihood of adverse outcome. CONCLUSION: Preoperative DBPV is associated with increased risk of readmission, wound infection and the combined endpoint of all adverse events. Intraoperative systolic blood pressure variability (SPBV) is associated with increased risk of acute kidney injury and the combined endpoint of all adverse events. Preoperative DBPV and intraoperative SBPV are independent risk factors for ninety-d postoperative outcomes. BPV should be considered in individualized risk assessment when assessing patient eligibility for elective procedures.

Age-dependent increase in Thy-1 protein in the rat supraoptic nucleus.

Mature mammalian CNS neurons often do not recover successfully following injury. To this point, unilateral lesion of the hypothalamo-neurohypophysial tract results in collateral sprouting from uninjured axons of the supraoptic nucleus (SON) in 35-day-old but not in 125-day-old rats. Thus, it appears that there are age-related changes within the SON that preclude the older rat from recovering following axotomy. We hypothesize that the intrinsic capacity for axon reorganization may depend, in part, on age-related alterations in cell adhesion molecules that allow normal astrocyte-neuron interactions in the SON. In support of our hypothesis, numerous reports have shown that Thy-1 is increased in neurons at the cessation of axon outgrowth. Therefore, we compared protein levels of Thy-1 and the Thy-1 interacting integrin subunits, alpha-v (αv), beta-3 (ß3), and beta-5 (ß5), in 35- and 125-day-old SON using western blot analysis. Our results demonstrated that there was significantly more Thy-1 protein in the 125-day-old SON compared to 35-day-old SON, but no change in the protein levels of the integrin subunits. Furthermore, we localized Thy-1-, αv integrin-, ß3 integrin-, and ß5 integrin-immunoreactivity to both neurons and astrocytes in the SON. Altogether, our results suggest that the observed increase in Thy-1 protein levels in the SON with age may contribute to an environment that prevents collateral axonal sprouting in the SON of the 125-day-old rat.