Comparative Study of the Efficacy and Safety of Radical Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy in Locally Advanced Gastric Cancer: A Propensity Score-Matching Analysis.

BACKGROUND: The effectiveness and safety of preventive hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric cancer (GC) remain controversial. This study aimed to describe the safety and efficacy of radical surgery (RS) with or without HIPEC for patients with locally advanced GC (LAGC). METHODS: The study identified 394 patients with LAGC who underwent RS with or without HIPEC in China. RESULTS: Of the 394 patients, 146 received RS+HIPEC, and 248 received RS alone. The RS-HIPEC procedure improved the relapse-free survival (RFS) of the GC patients (2-year RFS, 62.9 % vs 37.8 %; χ2 = 4.468; P = 0.035) compared with those who received RS alone. The incidence of postoperative myelosuppression (Z = 4.077; P = 0.043) was higher in the RS+HIPEC group, whereas the incidence of wound complications was lower (Z = 4.077; P = 0.043). In the subgroup analysis, HIPEC improved the OS (2-year OS, 69.9 % vs 40.8 %; χ2 = 5.537; P =0.019) and RFS (2-year RFS, 65.6 % vs 33.3 %; χ2 = 7.380, P = 0.007) of the patients with nerve invasion and the RFS of the patients with vascular invasion (2-year RFS, 60.7 % vs 31.6 %; χ2 = 3.891; P = 0.049). In addition, the prognosis of the patients who underwent HIPEC was better when the tumor diameter was smaller than 5 cm (2-year RFS, 68.6 % vs 37.9 %; χ2 = 3.957; P = 0.047). CONCLUSIONS: The RS + HIPEC procedure improved the RFS of the patients with LAGC compared with RS alone, especially the patients with nerve or vascular invasion and the patients with tumor smaller than 5 cm. Moreover, it reduced the incidence of wound complications and did not induce more perioperative complications in addition to myelosuppression.

Comparative Study of Short-Term Efficacy and Safety of Mitomycin versus Lobaplatin for Hyperthermic Intraperitoneal Chemotherapy after Radical Surgery in Colorectal Cancer with High-Risk Factors for Peritoneal Carcinomatosis: A Propensity Score Matching Analysis.

BACKGROUND: The drug selection of radical surgery (RS), with hyperthermic intraperitoneal chemotherapy (HIPEC), in pT4 colorectal cancer (CRC) remains controversial. METHODS: Adverse events after HIPEC were estimated by common terminology criteria for adverse events version 5.0. The efficacy was evaluated using overall survival (OS) and recurrence-free rate (RFR). Propensity score matching (PSM) was used to reduce the influence of confounders between Mitomycin and Lobaplatin groups. RESULTS: Of the 146 patients, from April 2020 to March 2021, 47 were managed with mitomycin and 99 with lobaplatin. There was no significant difference in the incidence of all adverse events between the two groups after PSM. OS and RFR were not significantly different between the two groups at 22 months (p = 0.410; p = 0.310). OS and RFR of the two groups also showed no significant difference for patients with T4a or T4b stage, tumor size < or ≥ 5 cm. Among patients with colon cancer, RFR at 22 months of the two groups was significantly different (100.0% vs. 63.2%, p = 0.028). CONCLUSIONS: In summary, the safety of mitomycin and lobaplatin for HIPEC was not different. Compared with lobaplatin, mitomycin for HIPEC after RS could benefit patients with colon cancer in RFR.

Comparative Study of Short-Term Efficacy and Safety of Radical Surgery with or without Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer with T4 Stage: A Propensity Score Matching Analysis.

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) in T4 colorectal cancer (CRC) remains controversial. The study aimed to explore the safety and efficacy of radical surgery (RS) with HIPEC in T4 CRC. METHODS: Adverse events after HIPEC were estimated by Common Terminology Criteria for Adverse Events version 5.0. The efficacy was evaluated using recurrence-free survival (RFS) and overall survival (OS). Propensity score matching (PSM) was used to reduce the effects of confounders between groups. RESULTS: Of the 417 patients (263 men and 154 women), 165 patients were treated with RS + HIPEC and 252 patients with RS alone. There was no significant difference in the incidence of all adverse events after PSM. Overall RFS and OS were not significantly different at 24 months (p = 0.580 and p = 0.072, respectively). However, in patients with T4b stage CRC (92.1% vs. 77.3%, p = 0.048) and tumor size ≥ 5 cm (93.0% vs. 80.9%, p = 0.029), RFS in the two groups showed a significant difference at 24 months. CONCLUSIONS: In summary, the safety of HIPEC in T4 CRC was confirmed. Compared with RS, though RS + HIPEC did not benefit the overall cohort at 24 months, RS + HIPEC could benefit patients with T4b stage CRC and tumor size ≥ 5 cm in RFS.

External fixation in the treatment of displaced supracondylar femoral fracture in children: A retrospective case series.

OBJECTIVE: The aim of this study was to evaluate the clinical and radiological outcomes and complications of external fixation use in the treatment of children with displaced supracondylar femoral fractures.. METHODS: In this retrospective study, 14 children (6 boys, 8 girls; mean age = 7.3 years; age range = 3.9 - 10.3 years) who underwent external fixation for the treatment of a displaced supracondylar femoral fracture from 2010 to 2017 were included. Their medical records were reviewed for general information and surgery details. Postoperative information, such as time to radiographic union, time to regain walking ability, Knee Society Scores (KSS) postoperative score, and KSS functional score were collected. Radiographic images were examined for the measurement of leg length discrepancy and valgus deformity. RESULTS: The mean follow up was 34 (range = 24-50) months. The mean time to radiographic union was 12.3 (range = 10-16) weeks, and the mean time to regain walking ability was 11.8 (range = 11-13) weeks. Leg length discrepancies were all less than 0.8 cm, and valgus deformity was all limited in 10°. The mean KSS postoperative score was 97.5 (range = 93-100), and the mean KSS functional score was 97.1 (range = 90-100). None of the patients exhibited functional deficiency. Neither deep infection nor refracture was detected postoperatively. CONCLUSION: External fixation seems to be an acceptable alternative modality for treatingdisplaced supracondylar femoral fractures in children, with favorable clinical and radiological outcomes as well as a low complication rate. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Closed reduction with crossed Kirschner wire fixation for displaced supracondylar femoral fractures in young children.

Supracondylar femoral fractures are uncommon in children, but may result in various deformities. Though many approaches have been used to manage them, there is no literally approved standard yet.From 2015 to 2017, 12 young children at the average age of 2.5 years old (range 3.6-1.6) with displaced supracondylar fractures were admitted to our department and received closed reduction with crossed Kirschner wire (K-wire) fixation as treatment. After the surgeries, we performed follow-up to every patient at the average length of 26 months (range 24-30) and used the Knee Society Score scale to evaluate the outcome.Fracture healing was observed within 10 weeks for all patients and walking was resumed between 10 to 13 weeks. No patient reported a valgus deformity more than 10°, neurovascular injury or knee infection. The average limb length discrepancy was 0.4 cm at the end of our follow-up. Every patient had perfect score on the Knee Society Score scale.Our study suggests that closed reduction with percutaneous crossed Kirschner wire is a favorable method for displaced supracondylar femoral fractures in young children.

External fixation and Kirschner wires in the treatment of paediatric displaced supracondylar femur fractures.

PURPOSE: Kirschner-wire fixation (KF) and external fixation (EF) for the treatment of displaced supracondylar femur fractures (SFFs) were demonstrated respectively in previous reports. However, there is no paucity of convincing information on better treatment options for children. The aim of this study was to show results of KF and EF in the treatment of paediatric SFFs according to clinical and radiological outcome. METHODS: A retrospective analysis including 22 displaced closed SFFs was performed. A total of 12 patients were treated with KF, other ten patients were treated with EF. All patients were followed up for at least 24 months. Demographic data, surgical outcomes and postoperative knee function using the Knee Society Score (KSS) scale were evaluated in this research. RESULTS: The patients in the KF group were significantly younger than in the EF group (p < 0.001). The KF group had superiority in operative time (p = 0.001), blood loss (p = 0.027) and length of hospital stay (p = 0.001). Clinical healing outcome did not differ between the two groups. The KF group achieved radiological union in a shorter period (p < 0.001), with a better range of movement (ROM) and KSS postoperative score. CONCLUSION: Both KF and EF can achieve excellent outcomes for paediatric SFFs. KF has many advantages in younger children. LEVEL OF EVIDENCE: IV.

Locking plate versus external fixation in the treatment of displaced femoral supracondylar fracture in children.

BACKGROUND: Displaced supracondylar femoral fractures (SFF) are difficult injuries to treat in children. Several techniques have been widely used but few studies have compared the merits and drawbacks of each surgical intervention in order to analyze clinical values. The aim of this study was to (1) evaluate postoperative and functional conditions after treatments with locking plate (LP) or external fixation (EF), (2) observe adverse events associated with these two techniques, and (3) evaluate the clinical value of these two techniques. METHODS: Twenty-eight patients less than 14 years of age were included in this study with supracondylar femoral fractures. They underwent locking plate or external fixation in authors' hospital. The postoperative healing and functional outcome were elevated according to radiographic and clinical measures, including American Knee Society Score (KSS). Fisher's exact test and independent samples t test were used for statistical analysis. RESULTS: All fractures healed without delayed union. The KSS scoring results of locking plate and external fixation groups were both excellent. The alignment of lower limbs was acceptable with knee valgus less than 2° for all involved patients. In addition, leg length discrepancy was less than 1 cm. No acute or severe complications were noted. There was significant difference in union time (p = 0.03), operating time (p< 0.001), intraoperative blood loss (p< 0.001), and limb length discrepancy (p = 0.04) between LP group and EF group. CONCLUSIONS: External fixation is superior than locking plate in terms of union, operation time phrases, and intraoperative blood loss. EF techniques are better options for treating displaced supracondylar femoral fracture in children. LEVEL OF EVIDENCE: Retrospective comparative study; level III.

Sulfur Dioxide Enhances Endogenous Hydrogen Sulfide Accumulation and Alleviates Oxidative Stress Induced by Aluminum Stress in Germinating Wheat Seeds.

Aluminum ions are especially toxic to plants in acidic soils. Here we present evidences that SO2 protects germinating wheat grains against aluminum stress. SO2 donor (NaHSO3/Na2SO3) pretreatment at 1.2 mM reduced the accumulation of superoxide anion, hydrogen peroxide, and malondialdehyde, enhanced the activities of guaiacol peroxidase, catalase, and ascorbate peroxidase, and decreased the activity of lipoxygenase in germinating wheat grains exposed to Al stress. We also observed higher accumulation of hydrogen sulfide (H2S) in SO2-pretreated grain, suggesting the tight relation between sulfite and sulfide. Wheat grains geminated in water for 36 h were pretreated with or without 1 mM SO2 donor for 12 h prior to exposure to Al stress for 48 h and the ameliorating effects of SO2 on wheat radicles were studied. SO2 donor pretreatment reduced the content of reactive oxygen species, protected membrane integrity, and reduced Al accumulation in wheat radicles. Gene expression analysis showed that SO2 donor pretreatment decreased the expression of Al-responsive genes TaWali1, TaWali2, TaWali3, TaWali5, TaWali6, and TaALMT1 in radicles exposed to Al stress. These results suggested that SO2 could increase endogenous H2S accumulation and the antioxidant capability and decrease endogenous Al content in wheat grains to alleviate Al stress.