Evidence-based clinical practice guideline: Reconstruction after skin cancer resection.

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

SUMMARY: A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

Water Transport-Induced Liquid-Liquid Phase Separation Facilitates Gelation for Controllable and Facile Fabrication of Physically Crosslinked Microgels.

Physically crosslinked microgels (PCMs) offer a biocompatible platform for various biomedical applications. However, current PCM fabrication methods suffer from their complexity and poor controllability, due to their reliance on altering physical conditions to initiate gelation and their dependence on specific materials. To address this issue, a novel PCM fabrication method is devised, which employs water transport-induced liquid-liquid phase separation (LLPS) to trigger the intermolecular interaction-supported sol-gel transition within aqueous emulsion droplets. This method enables the controllable and facile generation of PCMs through a single emulsification step, allowing for the facile production of PCMs with various materials and sizes, as well as controllable structures and mechanical properties. Moreover, this PCM fabrication method holds great promise for diverse biomedical applications. The interior of the PCM not only supports the encapsulation and proliferation of bacteria but also facilitates the encapsulation of eukaryotic cells after transforming the system into an all-aqueous emulsion. Furthermore, through appropriate surface functionalization, the PCMs effectively activate T cells in vitro upon coculturing. This work represents an advancement in PCM fabrication and offers new insights and perspectives for microgel engineering.

Survival of small-cell lung cancer patients after surgery: A single-center retrospective cohort study.

This study summarized and analyzed the clinical characteristics and prognosis of small-cell lung cancer (SCLC) patients after surgical treatment. The clinical data of 130 patients (99 males and 31 females) with SCLC treated by surgery and confirmed by postoperative pathological examination at Peking Union Medical College Hospital from April 2004 to April 2019 were retrospectively analyzed. Clinical characteristics, surgery, pathological stage, and perioperative treatment were summarized. Kaplan-Meier survival curve and Cox regression analysis were performed. Pathological examination revealed that 36 (27.69%) patients had stage I SCLC, 22 (16.92%) patients had stage II SCLC, 65 (50.00%) patients had stage III SCLC, and 7 (5.39%) patients had stage IV SCLC. The overall median survival time was 50 months (95% confidence interval, 10.8-89.2 months). The median survival time of stage I, II, III and IV SCLC patients was 148, 42, 32, and 10 months, respectively. In patients who underwent surgical treatment, postoperative adjuvant therapy and tumor stage were independent prognostic factors for survival (p < 0.05).Lobectomy and lymph nodes resection combined with adjuvant therapy were cautiously recommended for stage I-IIIa SCLC patients.

Engineering the Deformability of Albumin-Stabilized Emulsions for Lymph-Node Vaccine Delivery.

A major challenge in vaccine delivery is to achieve robust lymph-node (LN) accumulation, which can capitalize on concentrated immunocytes and cytokines in LNs to stimulate the onset and persistence of adaptive immune responses. Previous attempts at developing vaccine delivery systems have focused on the sizes, charges, or surface ligands but not on their deformability. In fact, the LN homing of antigen-presenting cells depends on deformability to pass through the cellular gaps. Herein, the deformability of albumin-stabilized emulsions is engineered. Owing to self-adaptive deformability, the droplets (≈330 nm) can attach to and deform between cells and adjust their sizes to pass through the endothelial gaps (20-100 nm), favoring direct LN transfer (intercellular pathway). Additionally, owing to relatively large sizes, some emulsions can be retained at the administration sites for potent antigen uptake and activation of APCs as well as LN-targeted delivery of vaccines (intracellular pathway). Compared with solid particles, the dual LN transfer strategy evidently enhances antigen accumulation and activation of LN drainage, potently stimulates cellular immune responses, and increases the survival rate of tumor-bearing mice. Thus, the deformability of albumin-stabilized droplets may offer an efficient strategy for potent LN targeting and enhanced vaccinations.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

SUMMARY: A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process. In some cases, a distinction was made between treatment options in the office-based setting as opposed to those in the facility setting. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology). Final recommendations are related to concepts concerning the timing of reconstruction, management of anticoagulation, use of antibiotics, methods of pain control, and follow-up assessment. At times, there was insufficient evidence to make high-level recommendations. The literature analysis highlights the need for additional methodologically robust studies in this area, to help guide clinical practice.

Economics of upper extremity replantation: national and local trends.

BACKGROUND: Reimbursements have fallen for reconstructive surgery. The purpose of this study was to show that not only are large teaching hospitals performing more of the reconstructive surgery procedures, specifically upper extremity replantation, they are also getting paid less to do so. METHODS: The authors examined trends in reimbursement, teaching status, and hospital size in both a national and a local database of patients who had undergone upper extremity replantation. Specifically, they used the 1993 to 2002 Nationwide Inpatient Sample as well as the local replant database from the past 5 years at Yale New Haven Hospital. RESULTS: A total of 3219 upper extremity replantations were coded in the Nationwide Inpatient Sample, representing 16,128 replantations performed in the United States from 1993 to 2002. The percentage of replantations performed at teaching hospitals increased over two-fold (44 percent versus 89 percent). Those performed at nonteaching hospitals declined (56 percent versus 11 percent). Also, a larger percentage of replantations were being performed at large hospitals (64 percent versus 82 percent). At Yale New Haven Hospital, the percentage of the professional fee that was actually paid dropped (100 percent in 2000 versus 32 percent in 2005). CONCLUSIONS: With respect to upper extremity replantation, teaching hospitals are bearing the proportionally largest economic burden of managed care's declining reimbursements for reconstructive procedures. The authors believe that these replantation data are representative of trends in reconstructive surgery, and that the model of ever-increasing volume and diminishing reimbursements in large academic medical centers may not be sustainable.