Hemodynamic Assessment with SPY-Indocyanine Green Angiography in Expansion Period: A Study for Expansion Capsule Pressure Optimization.

Tissue expansion-related severe complication exists, and the poor blood supply is one of the causes. After decades of negative correlation between capsule pressure and blood flow was verified, the widely recognized expansion capsule pressure is still absent. A prospective randomized controlled trial was performed to explore the optimal expanding capsule pressure. Thirty subjects were randomly divided into 5 groups, received a weekly expanding on 60-, 70-, 80-, 90-, and 100-mm Hg capsule pressure, respectively. All patients achieved 8-week follow-up; hemodynamic assessment by SPY-indocyanine green (ICG) angiography was taken every 2 weeks. Standardized indexes from SPY-ICG angiography were used to assess the blood supply, in which the ratio of ingress rate and the ingress rate of normal skin (IR/NIR) reflects the arterial perfusion level, and the ratio of Engress Rate and IR (ER/IR) indicates the venous reflux level. The expansion-related adverse events during the trial were recorded. The IR/NIR and the ER/IR are both obviously negatively correlated to the capsule pressure of tissue expander (P ≤ 0.05, the ER/IR's correlation coefficient = -0.453; the IR/NIR's correlation coefficient = -0.482). The post-expansion IR/NIR increased significantly after 8 weeks of expansion (P ≤ 0.05) in 90-mm Hg group. And the post-expansion ER/IR was significantly elevated (P ≤ 0.05) in 80 and 90-mmHg groups. There were 2 expansion-related complications reported in 100-mm Hg group, whereas no complication occurred in 4 other lower groups. SPY-ICG angiography is an objective measurement for tissue expansion hemodynamic monitoring. The expanding capsule pressure of 80 to 90 mm Hg is a reasonable upper limit.

Discordance of pathological thin melanoma thickness and T stage in SEER registry: impacts on clinical management and research directions.

BACKGROUND: Ultrathin melanoma was previously demonstrated to have higher risk for melanoma-specific mortality using SEER database. However, these guideline-changing conclusions has been recently challenged by miscoding of thickness. This present study was performed to assess the prognosis of thin and ultrathin melanoma using only surgically-treated, pathologically confirmed and after removal of discordant cases. METHODS: Melanoma patients from SEER database who were initially diagnosed with histologically confirmed and surgically treated melanoma from 1998 to 2012 were included. Subjects with discordance between T stage and tumor thickness were excluded. Kaplan-Meier curves, log-rank test and multivariate Cox proportional hazards regression models were used. RESULTS: 55,754 patients met the strict inclusion criteria, but 16 (0.02%) and 803 (1.4%) patients were removed due to T0 stage and discordance between T stage and thickness, respectively. Therefore, 54,935 patients entered the analyses, among which 52,751 were LN negative and 2,184 were LN positive. In either overall or LN-negative patients, a straightforward dose-effect relationship of larger thickness with increasing mortality was observed. In contrast, in LN positive patients, the T1 subgroup demonstrated a similar survival with tumors in T2 mm subgroup. Multivariable analysis revealed same pattern, and significant interaction between T stage and LN involvement was found. Further categorizing T1 melanoma into 10 equal 0.10 mm increments demonstrated an unexpected "N"-shaped pattern of mortality in overall and LN negative ultrathin melanoma but not in LN positive melanoma. CONCLUSIONS: No difference in mortality was observed in T1-3 tumors with LN involvement. External and independent validation studies are warranted.