Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

A Comparison of the Antibiotic Activities of Sisomicin, Gentamicin and Aminosidine Sulphate against Pseudomonas Aeruginosa

Sisomicin, gentamicin and aminosidine sulphate were compared for their antibiotic activity against Pseudomonas strains freshly isolated from clinical material. The activity of the three agents, expressed as a minimum inhibitory concentration, was determined using the same automatized system. </jats:p

A Comparison of the Minimum Inhibitory Concentrations of Sisomicin and of Fourteen Other Antibiotics

The activities of sisomicin and of fourteen other antibiotics have been compared for their inhibitory activity on all the different strains of bacteria isolated from a 3,000 bed hospital. The antibiotic sensitivity tests were performed in liquid medium and expressed as minimum inhibitory concentrations. The tests were performed over a period of four months. The results are discussed. </jats:p

Serratus Anterior Fascia Flap Versus Muscular Flap for Expander Coverage in Two-stage Breast Reconstruction Following Mastectomy: Early Post-operative Outcomes

Introduction: The demand for reconstructive breast surgery after mastectomy is increasing among women and the two-stage option remains the most commonly performed technique. We conducted a self-controlled prospective clinical trial comparing the use of the serratus anterior fascia with the serratus anterior detached fibers to cover the inferolateral aspect of the expander in immediate two-stage breast reconstruction following conservative mastectomies as oncological or risk-reducing procedures. Patients and Methods: We analyzed the surgical outcome of 29 bilateral mastectomies and immediate reconstruction with the positioning of a tissue expander in a pocket beneath the pectoralis major and serratus anterior muscle on one side and in a pocket beneath the pectoralis major and a serratus anterior fascia flap on the other side. We considered all complications presenting in the first month after surgery and patient-reported early post-operative pain. Results: Complication rates in the two groups did not significantly differ (p = 0.237). The total amount of drainage and the time of drainage permanence were significantly lower for the subfascial group (p < 0.05). Patient-reported early post-operative pain was significantly different between the two groups both at 24 h (p < 0.05) and at 5 days (p < 0.05) with significantly lower pain scores reported by the patients in the subfascial group. Discussion: Our self-controlled prospective trial demonstrated an advantage in performing an implant-based two-stage breast reconstruction using a serratus anterior fascia flap when compared with the serratus muscle fibers use for inferolateral implant coverage following mastectomy. The use of the anterior serratus fascia flap for inferolateral implant coverage in two-stage breast reconstructions following mastectomy could be considered as a safe and effective technique, presenting lower morbidity for the patient when compared with the serratus muscle fibers use and lower costs when compared with biological and synthetic meshes use, achieving good outcomes in terms of post-operative complications and women’s quality of life and satisfaction levels. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

On the use of digital microscopes at nursery and primary schools

In this paper we describe and analyze a new user interface program that allows students of nursery and primary schools to use digital microscopes in the Linux environment. Moreover, we want to provide teachers with new ideas for a conscious and effective use of digital microscopes in order to promote the interest toward the scientific exploration of nature in children.In our classes we have used the Intel® Play™ QX3™ Microscope, which is a unique tool to introduce children to technology. This microscope has technical features that make it very effective and simple to use; furthermore it allows, in combination with our software, to observe very small objects directly from the computer screen and realize videos by capturing images in long term experiments.Children can recombine the microscope images so as to produce new graphic objects, modify these images in a creative way and create new multimedia collections of their experiments. In particular, we aim at establishing a link among practical experience, geometry and artistic education; moreover, this tool can facilitate the integration of certified students, hyperactive students and students with deficit and attention disorder, since it can promote their concentration through an operative approach

Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique

Background: The combination of breast conserving surgery (BCS) together with plastic surgery techniques (oncoplastic breast surgery) is a useful surgical tool matching the radical oncological excision while preserving breast cosmesis. Upper-inner quadrant resections represent a challenge for breast surgeons. The aim of this study was to identify a reproducible technique to repair upper-inner quadrant defects with oncoplastic glandular reshaping in order to obtain a satisfactory aesthetic outcome together with a radical excision of the breast cancer. Methods: During the period from March 2014 to March 2016, 32 patients with an upper-inner quadrant’s breast cancer were treated at our Department. Post-operative complications, negative margins of resection rates and cosmetic outcome (both patient-reported and surgeon-reported) were assessed. Results: At a mean follow-up of 14 months (range 6–24), the complication rate was 25% (wound dehiscence, seroma formation, hematoma, marginal skin necrosis and partial NAC necrosis). Surgical margins of resection were negative in all procedures, and the overall satisfaction with the cosmetic outcome assessed by the patient was considered excellent in 17 cases (53.1%) and in 19 cases (59.4) when assessed by the surgeon. Conclusions: The proposed technique represents a valuable and reproducible solution for the challenging reshaping that follows upper-inner quadrantectomies due to its low complication rates, high free margins of resection rates and excellent cosmetic outcomes. Level of Evidence: Level IV, therapeutic study