Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. National Institute for Health and Care Research.

Peptic ulcer disease is a condition in which an important role has infection with H. pylori. The most common complication of peptic ulcer is bleeding. The presence of H. pylori triggers local and systemic cytokine signaling which may affect processes such as healing, gastric or duodenal rupture, and carcinogenesis. In this study, we examined the concentrations of IL-1β, IL-6, IL-10, TNF, TGF-β and IL-17A in serum by enzyme immunoassay and their mRNA expressions in periulcer biopsies obtained from patients with bleeding peptic ulcer by means of real-time-PCR. We have shown that pro-inflammatory IL-6 and TNF concentrations in serum were significantly higher in patients who were infected with H. pylori, while the concentrations of TGF-β and IL-17A were significantly lower compared to non-infected subjects. IL-17A expression in periulcer mucosa was significantly higher in patients who were infected with H. pylori, while the expression of other cytokines, there was no significant difference compared to non-infected controls. Considering higher serum concentrations in non-infected subjects and higher IL-17A expression in mucosal tissue of infected patients, our data support the studies that found IL-17A has protective role in eradication of H. pylori infection in infected patients.

The Glissonean pedicle approach in liver surgery provides new knowledge of the surgical anatomy of the liver and advances the technique of liver surgery. Extrafascial dissection of Glissonean pedicle without opening the liver substance, proposed by Takasaki, represents an effective and safe technique of anatomic liver resection. The presented approach allows early and easy ischemic delineation of appropriate anatomic liver territory (hemiliver, section, or segment) to be removed with selective inflow vascular control. It is not time-consuming and it is very useful in re-resection, as well as oncologically reasonably. According to Sugioka's proposal, for technical standardization, it is important to recognize the four anatomical landmarks; the Arantius plate, the umbilical plate, the cystic plate, and the Glissonean pedicle of the caudate process (G1c), and six Gates defined by the four anatomical landmarks. For the right extrahepatic Glissonean pedicle isolation, the cystic plate cholecystectomy should be the first procedure, whereas for the left, the Arantius plate or the umbilical plate should be detached from Laennec's capsule at first. Pedicles can be isolated by connecting Gates to each other. Further peripheral pedicles could be pulled out to the hepatic hilum and transected safely. In conclusion, the extrahepatic Glissonean pedicle approach based on Laennec's capsule would standardize anatomical liver resection including laparoscopic and robotic liver resection.

Introduction/Objective. The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods. In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey ? SF-36). Questionnaires were collected before and three months after hip surgery. Results. Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion. The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506.

Introduction Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare mesenchymal tumor originating from the endothelial smooth muscle of the intima and account for about 1-2% of all the sarcomas of the soft tissue. The objective of this article is to show a case of IVC leiomyosarcoma, it’s resection and reconstruction using ProxiCor. Case outlines We showed a case of a 65-year-old woman presented with abdominal pain and mass in subhepatic space, who underwent surgery and resection of a leiomyosarcoma of IVC. IVC was reconstructed with ProxiCor patch, and patohistology confirmed that it was leiomyosarcoma. Conclusion Our experience has shown that the application of extracellular matrix (ECM) is safe and has given a satisfactory treatment result. A comparison with a much larger number of patients will give a true picture of the advantages and disadvantages of this type of material in vascular reconstructive procedures.