Search

**Background:** Delphi research priority setting exercises in plastic and reconstructive surgery aim to encourage future research in areas that align with clinical needs. This can guide the allocation of research funding and further the knowledge base of the speciality. This systematic review evaluates the content and quality of existing Delphi research priority setting studies in plastic and reconstructive surgery, to inform future studies. **Method:** A predefined protocol and PRISMA guidelines were followed. The search was performed by a research librarian. Screening and data extraction was performed in duplicate with a third reviewer arbitrating. Primary outcomes included the number of studies and subject areas. Secondary outcomes were the methods and results (including types of stakeholders, uncertainties, numbers of stakeholders, journal impact factor, implementation plans and dissemination plans). The risk of bias was assessed using four domains of quality. Data underwent synthesis with descriptive statistics. **Results:** Seven articles were included in the review, covering breast reconstruction, craniomaxillofacial, burns, aesthetics, skin and soft tissue, and general plastics. Studies had national or international scope, used either Delphi or modified Delphi methodology, and had a variable number of rounds. Four included studies had funding, and implementation plans were absent in four included studies. **Discussion and conclusion:** Included studies had a variable methodology, making a direct comparison between studies difficult. Six of the seven included studies had a high or moderate risk of bias, and implementation plans for studies were variable or absent. The review highlights the need for future Delphi research priority setting exercises to have a more standardised method and adhere to quality criteria.

Summary: Intraneural perineurioma (IPN) is a rare benign neoplasm of the peripheral nerve sheath, most commonly affecting the sciatic nerve of adolescents or young adults. We present a rare case of perineurioma in a 67-year-old man with an infiltrative clinical presentation affecting his ulnar nerve. Complete excision required en-bloc resection of the ulnar neurovascular bundle from mid-forearm to mid-palm with sural nerve and saphenous vein grafts used to reconstruct the ulnar nerve and artery, respectively. Despite recurrence from a previously localized excision, there has been no recurrence to date following en-bloc resection. The available literature on intraneural perineurioma is reviewed in light of this case report. IPN is an important entity because of its ability to mimic neural malignancies, and this case challenges the assertion that it is a tumour that occurs strictly in the young.

Introduction: Prehabilitation is increasingly recognised as a therapeutic option to reduce postoperative complications. Investigating the beneficial effects of exercise on cellular mechanisms, we have previously shown that a single episode of exhaustive exercise effectively stimulates endothelial progenitor cells (a cell population associated with vascular maintenance, repair, angiogenesis, and neovascularization) in correlation with fewer postoperative complications, despite the ongoing debate about the appropriate cell surface marker profiles of these cells (common phenotypical definitions include CD45dim, CD133+, CD34+ and/or CD31+). In order to translate these findings into clinical application, a feasible prehabilitation programme achieving both functional and cellular benefits in a suitable timeframe to expedite surgery is necessary. Objective: The objective of this study was to test the hypothesis that a four-week prehabilitation programme of vigorous-intensity interval exercise training is feasible, increases physical capacity (primary outcome) and the circulatory number of endothelial progenitor cells within peripheral blood. Methods: In this unblinded, parallel-group, randomised controlled proof-of-concept clinical trial (German Clinical Trial Register number: DRKS00000527) conducted between 01st December 2014 and 30th November 2016, fifteen female adult patients scheduled for incontinence surgery with abdominal laparotomy at the University Hospital Cologne were allocated to either an exercise (n = 8, exclusion of 1 patient, analysed n = 7) or non-exercise group (n = 7, exclusion of 1 patient, analysed n = 6). The exercise group's intervention consisted of a vigorous-intensity interval training for four weeks preoperatively. Cardiopulmonary Exercise Testing accompanied by peripheral blood collection was performed before and after the (non-)training phase. Cellular investigations were conducted by flow cytometry and cluster-based analyses. Results: Vigorous-intensity interval training over four weeks was feasible in the exercise group (successful completion by 8 out of 8 patients without any harms), with significant improvements in patients' functional capacity (increased oxygen uptake at anaerobic threshold [intervention group mean + 1.71 ± 3.20 mL/min/kg vs. control group mean −1.83 ± 2.14 mL/min/kg; p = 0.042] and peak exercise [intervention group mean + 1.71 ± 1.60 mL/min/kg vs. control group mean −1.67 ± 1.37 mL/min/kg; p = 0.002]) and a significant increase in the circulatory number of endothelial progenitor cells (proportionate CD45dim/CD14dim/CD133+/CD309+/CD34+/CD31 + subpopulation within the circulating CD45-pool [p = 0.016]). Conclusions: We introduce a novel prehabilitation concept that shows effective stimulation of an endothelial progenitor cell subpopulation within four weeks of preoperative exercise, serving as a clinical cell-mediated intervention with the aim to reduce surgical complications. Funding: Institutional funding. DFG (German Research Foundation, 491454339) support for the Article Processing Charge.

Unrecognized progenitor cell perturbations underlying a disease state may limit the efficacy of cell therapies. Here, the authors use high-throughput, single-cell transcriptional analysis to identify disease-specific cellular alterations and prospectively isolate restorative cell subpopulations.

Systemic treatment of metastatic pancreatic adenocarcinoma achieves only modest benefits, with evidence indicating a survival advantage with 5-fluorouracil (5-FU) over best supportive care alone, and further advantage of single-agent gemcitabine over 5-FU. There are very few regimens better than single-agent gemcitabine despite multiple trials of cytotoxic and targeted agents. The addition of a platinum agent has improved response rate but not survival. The addition of erlotinib has improved survival but only by a small margin. The use of gemcitabine in multidrug regimens containing one or more of: a platinum agent; fluoropyrimidine; anthracycline; and taxane has demonstrated advantages in response rate, progression-free survival and, in one randomized study, overall survival. After gemcitabine failure, second-line therapy with oxaliplatin and 5-FU provides a further survival advantage. Further advances depend upon the current and future clinical trials investigating enhanced delivery of current agents, new agents and novel modalities, improved supportive care, and treatment more tailored to the individual patient and tumour.

N/A