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This paper introduced a procedure which integrates economical factors into the scheduling of disassembly operations for Material Recovery Opportunities (MRO). MRO are defined as opportunities to reclaim post-consumer products for recycling, remanufacturing and reuse. Traditionally, recyclers have resorted to using heuristics for analysing the breakdown of products and the associated costs. In this paper, a quantitative method of disassembly analysis is developed. Its aim is to improve the efficiency of the disassembly planning process and to generate an optimal disassembly sequence which maximizes profit. Three economic indices are used to evaluate the trade-off between reclamation and disposal of individual components. A systematic procedure of generating an optimal disassembly sequence based on maximizing the profits of material recovery is presented. Three criteria are established to reduce the search space and facilitate recovery opportunities: (1) material compatibility, (2) clustering for disposal, and (3) concurrent disassembly operations. An example is provided on a product being disassembled for recycling at a local recycling plant in Canada. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of salvage stereotactic body radiation therapy (SBRT) in patients with biopsy-proven local prostate cancer recurrence after radiation therapy.Methods and Materials: Between April 2010 and January 2017, 100 patients were included in 7 centers. Disease extension was assessed by pelvic multiparametric magnetic resonance imaging and choline positron emission tomography in 87% and 94% of patients, respectively. The median time interval between the 2 treatments was 7.5 years (range, 2-18). Median prostate-specific antigen at recurrence was 4.3 ng/mL (range, 2-38). Median SBRT dose was 36 Gy (range, 25-36.25) in 6 fractions (range, 5-6), every other day. Thirty-four percent of patients were treated by androgen deprivation therapy for a median duration of 12 months. Toxicity was assessed according to Common Terminology Criteria for Adverse Events version 4.03.Results: Median follow-up was 29.3 months (range, 4-91). Second biochemical recurrence-free survival rate at 3 years was 55% (95% confidence interval [CI], 42%-66%). The initial D'Amico group, time interval after first radiation therapy, and SBRT dose were prognostic factors of biochemical recurrence-free survival in multivariate analysis (P = .09, P = .025, P = .018, respectively). No patient developed acute gastrointestinal toxicity of grade >1; rates of acute genitourinary toxicity of grade 2 and 3 were 8% and 1%, respectively. The actuarial 3-year grade ≥2 genitourinary and gastrointestinal toxicity was 20.8% (95% CI, 13%-29%) and 1% (95% CI, 0.1%-5.1%), respectively. One patient presented with neuritis of grade 3.Conclusions: With a short follow-up, this study shows that salvage SBRT allows for encouraging control and acceptable toxicity. Further prospective studies are necessary to confirm these preliminary results and to determine late toxicity. [ABSTRACT FROM AUTHOR]

Transformation of waste into adsorbent achieves treating waste by waste. Here, 3D graphene with a large specific area was derived from waste leaf and employed for tetracycline removal from the aqueous solution. The influence of pH value on this antibiotic was evaluated, and then the adsorption behavior was studied by the analyses of two kinetics models (pseudo-first-order and pseudo-second- order equations) and two isotherm models (Langmuir and Freundlich). The Langmuir and the pseudo-second-order were best fitted for tetracycline uptake of the waste leaf graphene (WLG). The maximum adsorption capacity of WLG calculated from the Langmuir model was 909.09 mg/g. For the treatment of groundwater, WLG has an effective removal of organic pollutants and heavy metals, which indicates the fascinating potential application in water treatment. The facile preparation routine of graphene with low-cost and nontoxic characters is also resulting in macroscopic shape and excellent adsorption performance of the obtained 3D graphene. The study would offer a new version for the fabrication of graphene with the purpose of waste reclamation, and the obtained functional 3D graphene can be tremendously used in environmental pollution treatment and other areas. [ABSTRACT FROM AUTHOR]

Background: The objective of this investigation is to evaluate the outcomes and toxicity of carbon-ion re-irradiation (CIR) in patients with rare head and neck cancers (HNC). There is a paucity of data regarding treatment approaches in this patient cohort, which we aim to address in this work.Methods: Thirty-two (n = 32) consecutive patients with uncommon HNC treated between 2010 and 2017 were retrospectively analyzed in terms of clinical outcomes, patterns of failure, and toxicity.Results: Mucoepidermoid carcinoma (MEC) was the most common histology (22%). Patients received a median cumulative dose equivalent in 2 Gy fractions (EQD2) after CIR of 128.6 Gy (range, 105.8-146.5 Gy). The local and distant control rates 1 year after CIR were 66 and 72%. No serious acute or late toxicity (≥ grade 3) after CIR was observed.Conclusions: CIR may represent an effective and safe treatment alternative to palliative systemic therapies in these rare indications. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the oncological and functional outcomes of salvage high‐intensity focused ultrasound (S‐HIFU) for locally recurrent prostate cancer after low‐dose‐rate (LDR) brachytherapy. Patients and Methods: Clinical phase II studies (2003–2015) included 50 consecutive patients with post‐brachytherapy local recurrence treated by S‐HIFU. S‐HIFU was performed with post‐external beam radiotherapy (EBRT) parameters and, since 2008, with specific post‐brachytherapy parameters. Treatments were whole‐gland ablation and, since 2009, hemi‐ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure‐free survival, progression‐free survival (PFS), overall survival (OS), cancer‐specific survival (CSS), and metastasis‐free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan–Meier analysis estimated oncological outcomes. Results: In all, 13 patients were treated with post‐EBRT parameters, 37 with post‐brachytherapy parameters, 35 with whole‐gland treatment, and 15 with hemi‐ablation. The median follow‐up was 4.6 years. After S‐HIFU, the median prostate‐specific antigen level was 0.3 ng/mL. At 6 years, treatment failure‐free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post‐brachytherapy compared with post‐EBRT parameters reduced Grade 2–3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi‐ablation compared with whole‐gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S‐HIFU, 25 patients had a five‐item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months. Conclusion: S‐HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post‐brachytherapy parameters and hemi‐ablation improve the safety of the treatment. [ABSTRACT FROM AUTHOR]

Objective: To analyze functional outcomes and complication rates of distal double cuffs (DC) or transcorporal cuffs (TC) as salvage approaches in high-risk patients, since there is an ongoing debate about optimal cuff-placement in a salvage setting (SV). Existing studies analyzing DC or TC are controversial with respect to functional outcomes and complication rates. Studies directly comparing both approaches in SV are scarce.Methods and Patients: Prospective data collection was performed since 2009. DC/TC were applied according to a standardized protocol in SV. Salvage DC was chosen in case of a membranous single cuff explantation due to erosion or infection. TC were implanted after bulbar urethroplasty or DC explantation. Activation was performed 6 weeks postoperatively. Further follow-up was scheduled 6/24 months postoperatively and every 2 years thereafter. Primary/secondary endpoints were continence/complication rates.Results: In total, 71 high-risk patients were available for analysis (58 DC, 13 TC). Median age was 70 years. Median follow-up was 24 months. Objective/social continence were 88%/94% in the DC and 72%/100% in the TC cohort, respectively (P = .37/P = 1). Overall, there were no significant differences with respect to infections, erosions, mechanical failure, and explantation rates. The times of explantation-free survival were similar in Kaplan-Meier analysis (Log-rank 0.399).Conclusion: Complication and continence rates were not significantly different between both cohorts. Hence, a DC in SV can be considered as equally safe and effective. A sequential implantation (first DC, second TC) may be a viable approach to extend overall AUS incontinence therapy. [ABSTRACT FROM AUTHOR]

Post-traumatic defects of the distal third of the leg often require skipping a few steps of the well-established reconstructive ladder, due to the limited local reliable reconstructive options. In rare cases, the reconstructive plan and flap choice may encounter challenges when the patient has psychiatric illness affecting compliance with postoperative care. We describe a case of a patient with severe intellectual disability and an open fracture of the distal lower limb. After fracture management and debridement of devitalized tissues, the resultant soft tissue defect was covered with a free gracilis flap. On postoperative day 7, the patient ripped out the newly transplanted flap. The flap was too traumatized for salvage, so a contralateral free gracilis muscle flap was used. The patient showed good aesthetic and functional outcomes at a 1-year follow-up. When planning the postoperative management of patients with psychiatric illness, less complex and more robust procedures may be preferred over a long and complex surgical reconstruction requiring good compliance with postoperative care. The medical team should be aware of the risk of postoperative collapse, focus on the prevention of pain, and be wary of drug interactions. Whenever necessary, free tissue transfer should be performed despite potential compliance issues. [ABSTRACT FROM AUTHOR]

Adropin is a secreted polypeptide that has been demonstrated to serve an important role in protecting the vascular endothelium. Pharmacological activation of pro-survival kinases, such as PI3K-Akt and ERK1/2, are involved in the reperfusion injury salvage kinase (RISK) pathway. In the present study, the effects of adropin in cardiomyocyte injury induced by simulated ischemia/reperfusion (SI/R) were assessed. Additionally, the current study also assessed the mechanisms that govern SI/R in a H9c2 cardiomyoblast cell model. Cell viability was measured using an MTT assay. Cell injury was assessed using creatine kinase MB measurements. Apoptosis was assessed using flow cytometry and caspase-3 activity. The inflammatory response was measured using tumor necrosis factor α and interleukin-10 expression. Oxidative stress was assessed using malondialdehyde and superoxide dismutase. The expression levels of Akt, ERK1/2, glycogen synthase kinase 3β (GSK3β), Bcl-2 and Bax were determined using western blot analysis. The results of the current study revealed that moderate-dose adropin increased cell viability, reduced early apoptosis and caspase-3 activity, promoted Bcl-2 expression, inhibited Bax and increased the Bcl-2/Bax ratio. Adropin significantly increased the phosphorylation of Akt, ERK1/2 and GSK3β, whereas inhibitors of PI3K and ERK1/2, respectively, LY294002 and PD98059, abolished the cardioprotective role of adropin. Furthermore, no significant difference was observed in phosphorylated-STAT3/total-STAT3 expression between the adropin and SI/R groups and Janus kinase 2 inhibitor AG490 did not significantly inhibit the protective role of adropin. These results indicate that adropin exerts a protective effect against SI/R injury through the RISK pathway instead of the survivor activating factor enhancement pathway. [ABSTRACT FROM AUTHOR]

Background: First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability.Objectives: Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment.Methods: We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction).Results: Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp].Conclusions: Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations. [ABSTRACT FROM AUTHOR]

Somatostatin receptor subtype 2 upregulation is very common in meningiomas, and the use of peptide receptor radionuclide therapy (PRRT) is recognized in recent European guidelines, with long-term stable disease and a long overall survival. Treatment efficacy of radionuclide treatments is correlated with tumour radiation absorbed dose. Meningioma patients with low tumour uptake might benefit less from treatment. Thus, a method to increase tumour uptake in these patients is needed. We describe a case treated with both intravenous and intra-arterial PRRT. Tumour uptake after intravenous PRRT was disappointing, and after intra-arterial administration significantly increased tumour uptake was seen. Patient had a partial response on imaging and reduction in tumour-related complaints. Potentially, intra-arterial administration of PRRT could increase treatment efficacy in meningioma patients.Level of Evidence 5 (case report). [ABSTRACT FROM AUTHOR]

Background: Despite advances in treatment, the recurrence rates for laryngeal cancer range from 16% to 40%. Methods: Patients with recurrent laryngeal cancer treated at Memorial Sloan Kettering (MSK) from 1999 to 2016 were reviewed. Survival outcomes were analyzed. Results: Of 241 patients, 88% were male; the median age was 67 years; 71% had primary glottic tumors. At initial treatment, 72% of patients were seen with early stage disease; primary treatment was radiation (68%), chemoradiation (29%), and surgery (3%). The most common salvage surgery was total laryngectomy (74%). Forty‐seven percentage were upstaged at salvage surgery. The 2‐ and 5‐year disease‐specific survival (DSS) was 74% and 57%, respectively. Patients with cT4 disease treated with nonsurgical primary management had a 0% 5‐year DSS. Independent predictors of DSS were tumor location, perineural invasion, margin, and stage. Conclusions: Salvage surgery results in acceptable oncologic outcomes. Stage, disease site, perineural invasion, and margins are associated with inferior DSS. [ABSTRACT FROM AUTHOR]

Background: Salvage total laryngectomy (TL) and laryngopharyngectomy (LP) after chemoradiotherapy may produce disfiguring defects with severe complications that require complex reconstructions. Methods: Between January 2012 and December 2018, we enrolled 25 patients who underwent internal mammary artery perforator (IMAP) flap reconstruction after salvage TL or LP. We performed retrospective review of clinical charts to collect information such as history, timing of reconstruction, type of defect, follow‐up, donor and recipient site complications, and overall flap survival (OFS) rate. Three years overall survival (OS), relapse‐free survival (RFS), and disease‐specific survival (DSS) were calculated. Results: The OFS rate was 95%. One partial flap necrosis was recorded. No donor‐site complications were found. The mean follow‐up was 18 months. Three years OS was 44%, RFS was 47%, and DSS was 54%. Conclusions: IMAP flap appears to be safe, versatile, and easy to harvest, with minimal donor site morbidity. It is a reliable option in Head&Neck reconstruction, in salvage surgery as well. [ABSTRACT FROM AUTHOR]

• Geopolymerization of eggshell powder and flyash at ambient temperature. • Potential application in sustainable sub-base/subgrade construction. • Mixture of sodium silicate and sodium hydroxide was used as alkaline activator. • 10 M sodium hydroxide concentration was used in the alkaline activator solution. • Evaluation of strength with respect to activator ratio and precursor ratio. The eggshell powder (ESP) rich in calcium content is a poultry waste product, generated from grinding waste eggshells. Flyash (FA) is an industrial waste product, generated from the combustion of coal in power plants. Currently, disposal of these kinds of waste products is a global concern. Utilization of waste products as a sustainable construction material can solve many problems related to disposal. The current study aims to determine the possibility of utilization of calcium-rich eggshell powder and industrial waste flyash through geopolymerization, to give a sustainable construction material. Mixtures of sodium silicate (Na 2 SiO 3) and sodium hydroxide (NaOH) with fixed 10 M concentration were used as an alkaline activator solution. Modified Proctor test, unconfined compressive strength, and split tensile strength test were performed to analyze the behavior of mechanical strength. Three precursor ratios (ESP:FA) – 30:70, 50:50, and 70:30 and three activator ratios (Na 2 SiO 3 /NaOH) – 0.5, 1, and 2 were adopted. The geopolymer composites were cured at ambient temperature (25 ± 2 °C) for 7 days, 28 days, and 56 days to assess the long term strength development. Geopolymer composite 50ESP:50FA with activator ratio 2 was found optimum for unconfined compressive strength and split tensile strength. The optimum composites found in the research have the potential to be employed in sub-base/subgrade application as a sustainable construction material made from waste-by-product. [ABSTRACT FROM AUTHOR]

The Willis covered stent (WCS) may prolapse into the aneurysmal sac due to device migration or foreshortening. We present a useful salvage strategy that can reorient a prolapsed WCS into a more suitable alignment. An intra-procedural prolapse of a WCS into a large cavernous aneurysm occurred in a 70-year-old female patient. A pipeline embolization device (PED) was used to retrieve the WCS and successfully accomplish flow diversion. Maintaining proximal access and ensuring that the microwire is securely held within the central axis of the herniated stent are critical until the entire parent vessel can be reconstructed. This salvage technique may help to regain proximal access and reposition the flow diversion constructs following WCS prolapse. [ABSTRACT FROM AUTHOR]

• A novel application of SPME and UHPLC is described for elucidation of lemon wax. • SPME calibration allowed to quantify the volatile fraction. • By means of the UHPLC-PDA method eight coumarins were found in the wax. A novel application of SPME-GC and UHPLC is presented for the elucidation of an unexplored citrus by-product, namely lemon wax. In view of the current environmental protection strategies, directed toward reuse and/or recovery of waste products, this study aimed to evaluate a possible utilization of a discarded fraction from citrus fruits processing. Headspace SPME coupled with GC–MS and GC-FID allowed determining a residual amount (162.25 mg kg−1) of lemon volatiles, by means of accurate calibration of 38 terpenoids through linear regression analysis (R2 = 0.99). SPME method development, was supported by statistical analysis, consisting of experimental design and multisample comparison, where parameters such as type of coating, temperature and time of fiber exposure, were manipulated towards optimization. The optimized method was validated, showing limits of quantification (LOQ) and of detection (LOD) in the ranges 0.24 – 2.65 ng g−1 and 0.11 – 0.87 ng g−1, respectively; recoveries ranged from 84.9% to 111.5%. After optimization and validation, the UHPLC-PDA method revealed the presence in lemon wax samples of six coumarins, the most abundant being bergamottin (964 mg kg−1), followed, in decreasing amount, by citropten, 8-geranyloxypsoralen, biacangelicin, oxypeucedanin, 5-geranyloxy-7-methoxycoumarin; each analyte was calibrated by external standard methodology. Sensitivity (LOD, 31 – 112 ng g−1; LOQ, 102–370 ng⋅ g−1), accuracy (recovery, 81–94%), and precision (Retention time RSD, 0.03 – 0.09%; peak area RSD, 1.03–2.92%), were also measured. [ABSTRACT FROM AUTHOR]

To enable selection of a safer suspension site to use in face and neck lifting procedures, the spatial relationship between the tympanoparotid fascia and the great auricular nerve should be clarified. In this study, we aimed to elucidate the position of the tympanoparotid fascia and the pathway of the lobular branch of the great auricular nerve traversing the tympanoparotid fascia. Twenty hemifaces from non-preserved bequeathed Korean cadavers (5 males, 7 females; mean age, 77.0 years) were dissected to determine the great auricular nerve distribution close to the tympanoparotid fascia of clinical significance for face and neck lift procedures. We observed the tympanoparotid fascia in all specimens (20 hemifaces). The tympanoparotid fascia was located anteriorly between the tragus and intertragic notch. Regarding the spatial relationship between the tympanoparotid fascia and the great auricular nerve, we found the sensory nerve entering the tympanoparotid fascia in all specimens (100%), and the depth from the skin was approximately 4.5 mm; in 65% of the specimens, the lobular branch was found to run close to the tympanoparotid fascia before going into the earlobe. Provided with relatively safer surface mapping to access the tympanoparotid fascia free of the lobular branch of the great auricular nerve, surgeons may better protect the lobular branch by anchoring the SMAS-platysma flap and thread to the deeper superior and anterior portions of the expected tympanoparotid fascia. [ABSTRACT FROM AUTHOR]

A typical inflammatory response sequentially progresses from pro-inflammatory, immune suppressive to inflammatory repairing phases. Although the physiological inflammatory response resolves in time, severe acute inflammation usually sustains immune tolerance and leads to high mortality, yet the underlying mechanism is not completely understood. Here, using the leukemia-derived THP-1 human monocytes, healthy and septic human peripheral blood mononuclear cells (PBMC), we report that endotoxin dose-dependent switch of nicotinamide adenine dinucleotide (NAD) biosynthesis pathways sustain immune tolerant status. Low dose endotoxin triggered nicotinamide phosphoribosyltransferase (NAMPT)-dependent NAD salvage activity to adapt pro-inflammation. In contrast, high dose endotoxin drove a shift of NAD synthesis pathway from early NAMPT-dependent NAD salvage to late indoleamine 2,3-dioxygenase-1 (IDO1)-dependent NAD de novo biosynthesis, leading to persistent immune suppression. This is resulted from the IDO1-dependent expansion of nuclear NAD pool and nuclear NAD-dependent prolongation of sirtuin1 (SIRT1)-directed epigenetics of immune tolerance. Inhibition of IDO1 activity predominantly decreased nuclear NAD level, which promoted sequential dissociations of immunosuppressive SIRT1 and RelB from the promoter of pro-inflammatory TNF- α gene and broke endotoxin tolerance. Thus, NAMPT-NAD-SIRT1 axis adapts pro-inflammation, but IDO1-NAD-SIRT1-RelB axis sustains endotoxin tolerance during acute inflammatory response. Remarkably, in contrast to the prevention of sepsis death of animal model by IDO1 inhibition before sepsis initiation, we demonstrated that the combination therapy of IDO1 inhibition by 1-methyl-D-tryptophan (1-MT) and tryptophan supplementation rather than 1-MT administration alone after sepsis onset rescued sepsis animals, highlighting the translational significance of tryptophan restoration in IDO1 targeting therapy of severe inflammatory diseases like sepsis. [ABSTRACT FROM AUTHOR]

Activated endocytosis of extracellular macromolecules and their intracellular trafficking to lysosomes is an essential metabolic mechanism in cancer cells during their rapid proliferation. Cancer cells reuse a vast amount of N‐acetylglucosamine (GlcNAc) supplied from the GlcNAc salvage pathway for the accelerated synthesis of a pivotal uridine diphosphate (UDP)‐GlcNAc. A method to inactivate key glycosidases in lysosomes could critically contribute to the development of potent anticancer therapy. Here we demonstrate that "nanosomes" made of core metals covered by an antiadhesive mixed self‐assembled monolayer allow for avoiding nonspecific surface protein corona and targeted molecular delivery through activated endocytosis. Nanosomes carrying suicide substrates showed that lysosomal glycosidases such as β‐hexosaminidase and β‐galactosidase in cancer cells are promising targets for novel anticancer therapeutic nanomedicine that induce apoptotic cell death through lysosomal membrane permeabilization. The advantage of this method is evident because multivalent surface loading by antiadhesive nanosomes makes it possible to highlight "weak interactions" such as carbohydrate–lectin interactions independent of surface protein corona. [ABSTRACT FROM AUTHOR]

Chronic central venous occlusion represents a challenge for upper body central dialysis access for both surgical and endovascular interventions. The Surfacer (Surfacer Inside‐Out Access Catheter System) is a novel technique that offers a device‐based solution over various physician‐modified techniques in salvaging exhausted right‐sided neck veins for catheter placement. We report a retrospective series of four cases in which this system is used to gain upper body venous access from a single center in Singapore. This report seeks to integrate the understanding of the technical aspects of a new inside‐out device and its utility in recanalization of occluded right‐sided neck veins as it relates to Asian patients. [ABSTRACT FROM AUTHOR]

Background: To investigate the prognostic and therapeutic implications of time to biochemical relapse (BCR) in patients with prostate cancer after radical prostatectomy. Methods: The records of 3210 consecutive men with prostate cancer who underwent radical prostatectomy between January 1998 and June 2013 were retrospectively reviewed. Patients with BCR were divided into three groups based on quartiles of time to BCR, namely an early group (first quartile), an intermediate group (second and third quartiles) and late group (fourth quartile). Results: 817 (25.5%) patients experienced BCR at a median of 24.9 months after surgery. The 8-year rate of distant metastasis-free survival (64.3% vs. 41.3%, p = 0.002) and cancer-specific survival (86.6% vs. 63.4%, p < 0.001) was higher in the salvage radiotherapy (SRT) group than the androgen deprivation therapy (ADT) group in patients with early BCR, whereas those rates (91.3% vs. 87.9%, p = 0.607 and 100.0% vs. 93.1%, p = 0.144, respectively) were similar in patients with late BCR. In the intermediate BCR group, the impact of SRT over ADT on 8-year cancer-specific survival was modest (91.9% vs. 82.3%, p = 0.057) and was limited to patients with pT2 or pT3a disease. Conclusions: SRT may decrease the risk of distant metastasis and cancer-specific mortality in patients with early BCR. However, a survival benefit for those with late BCR was not apparent. For patients with intermediate BCR, SRT was associated with a cancer-specific survival benefit in patients with pT2 or pT3a disease. Novel genomic tests and imaging modalities may support clinical decision-making in these patients. [ABSTRACT FROM AUTHOR]

Identification of early nodal recurrence after primary prostate cancer (PCa) treatment by functional imaging may guide metastasis-directed therapy such as salvage lymph node dissection (SLND). The aim of this systematic review was to assess the oncological role and the safety of SLND in the era of modern imaging in case of exclusive nodal recurrence after primary PCa treatment with curative intent. A systematic literature search in the PubMed and Cochrane databases was performed up to August 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Overall, 27 SLND series have been selected for synthesis. Prostate-specific membrane antigen or choline positron emission tomography/computed tomography was the reference detection technique. SLND was performed by open or laparoscopic approach with <10% of grade 3 or more complication rate. Mean follow-up was 29.4 mo. Complete biochemical response after SLND was achieved in 13–79.5%of cases (mean 44.3%). The 2- and 5-yr biochemical progression-free survival rates ranged from 23% to 64% and from 6% to 31%, respectively. Fiver-year overall survival was approximately 84%. Main drawbacks limiting the interpretation of the effectiveness of SLND were the retrospective design of single-center series, heterogeneity between series in terms of adjuvant treatment, endpoints, definitions of progression and study population, as well as the absence of long-term follow-up. A growing body of accumulated data suggests that SLND is a safe metastasis-directed therapy option in nodal recurrence after primary treatment. However, to date, high level of evidence is still missing to draw any clinically meaningful conclusion about the oncological impact of SLND on long-term endpoints. When imaging identifies exclusive nodal recurrent prostate cancer, surgery directed to the positive lesions is safe and can offer at least a temporary biochemical response. The oncological role assessed by strong clinical endpoints remains uncertain. Salvage lymph node dissection in the setting of radiological node-only recurrence after primary prostate cancer treatment is associated with promising early oncological outcomes in terms of prostate-specific antigen response, and the safety profile is acceptable. Long-term comparative studies are awaited. [ABSTRACT FROM AUTHOR]

No studies have investigated whether narrow margin is a risk factor for hepatocellular carcinoma recurrence outside transplantability criteria. The objective was to assess on an intent-to-treat (ITT) basis whether hepatectomy with narrow margin affects the outcomes in patients enrolled in the salvage liver transplantation (LT) strategy. From 2007 to 2016, patients enrolled in the salvage LT strategy were divided into 2 groups: narrow (<10 mm) vs. wide (≥10 mm) margin groups. R1 resection was defined as positive histologic margin involvement. Recurrence rate, transplantability rate of recurrence and ITT overall survival (ITT-OS) were evaluated. A total of 81 patients were studied: 43 patients with narrow margin and 38 with wide margin. The recurrence rates, pattern and delay of recurrence, transplantability following recurrence, and ITT-OS were similar between the two groups. These results were maintained when comparing patients with R1 resection to those with R0 resection. On an ITT basis, hepatectomy with narrow margin or R1 resection did not impair the transplantability of recurrence and survival of patients enrolled in the salvage LT strategy. Narrow margin and even R1 resection following hepatectomy in the setting of salvage LT strategy should not be the basis for altering the strategy. [ABSTRACT FROM AUTHOR]

The prognosis of stage IVb non-small cell lung cancer (NSCLC) patients with multiple distant metastases or involvement of different extra-thoracic sites is poor. The prognosis following salvage surgery for patients with more than five metastases has been reported as most unfavourable. The following case is of a 71-year-old man with a 9-year survival duration after being diagnosed with stage IVb ALK-rearranged lung adenocarcinoma, who was treated for 6 years with whole-brain radiotherapy, pemetrexed-based chemotherapy, ALK-tyrosine kinase inhibitors (TKIs) including ceritinib and alectinib, and salvage sublobar resection of the primary lung cancer and who obtained treatment-free remission (TFR) for more than 3 years following surgery. [ABSTRACT FROM AUTHOR]

Hodgkin lymphoma (HL) is a highly curable hematologic malignancy. Relapsed/refractory (R/R) HL is an important clinical challenge, despite advances in treatment. Brentuximab vedotin (BV) is highly effective in R/R HL in the western world. However, there are no real-world data on the use of BV in the Asian population. Our study aimed to evaluate the efficacy and safety of BV as salvage therapy in R/R HL patients in Taiwan. We recruited 20 R/R HL patients who received BV at National Taiwan University Hospital. BV was administered at 1.8 mg/kg once every 3 weeks. The median number of systemic treatment received before BV was three. The overall response rate was 73.7% with a complete remission rate of 21.1% in R/R HL. Overall survival was not reached and progression-free survival was 6.8 months. BV could strengthen disease control before transplantation and improve post-transplant outcomes, even among those heavily pretreated patients, without significant overlapping toxicities with prior therapies. Our data suggest that BV is well tolerated and effective in the treatment of Asian patients with R/R HL. BV may offer long-term disease control in selected patients. [ABSTRACT FROM AUTHOR]

This paper examines the seabed's role as alternately an archive of technological feats and failures, and as a resource frontier. Beginning with nautical archaeological paradigms of cultural heritage and their enactment in politically motivated salvage expeditions, I explore how the deep seabed is simultaneously understood as a resource frontier, framing both salvage and seabed mining vis-à-vis settlement frontier imaginaries. I show that within legal regulation of the deep seabed, universal narratives of shared inheritance act in concert with opportunistic recoveries of minerals and archaeological objects. This leads me to posit a salvage-extraction dynamic, in which notions of the archive are superimposed onto the seabed and its extractive possibilities, producing it as a static reserve through which historical as well as progressive narratives emerge. [ABSTRACT FROM AUTHOR]

Existing study gives ordering policy for non-instantaneous deteriorating items having three-variable Weibull distribution deterioration rate. Demand rate varies in different time interval. Before deterioration starts, demand is constant and after that it decreases exponentially with respect to time. The study considers total cost function as objective function including salvage value. Shortages are not allowed to stay in time-based competition. Results are proved theoretically and numerically. Sensitivity analysis is performed with respect to salvage value, scale parameter, shape parameter and location parameter including in deterioration rate function to show the liability of the model. [ABSTRACT FROM AUTHOR]

Queuosine (Q) is a complex tRNA modification widespread in eukaryotes and bacteria that contributes to the efficiency and accuracy of protein synthesis. Eukaryotes are not capable of Q synthesis and rely on salvage of the queuine base (q) as a Q precursor. While many bacteria are capable of Q de novo synthesis, salvage of the prokaryotic Q precursors preQ0 and preQ1 also occurs. With the exception of Escherichia coli YhhQ, shown to transport preQ0 and preQ1, the enzymes and transporters involved in Q salvage and recycling have not been well described. We discovered and characterized 2 Q salvage pathways present in many pathogenic and commensal bacteria. The first, found in the intracellular pathogen Chlamydia trachomatis, uses YhhQ and tRNA guanine transglycosylase (TGT) homologs that have changed substrate specificities to directly salvage q, mimicking the eukaryotic pathway. The second, found in bacteria from the gut flora such as Clostridioides difficile, salvages preQ1 from q through an unprecedented reaction catalyzed by a newly defined subgroup of the radical-SAM enzyme family. The source of q can be external through transport by members of the energy-coupling factor (ECF) family or internal through hydrolysis of Q by a dedicated nucleosidase. This work reinforces the concept that hosts and members of their associated microbiota compete for the salvage of Q precursors micronutrients. [ABSTRACT FROM AUTHOR]

Clinically relevant inhibitors of dihydroorotate dehydrogenase (DHODH), a rate-limiting enzyme in mammalian de novo pyrimidine synthesis, have strong antiviral and anticancer activity in vitro. However, they are ineffective in vivo due to efficient uridine salvage by infected or rapidly dividing cells. The pyrimidine salvage enzyme uridine-cytidine kinase 2 (UCK2), a ∼29 kDa protein that forms a tetramer in its active state, is necessary for uridine salvage. Notwithstanding the pharmacological potential of this target, no medicinally tractable inhibitors of the human enzyme have been reported to date. We therefore established and miniaturized an in vitro assay for UCK2 activity and undertook a high-throughput screen against a ∼40,000-compound library to generate drug-like leads. The structures, activities, and modes of inhibition of the most promising hits are described. Notably, our screen yielded non-competitive UCK2 inhibitors which were able to suppress nucleoside salvage in cells both in the presence and absence of DHODH inhibitors. [ABSTRACT FROM AUTHOR]

Transfusion, as we know it today, developed into a very sophisticated treatment modality as a result of centuries of experimentation. Intraoperative cell salvage is a transfusion technique where autologous blood lost during surgery is reinfused. The success of this process relies on specialised equipment and techniques to collect, process, anticoagulate filter and reinfuse blood. Through a literature review, we collected information about the early origins of specific techniques relevant to intraoperative cell salvage: the ability to collect lost blood, to prevent collected blood from clotting, to remove debris through processing and other harmful aspects through filtering, the benefits of autologous blood transfusion, reinfusion and traditional concerns and contraindications. A culmination of knowledge specific to each of these techniques over centuries provides the background to the safe intraoperative cell salvage technique used today. In addition, we aimed to identify the reasons why specific equipment and techniques developed, why practice changed and what is still unknown. This article reviews relevant allogeneic transfusion and autotransfusion history, starting in Roman times, and includes landmark events through the centuries. [ABSTRACT FROM AUTHOR]

This essay excavates geographies of environmental injustice and racial violence in San Francisco, California using the artwork of Asian/American artists Weston Teruya, Michael Arcega, and Stephanie Syjuco made during their residencies at Recology (the city's privately-owned waste management facility). At Recology's Artist-In-Residence program, cultural workers salvage materials from the dump, transforming the city's waste into objects with educational and artistic value. Reading the visual lexicon deployed in, and the conditions of production and circulation of, these assemblages, I trace the wastelanding of communities of color across the Northern California region through processes of incarceration, toxic exposure, displacement, and labor exploitation. These artworks, I argue, assist in uncovering the terrain of slow violence in the region and across scales, or what Rob Nixon has called "landscapes of temporal overspill that elude rhetorical cleanup operations with their sanitary beginnings and endings" (2011, 8). [ABSTRACT FROM AUTHOR]

Objective: Elective neck dissection (END) for salvage laryngectomy remains controversial due to variability in reported occult nodal metastasis rates and postoperative complications. We performed a meta-analysis to examine the role of END for treatment of the clinically N0 (cN0) neck in the salvage setting.Methods: A PubMed search, without limit on years searched, was conducted for English language articles. Additional sources were found by reviewing bibliographies of pertinent articles. Studies had to include END data for salvage laryngectomy for locally recurrent squamous cell carcinoma of the larynx with clinically negative regional metastasis. For patients who underwent END, pathological node status had to be reported. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations were followed. Data were pooled using a random-effects model.Results: Nineteen studies were included in the analysis. Within the END group, 31% were supraglottic, 61% were glottic, 6% were transglottic, and 1% were subglottic. The pooled rate of occult nodal metastasis was 14% (95% CI = 0.11-0.17) for all subsites. In subsite-specific analyses, occult nodal metastasis rates were 24% for supraglottic, 9% for glottic, and 17% for transglottic recurrences. Occult nodal metastasis was higher in recurrent T3/4 tumors (21%) compared to recurrent T1/2 tumors (9%) (relative risk (RR) = 2.17, 95% CI = 1.23-3.63, p = 0.003). The RR of postoperative complications with END compared to observation was 1.72 (95% CI = 0.96-3.10, p = 0.07).Conclusions: The highest rates of occult nodal metastasis are associated with supraglottic recurrence and recurrent T3/T4 tumors. These data should be considered when deciding whether to perform END for salvage laryngectomy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to report on the use of high-dose-rate (HDR) endobronchial interventional radiotherapy (brachytherapy) for isolated endobronchial tumor recurrence in patients with non–small-cell lung cancer, in whom a surgery or external radiation treatment is not possible. A retrospective review of the patients with endobronchial tumors treated with HDR–endobronchial interventional radiotherapy at our institution (1995–2015) was performed. Treatment results and treatment-related toxicity were recorded. Clinical response was evaluated by bronchoscopy 3 months after treatment. Disease-free survival and overall survival were analyzed. One hundred twenty-six patients were identified. The median age was 63 years, and median followup time was 67.2 months. Three-month complete local response was 86.5%. At 5 years, disease-free survival was 41.4% and overall survival was 23.6%. 12.7% of the patients died from massive hemoptysis. HDR-endo brochial brachytherapy is an effective treatment option with acceptable toxicity for patients with endobronchial tumor recurrence in whom surgery and external beam radiotherapy are contraindicated. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of [68Ga]-PSMA-11 PET/CT or [68Ga]-PSMA-11 PET/MRI (PSMA-11 PET/CT(MRI)) for lymph node (LN) staging using salvage LN dissection (SLND) in patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Patients and methods: In a prospective study, 65 consecutive patients who developed BCR after RP underwent SLND after PSMA-11 PET/CT(MRI) between 2014 and 2018. Extended SLND up to the inferior mesenteric artery was performed in all patients. Regional and template-based correlations between the presence of LN metastases on histopathology and whole-body PSMA-11 PET/CT(MRI) results were evaluated. The diagnostic accuracy of PSMA-11 PET/CT(MRI) was also evaluated in relation to PSA level at the time of SLND. Results: The median age of the patients at the time of SLND was 65 years (IQR 63–69 years) and the median PSA level was 1.4 ng/ml (IQR 0.8–2.9 ng/ml). Before SLND, 50 patients (77%) had additional therapy after RP (26.2% androgen-deprivation therapy and 50.8% radiotherapy). The median number of LNs removed on SLND was 40 (IQR 33–48) and the median number of positive nodes was 4 (IQR 2–6). LN metastases were seen in 13.8% of resected LNs (317 of 2,292). LNs positive on PSMA-11 PET/CT(MRI) had a median diameter of 7.2 mm (IQR 5.3–9 mm). Metastatic LNs in regions negative on PSMA-11 PET had a median diameter of 3.4 mm (IQR 2.1–5.4 mm). In a regional analysis, the sensitivity of PSMA-11 PET/CT(MRI) ranged from 72% to 100%, and the specificity from 96% to 100%. Region-specific positive and negative predictive values ranged from 95% to 100% and 93% to 100%, respectively. Conclusion: PSMA-11 PET/CT(MRI) has a very good performance for the identification of LN metastases in patients with BCR after RP. The high diagnostic accuracy in the regional and subregional analyses demonstrates the potential of this approach to enable a region-directed instead of a complete bilateral therapeutic intervention. The performance of PSMA-11 PET/CT(MRI) is dependent on the PSA level and the size of the metastatic deposit. [ABSTRACT FROM AUTHOR]

Recurrence of prostate cancer after initial treatment with radiation therapy (RT) is highly dependent on pretreatment risk group and unfortunately, a proportion of patients fail primary treatment. The treatment of recurrence after primary radiation is rapidly changing with advances in imaging and it is important to distinguish those with a local failure from those with distant failure. If disease remains locally confined, salvage treatment with a variety of techniques can still provide a potential cure. Patients with distant failure are often treated with androgen deprivation, or in those with a shorter life expectancy, conservative management. In patients with a higher burden of metastatic disease, there is emerging evidence that chemotherapy and advanced androgen therapy can improve survival. We review the relevant literature on available salvage treatment options and appropriate patient selection for patients with recurrent prostate cancer after RT. We report on the efficacy and adverse effects of the currently available local salvage modalities including salvage radical prostatectomy, high dose rate and low dose rate brachytherapy, cryotherapy, high intensity focused ultrasound, and stereotactic body RT. We additionally discuss diagnosis of oligometastatic disease on imaging and current approaches to treatment with either radiation or surgery. While a full review of chemotherapy and advanced androgen therapies is beyond the scope of this article we briefly discuss their use in the treatment of newly diagnosed recurrence after radiation. [ABSTRACT FROM AUTHOR]

Outcomes for adults with relapsed/refractory acute lymphoblastic leukemia (ALL) are poor with chemotherapy, particularly in later salvage. The TOWER study examined survival, remission, bridge to allogeneic hematopoietic stem cell transplantation (HSCT), and safety with blinatumomab versus chemotherapy. This report examined outcomes separately for study treatment as first or later salvage. Adults with Philadelphia chromosome-negative B-cell precursor ALL relapsed/refractory to chemotherapy were randomly assigned 2:1 to receive blinatumomab by continuous infusion for 4 weeks in 6-week cycles, or standard salvage chemotherapy. Overall survival for blinatumomab versus chemotherapy was higher both in first salvage and in later salvage. Safety was similar between patients in first salvage and those in later salvage. Blinatumomab as later salvage was associated with higher complete remission rates and served as a bridge to allogeneic HSCT, supporting the use of blinatumomab in both settings. This study is registered at as #NCT02013167. [ABSTRACT FROM AUTHOR]

Purpose: To explore the role of salvage radiotherapy (RT) for recurrent thymoma as an alternative to surgery. Materials and Methods: Between 2007 and 2015, 47 patients who received salvage RT for recurrent thymoma at Yonsei Cancer Center were included in this study. Recurrent sites included initial tumor bed (n = 4), pleura (n = 19), lung parenchyma (n = 10), distant (n = 9), and multiple regions (n = 5). Three-dimensional conformal and intensity-modulated RT were used in 29 and 18 patients, respectively. Median prescribed dose to gross tumor was 52 Gy (range, 30 to 70 Gy), with equivalent doses in 2-Gy fractions (EQD2). We investigated overall survival (OS), progression-free survival (PFS), and patterns of failure. Local failure after salvage RT was defined as recurrence at the target volume receiving >50% of the prescription dose. Results: Median follow-up time was 83 months (range, 8 to 299 months). Five-year OS and PFS were 70% and 22%, respectively. The overall response rate was 97.9%; complete response, 34%; partial response, 44.7%; and stable disease, 19.1%. In multivariate analysis, histologic type and salvage RT dose (=52 Gy, EQD2) were significantly associated with OS. The high dose group (=52 Gy, EQD2) had significantly better outcomes than the low dose group (5-year OS: 80% vs. 59%, p = 0.046; 5-year PFS: 30% vs. 14%, p=0.002). Treatment failure occurred in 34 patients; out-of-field failure was dominant (intra-thoracic recurrence 35.3%; extrathoracic recurrence 11.8%), while local failure rate was 5.8%. Conclusion: Salvage RT for recurrent thymoma using high doses and advanced precision techniques produced favorable outcomes, providing evidence that recurrent thymoma is radiosensitive. [ABSTRACT FROM AUTHOR]

This paper studied the optimal inventory decision of a retailer selling a single product in two sales periods in the presence of the myopic consumers and the strategic consumers who were averse to disappointment. Specifically, we focused on the impact of the disappointment aversion level and the proportion of strategic consumers on the retailer's inventory decision and revenue respectively. In addition, we also considered the situation that the retailer increased the salvage price during the clearance period. The results show that, for high-profit products, if and only if the disappointment aversion level is higher than a critical value, disappointment aversion can mitigate consumers' strategic buying behavior, and improve the retailer's inventory and revenue. For low-profit products, as long as the strategic consumers are averse to disappointment, disappointment aversion can always mitigate consumers' strategic buying behavior, and improve the retailer's inventory and revenue. In addition, when the disappointment aversion level is low and the proportion of strategic consumers is high, the retailer's revenue will increase by raising the salvage price; on the contrary, when the disappointment aversion level is high, the retailer will suffer loss of profit by raising the salvage price. The numerical examples show that, with the disappointment aversion level from 1.7 to 2.1, the retailer can increase revenue by as much as 12.5% and 10.6% for high-profit and low-profit products respectively when the proportion of strategic consumers is 0.2, while the retailer can increase revenue by as much as 200% and 61.8% for high-profit and low-profit products respectively when the proportion is 0.8. [ABSTRACT FROM AUTHOR]

Rectal cancer surgery conveys significant morbidity/mortality, long-term functional impairment and urinary & sexual dysfunction, especially if associated with neoadjuvant chemoradiotherapy (ChRT). Watch & Wait (W&W) is gaining momentum as an option for patients with clinical complete response (cCR) after ChRT. Approximately 30% will develop a local regrowth (RG) and need deferred surgery. Our study aimed to assess the short-term clinical outcomes after surgery for regrowths. Consecutive rectal cancer patients from a tertiary institution who underwent neoadjuvant ChRT, between January 2013 and October 2018, were identified from a prospectively maintained database. Patients with RG under W&W surveillance were operated - regrowth deferred surgery (RDS) group - and compared to those with persistent disease after ChRT who did undergo surgery - non-deferred surgery (NDS) group. Total of 124 patients received neoadjuvant treatment: 46 (37%) underwent surgery for persistent disease; 78 (63%) with cCR entered W&W. Twenty three developed RG and underwent surgery, while 55 remain under surveillance. RDS group had lower tumors than NDS group (2.3 cm ± 2 vs 4.5 cm ± 3, p = 0.002). All RG underwent minimally invasive surgery (MIS). Anastomotic leaks, 30-day morbidity, reintervention and readmission rates were similar. Pathology features and 3-year oncological outcomes were identical between groups. Patients with initial cCR and local regrowth may be safely managed by deferred surgery. Short-term outcomes suggest equivalent results to patients with incomplete clinical response and immediate radical surgery. Delayed MIS appears to have no negative impact on oncological outcomes. [ABSTRACT FROM AUTHOR]

Background. Unmanipulated haploidentical stem cell transplantation (haploSCT) with post-transplant cyclophosphamide is an option for patients with advanced hematologic malignancies. It offers a platform both for non-major histocompatibility complex-restricted alloimmunity due to killer-like immunoglobulin receptor (KIR)-mediated mechanisms of natural killer lymphocyte regulation and for classical T-cell mediated antileukemic effects. Objectives. The devastating long-term sequelae after total body irradiation (TBI) in children are encouraging omission of irradiation techniques in pediatric stem cell transplantations (SCT). Material and methods. Five children, 4 with acute leukemia and 1 with hemophagocytic lymphohistiocytosis, aged from 1 to 10 years, underwent haploSCT with post-transplantation cyclophosphamide. In all children, the conditioning regimen consisted of chemotherapy without TBI. The graft material was bone marrow (BM) in 4 cases and peripheral blood stem cells in 1 case. Three out of 5 leukemic patients showed better KIR haplotype associated with augmented alloreactivity. Results. Engraftment with complete donor chimerism was achieved in 4 patients, and 1 recipient died before leukocyte recovery. Three patients developed skin acute graft-versus-host-disease (aGvHD), 1 gut aGvHD and 1 liver aGvHD. In 2 recipients, chronic graft-versus-host-disease (cGvHD) was observed (1 limited and 1 extensive). The 4 engrafted patients were alive and in complete remission 3, 9, 32, and 36 months after transplantation. A T-cell count of 200 cells/uL was reached 90 days after haploSCT in all patients. Conclusions. HaploSCT with TBI-free protocols can be a viable option for heavily pretreated patients with advanced malignancies. [ABSTRACT FROM AUTHOR]

Background: Outcomes following surgical intervention for laryngeal and hypopharyngeal tumors are dependent on several factors. In the present study, we sought to determine whether tumor subsite, salvage status, and extent of resection influenced postoperative outcomes. Methods: Retrospective review of 107 patients at a single institution who underwent total laryngectomy or partial/total laryngopharyngectomy. Results: Hypopharyngeal subsite and total laryngopharyngectomy subgroups had inferior speech and swallow outcomes compared to their respective cohorts (P < .05). Salvage patients had inferior 3‐year overall survival (P < .05) and swallow outcomes (P < .001). Previously radiated patients had increased fistula rates (29.9% vs 10%, P = .02), and the use of tissue coverage in salvage total laryngectomy had a protective effect on fistula formation (10% vs 37%, P = .04). Conclusions: By stratifying patients across multiple subgroups, we provide a detailed narrative in surgical outcomes that can be incorporated into treatment planning. Further prospective studies are needed to compare surgical outcomes to those of organ preservation therapy. [ABSTRACT FROM AUTHOR]

Frostbite is a cold injury that results in soft tissue loss and can lead to amputation. Vascular thrombosis following injury causes ischemic tissue damage. Despite understanding the pathology, its treatment has remained largely unchanged for over 30 years. Threatened extremities may be salvaged with thrombolytics to restore perfusion. The authors performed a systematic review to determine whether thrombolytic therapy is effective and to identify patients who may benefit from this treatment. The Pubmed, EBSCO, and Google Scholar databases were queried using the key words "thrombolytics," "frostbite," "fibrinolytics," and "tPA." Studies written after 1990 in English met inclusion criteria. Exclusion criteria were failure to delineate anatomic parts injured, failure to report number of limbs salvaged, animal studies, and non-English language publications. Thrombolytic therapy was defined as administration of tPA, alteplase, urokinase, or streptokinase. Forty-two studies were identified and 17 included. Included were 1 randomized trial, 10 retrospective studies, 2 case series, and 4 case reports. One thousand eight hundred and forty-four limbs and digits in 325 patients were studied and 216 patients treated with thrombolytics and 346 amputations performed. The most common means of thrombolysis was intra-arterial tPA. The most common duration of therapy was 48 hours. Limb salvage rates ranged from 0% to 100% with a weighted average of 78.7%. Thrombolytics are a safe and effective treatment of severe frostbite. They represent the first significant advancement in frostbite treatment by preventing otherwise inevitable amputations warranting both greater utilization and further research to clarify the ideal thrombolytic protocol. [ABSTRACT FROM AUTHOR]

Objective: To assesses the efficacy of ultrasound-guided targeted cryoablation (UTC) of the perispermatic cord as a salvage treatment for patients who failed microsurgical denervation of the spermatic cord.Methods: Retrospective review of 279 cases (221 patients: 58 bilateral) undergoing UTC between November 2012 and July 2016, performed by 2 fellowship trained microsurgeons. UTC was performed using a 16-gauge cryo needle (Endocare, HealthTronics, Austin, TX). Branches of the genitofemoral, ilioinguinal, and inferior hypogastric nerves were cryoablated medial and lateral to the spermatic cord at the level of the external inguinal ring. Level of pain was measured preoperatively and postoperatively using the visual analog scale and Pain Index Questionnaire-6 (QualityMetric Inc., Lincoln, RI).Results: Median age was 43 years, operative duration 20 minutes, and postoperative follow-up 36 months (24-60). Subjective visual analog scale outcomes: 75% significant reduction in ain (11% complete resolution and 64% ≥50% reduction in pain). Objective Pain Index Questionnaire-6 outcomes: 53% significant reduction at 1 month (279 cases), 55% at 3 month (279 cases), 60% at 6 month (279 cases), 63% at 1 year (279 cases), 65% at 2 years (275 cases), 64% at 3 years (232 cases), 59% at 4 years (128 cases) and 64% at 5 years (53 cases) post-op.Complications: 2 wound infections, 4 penile pain cases (resolved in a few months).Conclusion: UTC of the perispermatic cord is a safe potential treatment option for the salvage management of persistent chronic scrotal pain in patients who have failed microsurgical denervation of the spermatic cord. [ABSTRACT FROM AUTHOR]