King Chulalongkorn Memorial Hospital

Postoperative wound complications — including surgical site infection (SSI), cerebrospinal fluid (CSF) leakage, and wound dehiscence — remain a significant challenge following surgery for spinal dysraphism, particularly in neonates and infants. Closed incisional negative pressure wound therapy (ciNPWT) has demonstrated benefit in several surgical subspecialties; however, evidence regarding its routine use in pediatric spinal dysraphism surgery is limited. A retrospective review was conducted of all pediatric patients (age < 18 years) who underwent surgery for spinal dysraphism and received ciNPWT as part of postoperative wound management at King Chulalongkorn Memorial Hospital between June 2020 and March 2024. Primary outcomes included postoperative wound complications (SSI, CSF leakage, wound dehiscence, and wound necrosis) within 30 days of surgery. The number of postoperative dressing changes was recorded as a secondary outcome and surrogate marker of wound care burden. A total of 28 patients were included: 8 with open spinal dysraphism (myelomeningocele, myeloschisis, or hemimyelomeningocele) and 20 with closed spinal dysraphism or related conditions (including 2 pygopagus conjoined twins). The median number of dressing changes was 3 (range 3–5) for open dysraphism and 2 (range 1–2) for closed dysraphism. Primary wound closure was achieved in all cases. No postoperative wound complications — including SSI, CSF leakage, wound dehiscence, or wound necrosis — were observed during the follow-up period. Closed incisional negative pressure wound therapy appears to be a safe and effective adjunct for postoperative wound management in pediatric spinal dysraphism surgery, demonstrating favorable wound outcomes across both open and closed dysraphism types, including complex high-risk cases.

Pathogenic variants in KCNT1, a gene encoding a sodium-activated potassium channel, are classically associated with severe early-onset epileptic encephalopathies. Emerging evidence indicates that some individuals with KCNT1-related disorders also develop systemic-to-pulmonary vascular anomalies, often initially misidentified as major aortopulmonary collateral arteries (MAPCAs) due to radiographic similarities with congenital heart disease. Unlike true MAPCAs, these vessels arise in the absence of structural cardiac defects and appear to result from abnormal angiogenesis driven by dysregulated KCNT1-mediated signaling. Misclassification may lead to inappropriate interventions or management strategies. Here, a multidisciplinary expert working group reviewed published cases, institutional experience, and imaging findings to develop an expert opinion for nomenclature, diagnosis, and management of these vascular anomalies. We recommend adopting the term systemic-pulmonary collaterals (SPCs) to accurately describe these angiogenic vessels. Risk-based screening, judicious catheter-based embolization when physiologically indicated, and careful avoidance of standard pulmonary vasodilators are emphasized. This statement aims to improve clinical recognition, precision in terminology, and safe management of vascular complications in patients with KCNT1-related disorders.

BACKGROUND:Multidisciplinary team care is the standard of care for diabetic foot ulcer (DFU) management, yet traditional models often involve sequential consultations that may delay treatment initiation. OBJECTIVES:To evaluate whether a one-stop multidisciplinary clinic improves DFU healing outcomes compared with traditional sequential-consultation care. METHODS:This retrospective cohort study included patients with new-onset DFUs between April 2016 and March 2024. A historical control group (April 2016-March 2020) was compared to an intervention group treated at a one-stop integrated clinic (April 2020-March 2024). The primary outcome was time to complete healing. Secondary outcomes included major lower extremity amputation, and mortality rates. Kaplan-Meier survival analysis and Cox proportional hazards regression models were employed. RESULTS:Among 237 patients (former clinic, n = 118; integrated clinic, n = 119), the integrated clinic group achieved an overall healing rate of 82%, compared to 71% in the traditional group (p = 0.103). After adjusting baseline characteristics, the integrated clinic was independently associated with faster healing (adjusted hazard ratio = 1.41; 95% CI: 1.04-1.90; p = 0.027). Major amputation and mortality rates remained comparably low across both groups. CONCLUSIONS:The one-stop multidisciplinary team model significantly improved healing outcomes by providing coordinated, same-day care, effectively overcoming the limitations of sequential referral pathways.

Background: The estimated incidence of acute kidney injury requiring continuous renal replacement therapy (CRRT) in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques—integration and separation—are utilized for combining CRRT and ECMO circuits. The efficacy of these two techniques is still unknown. Therefore, this study aimed to compare the circuit lifespan of CRRT between the integration and separation techniques. Methods: A multicentered randomized controlled study with an unblinded design will be conducted to determine circuit lifespan differences between integration and separation techniques. Hypothesis: We hypothesize that the integration technique will yield a longer circuit lifespan for CRRT compared to the separation technique. Trial registration: NCT05036616

In breast cancer patients converting from clinically positive (cN+) to negative (ycN0) lymph node status after neoadjuvant chemotherapy (NACT), surgical staging by axillary lymph node dissection (ALND) is increasingly replaced by less invasive procedures like targeted axillary dissection (TAD) or sentinel lymph node biopsy (SLNB), possibly followed by completion ALND or regional radiotherapy if positive. Prospective data comparing oncologic safety of different procedures as a primary approach after NACT are currently scarce. We report 3-year axillary recurrence-free survival (ARFS) as the first primary endpoint analysis of the AXSANA/EUBREAST 3(R) study (NCT04373655, www.eubreast.org/axsana), initiated by the European Breast Cancer Research Association of Surgical Trialists (EUBREAST e.V.). In an international multicenter cohort study, patients with cN+ breast cancer who receive at least four cycles of NACT and convert to ycN0 are eligible. Axillary staging after NACT is performed according to institutional routine. Grouping of patients was based on the primary staging procedure, not on final axillary surgery, e.g., completion ALND following a positive SLNB was classified as SLNB. Co-primary endpoints are ARFS, invasive breast cancer-specific survival (iBCSS), and patient-reported quality of life. Data entry is systematically monitored. Less extensive axillary staging procedures as first surgery after NACT (TAD, SLNB, targeted lymph node biopsy (TLNB)) are considered non-inferior to staging by ALND if the lower bound of a two-sided 90% confidence interval (CI) around 3-year ARFS exceeds 97%. 750 patients were required per group (TAD/SLNB/TLNB vs ALND). From June 2020 to April 2025, 6,474 patients (26 countries, 288 study sites) were enrolled, 2,632 of whom had completed surgery by December 31, 2023 and were selected for analysis. Primary staging procedure was ALND in 799 patients (30.4%) and less invasive procedures (419 SLNB, 1399 TAD, 15 TLNB) in 1,833 (69.6%). Nodal complete pathological response was reported in 1,345 patients (51.1%): 423 (31.4%) after ALND and 922 (68.6%) after TAD/SLNB/TLNB. 2489 patients (94.6%) received post-NACT nodal radiotherapy: 759 (95.0%) after ALND and 1730 (94.4%) after TAD/SLNB/TLNB. After a median follow-up of 2.0 years (range, 0.01-4.5), 15 axillary recurrences occurred after TAD/SLNB/TLNB and 4 after ALND (4.2 vs 2.5 events/1000 person-years, p=0.351). 3-year ARFS was 99.2% (95% CI 98.2-100.0) after ALND and 98.8% (95% CI 98.1-99.5) after TAD/SLNB/TLNB. For TAD/SLNB/TLNB, the lower bound of a 90% CI was 98.2%. After SLNB, 1 axillary recurrence occurred and 14 after TAD (1.2 vs 5.1 events/1000 person-years, p=0.132). Results were similar upon controlling for clinicopathological risk factors and neoadjuvant treatment or exclusion of 143 patients without radiotherapy. iBCSS at 3 years was 85.7% (95% CI 82.6-89.0) for ALND and 88.2% (95% CI 86.0-90.3) for TAD/SLNB/TLNB. In patients who convert from clinically node-positive to node-negative breast cancer, the AXSANA study showed that less invasive surgical staging procedures are associated with a low axillary recurrence rate, not inferior to ALND after 3 years, regardless of initial tumor stage or subtype. These findings reinforce efforts to minimize surgical morbidity without compromising oncologic outcomes. T. Kühn, M. Banys-Paluchowski, N. Ditsch, E. Stickeler, M. Hauptmann, J. Schroth, G. Karadeniz Cakmak, M. Hahn, M. Thill, T. Reimer, S. Fröhlich, E. Schmidt, M. Lux, H. Kolberg, I. Rubio, M. Gasparri, M. Kontos, E. Bonci, L. Niinikoski, D. Murawa, D. Pinto, F. Peintinger, E. Schlichting, H. Nina, H. Valiyeva, M. Vanhoeij, L. Rebaza, B. Aktas Sezen, K. Jursik, G. Kadayaprath, L. Dostalek, A. Kothari, A. Perhavec, T. Ivanov, D. Zippel, S. Thongvitokomarn, B. Adamczyk, M. Gurleyik, D. Watermann, M. Porpiglia, S. Grasshoff, S. Loibl, D. Krug, A. Lebeau, R. Di Micco, O. Gentilini, J. de Boniface, S. Hartmann, AXSANA study group.. More versus less invasive axillary surgical staging procedures in breast cancer patients converting from a clinically node-positive to a clinically node-negative stage through neoadjuvant chemotherapy - primary endpoint analysis of the international prospective multicenter AXSANA/EUBREAST 3(R)study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr GS2-01.