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A multicenter retrospective analysis by the Korean association of pediatric surgeons comparing laparoscopic and open surgical repair of congenital duodenal obstruction

2026-05-01T00:00:00Z

Title: A multicenter retrospective analysis by the Korean association of pediatric surgeons comparing laparoscopic and open surgical repair of congenital duodenal obstruction Authors: Park, Jinyoung; Ko, Dayoung; Koo, Eun-jung; Kwon, Hyunhee; Kim, Ki Hoon; Kim, Dae Yeon; Kim, Seong Chul; Kim, Soo-Hong; Kim, Wontae; Kim, Hae-Young; Kim, Hyun-Young; Nam, So Hyun; Namgoong, Jung-Man; Park, Junbeom; Park, Taejin; Bang, Min-Jung; Seo, Jeong-Meen; Sul, Ji-Young; Son, Joonhyuk; Sim, Joohyun; Ahn, Soo Min; Yang, Hee-Beom; Oh, Jung-Tak; Oh, Chaeyoun; Youn, Joong Kee; Lee, Sanghoon; Lee, Ju Yeon; Ihn, Kyong; Chang, Hye Kyung; Jeong, Yeon Jun; Jung, Eunyoung; Chung, Jae Hee; Cho, Min Jeng; Choe, Yun-Mee; Han, Seok Joo; Ho, In Geol; Hong, Jeong Abstract: Background: This multicenter retrospective study aimed to compare key perioperative outcomes such as operative time, time to full enteral feeding, hospital stay duration, postoperative complications, and mortality, between laparoscopic and open surgical repair of congenital duodenal obstruction (CDO) performed by members of the Korean Association of Pediatric Surgeons (KAPS). Methods: A national survey conducted between 2021 and 2023 provided data from 75 patients. Demographic characteristics, associated anomalies, anatomical types, surgical approach, and postoperative outcomes were compared between the laparoscopic (n = 36) and open (n = 39) groups. Results: Among the 75 patients (30 males, 45 females; male-to-female ratio 1:1.5), no significant differences were observed between groups in sex, birth weight, or gestational age. Surgical procedures included 66 duodenoduodenostomies, four duodenojejunostomies, two gastrojejunostomies, two web excisions with duodenoplasty, and one segmental duodenal resection. Laparoscopic repair was associated with longer operative times (p = 0.005). Time to full enteral feeding was comparable in both groups (p = 0.117). Hospital stay was significantly shorter in the laparoscopic group (p = 0.012). Postoperative complications and mortality did not differ between groups; no deaths occurred. Conclusion: Laparoscopic repair can be considered a safe and effective alternative to open surgery for selected patients with CDO, assuming adequate surgical expertise. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

A large puncture closer of aortic wall by multi-memory actions with thrombo-hemodynamic control

2026-05-01T00:00:00Z

Title: A large puncture closer of aortic wall by multi-memory actions with thrombo-hemodynamic control Authors: Cho, Sungwoo; Ha, Hyun-Su; Lee, Sangmin; Kim, Hyunjae; Lee, Seok Joon; Kim, Jueun; Lee, Yerin; Lee, Kang Suk; Joo, Hyun-Chel; Sung, Hak-Joon; 하현수; 이예린 Abstract: The vascular wall regulates the pattern and pressure of blood flow. In cardiovascular interventions, catheters are deployed by puncturing the vessel wall, without exception. Despite continuous progress, the outcomes remain highly operator-dependent, and large punctures with high-pressure bleeding continue to pose clinical challenges. As a translatable solution, this study introduces a shape memory vascular wall plug (VWP) that automates both the Body and Wing functions within a single component, supported by a Ring assembly to maximize pressure resistance. The VWP is deployed into a 6-mm puncture in a porcine thoracic aorta under peak blood pressure, and shape recovery is triggered by a 45 degrees C saline flush to enable automated activation. Upon recovery, Body expansion combined with Ring compression tightly seals the puncture tract. The curved Wing induces hemostatic sealing and then flattens to maintain healthy blood flow and physiologic pressures. The VWP achieves suturinglevel performance in aortic puncture closure, demonstrating effective hemostasis, patency, and endothelialization. The flow-blockage ratio required to balance hemostasis with hemodynamics is computationally modeled and validated using whole-blood microfluidics. Pressure resistance is maximized by tuning Ring strain through polymer blending, indicating multi-level strategies in polymer, device design, and memory function to advance the vascular closure technology.

Clinicopathologic characteristics and lymph node status in the NAUTILUS clinical trial:KBCSG-21

2026-04-01T00:00:00Z

Title: Clinicopathologic characteristics and lymph node status in the NAUTILUS clinical trial:KBCSG-21 Authors: Ryu, Jai Min; Lee, Han-Byoel; Han, Wonshik; Chung, Il-Yong; Ahn, Se Hyun; Lee, Seeyoun; Park, Seho; Jeong, Joon; Lim, Woosung; Lee, Jeong Eon; Kang, Eunhye; Chang, Ji Hyun; Shin, Kyung Hwan; Chang, Jung Min; Moon, Woo Kyung; Kim, Eun-Kyu Abstract: Background: The NAUTILUS trial randomized cT1-2/N0 breast cancer patients to evaluate the non-inferiority of omitting SLNB. We report the clinicopathologic characteristics and axillary lymph node (ALN) status of the patients enrolled in the NAUTILUS trial and suggest expectations based on the results of this trial, which are relevant in the context of the SOUND and INSEMA trials, where the majority of participants were aged 50 years or older. Methods: The NAUTILUS trial randomized 1734 subjects into SLNB or no-SLNB arms. Axillary ultrasonography was mandatory to determine clinical N0. Clinicopathologic variables and ALN status in the SLNB arm were analyzed to determine expectations for the NAUTILUS trial results compared to other clinical trials. Results: Among 1734 patients, 1664 subjects were available for clinicopathologic analysis; 50.4% were in the SLNB arm and 49.6% were in the no-SLNB arm. Median age was 55 (range, 29-92) years, and 40.1% were premenopausal. Overall, 1.7%, 83.9%, and 14.0% subjects were pTmic, pT1, and pT2, respectively, with a median tumor size of 1.3 cm (range, 0.1-6.0). In the SLNB arm, 11.2% had ALN metastasis, comprising 1.1%, 9.4%, and 0.6% with pN1mic, pN1, and pN2-3, respectively. ALN metastasis rates according to tumor size were 7.0%, 12.8%, and 17.2% for sizes <= 1.0 cm, >1.0 cm & <= 2.0 cm, and >2.0 cm & <= 5.0 cm, respectively. Conclusions: The NAUTILUS trial completed enrollment, with included 14.0% pT2 and 40.1% premenopausal subjects and is expected to show the impact of SLNB omission in these subgroups. Trial registration: ClinicalTrials.gov Identifier: NCT04303715.

Late distant recurrence prediction model in premenopausal women with ER-positive/HER 2-negative breast cancer: A multicenter retrospective study

2026-04-01T00:00:00Z

Title: Late distant recurrence prediction model in premenopausal women with ER-positive/HER 2-negative breast cancer: A multicenter retrospective study Authors: Shin, Dong Seung; Lee, Janghee; Kang, Eunhye; Noh, Dasom; Cheun, Jong-Ho; Lee, Jun-Hee; Son, Yeongyeong; Bae, Soong June; Kwon, Sunyoung; Lee, Han-Byoel; Ryu, Jai Min; Ahn, Sung Gwe Abstract: Background: Late distant recurrence (DR) remains a significant challenge in estrogen receptor (ER)-positive/Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer, especially in premenopausal patients. This study aimed to develop a machine-learning model predicting late DR risk in premenopausal patients and to assess the clinical benefit of extended endocrine therapy (ET) according to risk stratification. Methods: This retrospective multicenter study included patients aged <= 45 years with ER-positive/HER2-negative breast cancer who underwent surgery between January 2000 and December 2011. This study was designed as a landmark analysis, with the effective baseline set at 5 years after surgery. Eligible patients had five to 10 years of follow-up and received adjuvant ET for at least two years. The primary outcome was late DR, defined as distant metastasis occurring between five and 10 years after surgery. Results: Among 1701 included patients (median age, 41 years), late DR occurred in 108 patients (6.3%). A machine-learning model using eight clinicopathologic variables demonstrated strong predictive performance (AUC = 0.78). Patients classified as high-risk by the model exhibited significantly worse late DMFS compared to low-risk patients (HR,7.36; 95% CI,4.43-12.20; P<0.001). Among high-risk patients, those who received extended ET had significantly improved late DMFS compared to those who did not (HR,0.32; 95% CI,0.18-0.55; P < 0.001). In low-risk patients, extended ET was not associated with a statistically significant benefit (HR,0.45; 95% CI,0.16-1.22; P = 0.081). Conclusion: The machine-learning model effectively stratified patients into distinct DR risk groups and highlighted the benefit of extended ET in high-risk patients. This model supports tailored decision-making regarding extended ET in premenopausal patients with ER-positive/HER2-negative breast cancer.