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Background and Objectives: To compare the feasibility and diagnostic value of sentinel lymph node (SLN) mapping with carbon nanoparticles (CNPs) and indocyanine green (ICG) in endometrial cancer (EC).Methods: This was a single-center, open-label, randomized controlled trial. Between August 1, 2020 and April 30, 2022, patients with early-stage EC were assessed for enrollment. All patients underwent SLN mapping with ICG or CNPs ± pelvic and/or para-aortic lymphadenectomy. The detection rate (DR), its impact factors, the sensitivity and the negative predictive value (NPV) of SLN mapping were analyzed.Results: In total, 206 patients, with 103 per group, were included. The overall and bilateral DRs of the two groups were comparable without significant differences.There was no difference regarding the distribution of mapped SLNs. The sensitivity was 66.7% for both groups, and the NPVs were not significantly different.Furthermore, the sensitivity and NPV reached 100% when calculated either per hemipelvis or only in patients with bilateral SLN detection.Conclusions: SLN mapping by CNPs in EC is feasible with high DRs and diagnostic accuracy compared with ICG. CNPs might be an alternative to ICG for SLN mapping when near-infrared imaging equipment is lacking, especially in stage IA patients.carbon nanoparticles, endometrial cancer, indocyanine green, sentinel lymph node mapping | INTRODUCTIONEndometrial cancer (EC) is the most common gynecologic malignancy in the United States, and its rapidly increasing incidence rate ranks second in China. 1,2 The metastatic status of regional lymph nodes is considered an independent prognostic factor for EC. Thus, the evaluation of lymph nodes should be completed precisely, as this is essential for tumor staging and clinical decisions on the selection of adjuvant therapy. For preoperatively presumed early-stage EC patients, comprehensive lymphadenectomy (LAD) is often adopted

Background Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, but many patients complain of severe drainage pain that cannot be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, but whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB + RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 h after surgery. Secondary outcomes included opioid consumption within 48 h, postoperative pain scores, time to extubation, and length of stay in the hospital. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α before and the first 24 h after surgery were measured. Results A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 h after surgery was 2.33 ± 1.77 mg in the PIFB + RSB group vs 3.81 ± 2.24 mg in the PIFB group (p = 0.010). Opioid consumption within 48 h after surgery was also reduced in the PIFB + RSB group (4.71 ± 2.71 mg vs 7.25 ± 3.76 mg, p = 0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, or the levels of IL-6, IL-10 and TNF-α between the two groups. Conclusions The combination of PIFB and RSB reduced postoperative intravenous opioid consumption until 48 h after cardiac surgery. Trial registration This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.

Background: Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, while many patients complained of severe drainage pain which can’t be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods: This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB+RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 hours after surgery. Secondary outcomes included opioid consumption within 48 hours, postoperative pain scores, time to extubation, length of stay in the hospital. Interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-a before and the first 24 hours after surgery were measured. Results: A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 hours after surgery was 2.33±1.77 mg in the PIFB+RSB group vs 3.81±2.24 mg in the PIFB group (p=0.010). Opioid consumption within 48 hours after surgery was also reduced in the PIFB+RSB group (4.71±2.71 mg vs 7.25±3.76 mg, p=0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, the level of IL-6, IL-10 and TNF-a between two groups. Conclusions: The combination of PIFB and RSB reduced postoperative intravenous opioid consumption and prolong the duration of single shot in cardiac surgery. Trial registration: This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.

Purpose This study aimed to compare the distribution and drainage pathway of sentinel lymph nodes between high- and low-risk endometrial cancers. Methods In total, 429 patients with endometrial cancer who underwent sentinel lymph node biopsy in Peking University People’s Hospital from July 2015 to April 2022 were retrospectively enrolled. There were 148 patients in the high-risk group and 281 patients in the low-risk group. Results The unilateral and bilateral detection rates of sentinel lymph nodes were 86.5% and 55.9%, respectively. The highest detection rate was achieved in the subgroup with a combined use of Indocyanine green (ICG) and Carbon nanoparticles (CNP) (94.9% for unilateral detection and 66.7% for bilateral detection). The upper paracervical pathway (UPP) was detected in 93.3% of cases in the high-risk group and 96.0% of cases in the low-risk group (p = 0.261). The lower paracervical pathway (LPP) was detected in 10.0% of cases in the high-risk group and 17.9% of cases in the low-risk group (p = 0.048). Remarkably increased detection rates of SLN in the common iliac (7.5%) and para-aortic or precaval areas (2.9%) were observed in the high-risk group. In contrast, a markedly decreased detection rate of SLN in the internal iliac area (1.9%) was observed in the high-risk group. Conclusion The combined use of ICG and CNP improved the bilateral detection rate of SLN in the high-risk group. The detection of UPP is important for both high-risk and low-risk cases, while LPP detection plays a more important role in the low-risk group. Lymphadenectomy in the common iliac and para-aortic or precaval areas is essential for patients with high-risk EC. Removal of internal iliac lymph nodes is essential for patients with low-risk EC, in case of ineffective SLN mapping.