Modifying the t-CS by replacing disease-free interval, number of metastases, and CEA level with RAS mutation status produced an m-CS that outperformed the t-CS. The m-CS is therefore a simple validated tool that predicts survival after resection of CLM.

Objective To evaluate the relationship between RAS mutation and resection margin status in patients undergoing resection of colorectal liver metastases (CLM). Background In patients undergoing resection of CLM, resection margin status is a significant predictor of survival, particularly in patients with suboptimal response to preoperative therapy. RAS mutations have been linked to more invasive and migratory tumor biology and poor response to modern chemotherapy. Methods Patients who underwent curative resection of CLM from 2005 through 2013 with known RAS mutation status were identified from a prospectively maintained database. A positive margin was defined as tumor cells less than 1 mm from the parenchymal transection line. Results The study included 633 patients, of whom 229 (36.2%) had mutant RAS. The positive margin rate was 11.4% (26/229) for mutant RAS and 5.4% (22/404) for wild-type RAS (P = 0.007). In multivariate analysis, the only factors associated with a positive margin were RAS mutation (hazard ratio [HR], 2.439; P = 0.005) and carcinoembryonic antigen level 4.5 ng/mL or greater (HR, 2.060; P = 0.026). Among patients presenting with liver-first recurrence during follow-up, those with mutant RAS had narrower margins at initial CLM resection (median, 4 mm vs. 7 mm; P = 0.031). A positive margin (HR, 3.360; P < 0.001) and RAS mutation (HR, 1.629; P = 0.044) were independently associated with worse overall survival. Conclusion RAS mutations are associated with positive margins in patients undergoing resection of CLM. Tumors with RAS mutation should prompt careful efforts to achieve negative resection margins.

The evidence that BCG (bacille Calmette-Guerin) vaccine may increase the ability of the immune system to fight off pathogens other than tuberculosis has been studied in the past. This nonspecific immunity gained our interest, especially after initial reports of less cases in countries with universal BCG vaccination. In hopes of possible protective immunity, all staff of the Emirates International Hospital (United Arab Emirates) were offered a booster BCG vaccine in early March 2020. All the hospital staff were then tested for Covid-19 infection by the end of June 2020. We divided the subjects into two groups: booster vaccinated versus unvaccinated. The rate of Covid-19 infection was compared between the groups. Criteria included all staff who were offered the vaccine. Seventy-one subjects received the booster vaccination. This group had zero cases of positive COVID 19 infection. Two hundred nine subjects did not receive the vaccination, with 18 positive PCR confirmed COVID 19 cases. The infection rate in the unvaccinated group was 8.6% versus zero in the booster vaccinated group (Fisher’s exact test p -value = .004). Our findings demonstrated the potential effectiveness of the booster BCG vaccine, specifically the booster in preventing Covid-19 infections in an elevated-risk healthcare population.

Introduction : The evidence that BCG (bacille Calmette-Guerin) vaccine may increase the ability of the immune system to fight off pathogens other than tuberculosis has been studied in the past. This nonspecific immunity gained our interest, especially after initial reports of less cases in countries with universal BCG vaccination. In hopes of possible protective immunity, all staff of the Emirates International Hospital (United Arab Emirates) were offered a booster BCG vaccine in early March 2020. All the hospital staff were then tested for Covid-19 infection by the end of June 2020. Methodology : We divided the subjects into two groups: booster vaccinated, versus unvaccinated. The rate of Covid-19 infection was compared between the groups. Criteria included all staff who were offered the vaccine. Results: 71 subjects received the booster vaccination. This group had zero cases of positive COVID 19 infection. 209 subjects did not receive the vaccination, with 18 positive PCR confirmed COVID 19 cases The infection rate in the unvaccinated group was 8.6% versus zero in the booster vaccinated group. (Fishers exact test p-value=0.004). Conclusion : Our findings demonstrated the potential effectiveness of the booster BCG vaccine, specifically the booster in preventing Covid-19 infections in an elevated-risk healthcare population.

The identification and proper avulsion neurectomy of this newly described sensory FTN may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.