tbuckley/cabot-search huggingface dataset:
The Epstein-Barr virus and osteosarcoma in Iranian children.
Authors: Mahtab Rahbar, Keykhosro Mardanpour
Journal: Journal of Clinical Oncology (2020)

e23543 Background: This study was conducted to describe the possible association between EBV infection and OS in Iranian children. Methods: This study carried out at Kermanshah university hospital on 48 OS tissue and ten non-cancerous bone tissue as a control group by three laboratory methods. The real-time polymerase chain reaction (RT-PCR) and Chromogenic in-situ hybridization (CISH) done to detect the Epstein Barr Encoded RNA (EBER1) expression as long as immunohistochemistry staining (IHC) to detect EBV latent membrane protein-1 (LMP-1) in tumor cells and controls. Overall-survival (O-S), prognosis free survival (PFS) and disease-free survival (DFS) provided based on the Kaplan-Meier method. Results: Specimen considered positive when EBER using PCR and CISH associated with LMP-1 using IHC stain were expressed separately in the same sample. Six out of eighty-four (12.5%) of OS cases were simultaneously EBV positive in all three methods within the tumor cells as compared to the control group. (P &lt; 0.22) Association between EBV positivity and histologic characteristics of OS cases such as nodal involvement (P &lt; 0.04), metastasis (P &lt; 0.04), Ki67 reactivity (as proliferation index) (P &lt; 0.03), and tumor stage (P &lt; 0.05) were significant. EBV Positive patients show worse clinical symptoms in older age as well as the worse prognosis compared with negative patients. EBV positive patients presented shorter DFS, PFS, and OS. Conclusions: Our research could not find a statistical association between EBV infection and OS in Iranian children significantly. Meanwhile, we found, EBV infection could interfere in the invasive behavior of tumors. [Table: see text]
The optimization of 64-MDCT brain and neck angiography
Authors: Xiao-feng Tang, Yu-ming Liu, Zhong-wei Li, De-xin Qu, Shan-ji Qu, Qing-zhu Gai
Journal: BMJ (2009)

Sixty patients who underwent brain and neck CT angiograpby (CTA) were randomly divided into two groups: conventional protocol group and optimizing protocol group with 30 in each. The images were evaluated by two radiologists independently. The images of optimizing group avoided the artifact disturbance of the brachiocephalic vein effectively and greatly improved the imaging quality of arteria carotis communis and arteria vertebralis initial segment. Compared with the conventional group the differences were statistically significuat(P <0.05). The optimization of 64-MDCT brain and neck CTA is feasible and effective.

Key words: 
Tomography,spiral computed; Angiography
Current status in epidemiological studies on gestational diabetes mellitus
Authors: 杨慧霞
Journal: BMJ (2005)

妊娠合并糖尿病是妊娠期最常见的内科合并症之一,其发病率逐年上升,包括孕前患有糖尿病者(糖尿病合并妊娠)以及妊娠糖尿病(gestational diabetes mellitus, GDM),其中GDM约占80%～90%.GDM是指妊娠期发生或首次发现的不同程度的糖耐量异常,1979年世界卫生组织(WHO)将其列为糖尿病的一个独立类型.近年来,随着国内学者对GDM认识的提高,重视对该病的筛查,使得其检出率明显提高。
Superior therapy response predictions for patients with acute myeloid leukemia (AML) using Cellworks Singula: MyCare-009-01.
Authors: Guido Marcucci, Drew Watson, Shweta Kapoor, Swaminathan Rajagopalan, Rajan Parashar, Aktar Alam, Diwyanshu Sahu, Deepak Anil Lala, Divya Singh, Kabya Basu, Himanshu Grover, Poornachandra G, Anuj Tyagi, Michele Macpherson, Yugandhara Narvekar, Ashish Agrawal, Upasana Mitra, Mohammed Sauban, Rema Mandal, Anthony Selwyn Stein
Journal: Journal of Clinical Oncology (2020)

e19502 Background: Despite using cytogenetic and molecular-risk stratification and precision medicine, the current overall outcome of AML patients remains relatively poor. Therapy selection is often based on information considering only cytogenetics and single molecular aberrations and ignoring other patient-specific omics data that could potentially enable more effective treatments. The Cellworks Singula™ report predicts response for physician prescribed therapies (PPT) using the novel Cellworks Omics Biology Model (CBM) to simulate downstream molecular effects of cell signaling, drugs, and radiation on patient-specific in silico diseased cells. We test the hypothesis that Singula is a more accurate predictor of patient-specific therapy response than PPT. Methods: Singula’s ability to predict response was evaluated in an independent, randomly selected, retrospective cohort of 494 AML patients aged 2 to 85 years (median 54) treated with PPT. Patient omics data was available from PubMed. The accuracy of Singula was compared to that of PPT using McNemar’s test to account for the correlation between Singula and PPT. Multivariate logistic regression modeled complete response (CR) as a function of patient age, PPT, and Singula against any non-response (NR). Likelihood ratio tests were performed to further validate if Singula provides predictive information beyond PPT or patient age. Similar analyses were performed for overall survival (OS) using proportional hazards regression. Results: Singula was a better predictor for CR than PPT (McNemar’s χ 2 = 72.0, p-value &lt; 0.0001), with an overall accuracy of 88.5% (95% CI: 85.3%, 91.1%) compared to 70.2% (95% CI: 66.0%, 74.2%) for PPT. Singula exhibited a sensitivity and specificity of 97.1% and 68.0%, respectively. In multivariate regression analysis, Singula (p &lt; 0.0001) remained an independent predictor for CR after adjusting for patient age (p = 0.0329) while PPT became not significant (p = 0.75). Singula was also an independent predictor for OS (p &lt; 0.0001) after adjusting for patient age (p = 0.0018) and PPT (p = 0.0011). For all 100 true negatives, Singula generated alternative standard of care therapy selections with predicted clinical response. Conclusions: Singula is a superior independent predictor for CR and OS compared to PPT in AML patients. The Singula report can also validate therapy selection, correctly identify non-responders to PPT and further provide alternative therapy selections.
Effects of cognitive factors on quality of life in patients with functional dyspepsia
Authors: Jin Zuo, Guobin He, Wen Ming
Journal: BMJ (2015)

One hundred and eighty two outpatients with functional dyspepsia(FD)were enrolled. The cognitive questionnaire and the short form Nepean Dyspepsia Index (NDI) were used for survey. Spearman analysis showed that the cognitions of symptoms affected by emotion (r=0.284, P=0.006), somatisation symptoms induced by other diseases (r=0.211, P=0.045), and fears of cancer (r=0.217, P=0.039) were positively correlated with NDI scores. Multiple linear regression analysis demonstrated that cognition of symptoms affected by emotion (β=3.709, P=0.009), somatisation symptoms induced by other diseases (β=3.259, P=0.020), need of hospitalization (β=4.533, P=0.006), and need of medication for several years (β=-3.207, P=0.029) were associated with NDI scores. These results suggest that the quality of life might be effected by cognitive factors, and the correction of cognitive mistakes may improve quality of life of FD patients.


Key words: 
Dyspepsia; Cognition; Questionnaires
FOLFIRI plus ramucirumab versus paclitaxel plus ramucirumab as second-line therapy for patients with advanced or metastatic gastroesophageal adenocarcinoma with or without prior docetaxel: Results from the phase II RAMIRIS Study of the AIO.
Authors: Sylvie Lorenzen, Peter C. Thuss-Patience, Claudia Pauligk, Eray Goekkurt, Thomas Jens Ettrich, Florian Lordick, Michael Stahl, Peter Reichardt, Martin Soekler, Daniel Pink, Stephan Probst, Axel Hinke, Thorsten Oliver Goetze, Salah-Eddin Al-Batran
Journal: Journal of Clinical Oncology (2020)

4514 Background: Ramucirumab (Ram) as monotherapy or plus paclitaxel is a proven second-line option for advanced gastroesophageal adenocarcinoma (GEA). More and more patients (pts) are pretreated with docetaxel in the perioperative or first-line setting. These pts may benefit more from another, non-cross resistant chemotherapy backbone regimen. This trial evaluates the addition of Ram to FOLFIRI as second line treatment. Methods: This is a multicenter, randomized, investigator initiated, phase II trial. Pts with GEA who have progressed after treatment with a fluoropyrimidine/platinum-containing regimen were randomized 2:1 to either FOLFIRI plus Ram every two weeks (Arm A) or paclitaxel (days 1, 8, 15 of a 28-day cycle) plus Ram every two weeks (Arm B). Major endpoints were overall survival (OS), objective response rate (ORR), disease control rate (DCR), progression free survival (PFS) and toxicity. Results: 111 pts (median age 61 years, 65% of pts had prior docetaxel therapy) were enrolled and 110 analyzed within intention to treat population (ITT, Arm A, 72; Arm B, 38). In the ITT, there was no significant difference in median OS (A, 6.8 vs. B, 7.6 months, HR 0.94, p = 0.77) and median PFS (A, 4.6 vs. B, 3.6 months, HR 0.72, p = 0.12). For pts with prior docetaxel use (71/110), median PFS was A, 4.3 vs. B, 2.0 months, HR 0.49, p = 0.008 and median OS was A, 7.5 vs. B, 6.4 months, HR 0.71, p = 0.25. In 101 pts with tumor assessment and included in the response analysis, ORR and DCR was 23% and 65% in Arm A and 11% and 60% in Arm B, respectively. 67 pts assessable for response were pre-treated with docetaxel. In these pts, ORR was 24% in Arm A and 9% in Arm B. Disease control rate (DCR) was 67% and 41% for Arm A and B respectively. Both therapies were similarly tolerable, final safety results will be shown. Conclusions: The RAMIRIS trial demonstrated feasibility of the combination of FOLFIRI and Ram. With a response rate of 24% and a median PFS of 4.3 months, docetaxel pre-treated pts seemed to derive pronounced benefit from FOLFIRI-Ram, providing a rationale for a phase III trial, which is currently ongoing. Clinical trial information: NCT03081143 .
Clinical analysis of infective endocarditis complicated with intracranial hemorrhage
Authors: Yu Lingling, Zheng Tingting, Liu Deping
Journal: BMJ (2016)

Objective
To analyze the clinical characteristics of infective endoearditis complicated with intracranial hemorrhage.


Methods
The clinical characteristics, brain CT and MRI results and prognosis of 7 patients with infective endocarditis and intracranial hemorrhage admitted between January 1991 and May 2015 were retrospectively analyzed.


Results
All seven patients presented varying degrees of fever, cardiac murmur and neurological symptoms. The continuous fever lasted from 21 d to 227 d (average 91 d). Mitral valve (4 cases) and aortic valve (3 cases) were the most common affected ones. The brain CT or MRI scan presented intracranial hemorrhage in 6 cases. More than 2 hemorrhage locations were found in 5 patients and parietal lobe was most common one (4 cases). All patients were treated with antimicrobial agents and three patients underwent valve replacement surgery. Three patients were cured and another 2 died due to fatal hemorrhage.


Conclusions
Patients with long fever history and ineffective antimicrobial treatment are prone to intracranial hemorrhage. Brain CT or MRI scan need be performed in infective endocardits when neurological symptoms are present, and brain angiography should be also considered if necessary.


Key words: 
Endocarditis, bacterial; Intracranial hemorrhage; Aneurysm, infected
Predictors of and longitudinal assessment of health utility scores in patients with small cell lung cancer using real-world data.
Authors: Nathan Kuehne, Katrina Hueniken, Wei Xu, Sharara Shakik, Ali Vedadi, Dixon Pinto, Catherine Brown, Penelope Ann Bradbury, Frances A. Shepherd, Adrian G. Sacher, Natasha B. Leighl, Benjamin H. Lok, Geoffrey Liu, Grainne M. O'Kane
Journal: Journal of Clinical Oncology (2020)

e19306 Background: Recent advances in small cell lung cancer (SCLC) treatments necessitate a better understanding of health utility scores (HUS) of patients treated under standard regimens to facilitate robust pharmaco-economic assessments. HUS collected in clinical trials may be inherently skewed due to restrictive eligibility criteria, highlighting the need for real-world data. Methods: In this cohort observational study, HUS were evaluated in SCLC patients through EQ-5D surveys. We also evaluated patient reported (pr) ECOG performance status (PS)), treatment toxicities (modified patient reported (mpr) CTCAE) and symptoms (Edmonton Symptom Assessment System, ESAS). Clinical data were abstracted from electronic medical records. The impact of these variables on HUS was explored using regression. Results: Of 282 clinical encounters (12% newly diagnosed; 37% stable on treatment; 22% progressing; 29% stable off therapy/other) in 111 SCLC patients (58% male; 64% extensive stage), 29% had pr-ECOG PS ≥ 2 at the first encounter. Mean HUS in treatment naïve patients with limited disease was 0.848 (SEM = 0.028); for extensive stage, mean HUS = 0.715 (SEM = 0.046). Extensive stage (β = -0.12; p = 0.03), bone metastases (β = -0.10; p = 0.04), females (β = -0.07; p = 0.006), and pr-ECOG PS ≥ 2 (β = -0.21; p &lt; 0.001) were each associated with decreased HUS in multivariable analyses. When excluding pr-ECOG PS from the model (highly correlated with HUS), progressive disease (β = -0.07; p = 0.02) was also associated with decreased HUS. Longitudinally, in patients with disease stability, HUS were unchanged in limited disease, but slowly decreased for extensive stage over time. HUS were inversely associated with increasing severity of most measured toxicities (mpr-CTCAE rho values ranged from -0.34 to -0.47) and symptoms (rho values -0.27 to -0.54). Conclusions: HUS in SCLC is impacted by the presence of extensive stage and bone metastases, in addition to cancer symptoms and treatment toxicities. The values reported from this real-world sample provides a basis in which to compare with new SCLC therapies in health technology assessments. [Table: see text]
High-risk of recurrence for nodal micrometastasis with breast pathologic complete response (ypT0/Tis ypN1mi) after neoadjuvant chemotherapy.
Authors: Esmeralda Garcia Torralba, Pilar de la Morena, Marina Garcia Gomez, Alejandra Ivars Rubio, Elena Garcia Martinez, Elisa Garcia-Garre, Maria Martinez Galvez, Gema Marin Zafra, Jose Aguilar Jimenez, Esther Navarro Manzano, Francisco Ayala
Journal: Journal of Clinical Oncology (2020)

e12524 Background: Nodal micrometastatic disease (ypN1mic) after neoadjuvant chemotherapy (nCT) for breast cancer (BC) is considered an indication for axillary lymph node disection. While pN1mic prognostic impact has been extensively studied, the prognostic impact of ypN1mic disease is uncertain and these patients are usually grouped together with nodal macrometastatic disease. Since outcomes may be difficult to evaluate in the setting of BC residual disease, our aim was to compare the prognostic meaning of ypN1mic with that of ypN0 when a pCR is obtained in the breast. Methods: We retrospectively analyzed a series of 454 BC consecutive patients treated between 2010 and 2018 with neoadjuvant chemotherapy (nCT) based on anthracyclines and taxanes (plus antiHER2 treatment when appropriate). Pathologic complete response (pCR) was defined as ypT0/Tis ypN0. Patients with pre-nCT sentinel lymph node biopsy or without post-nCT pathologic evaluation were excluded. Disease free (DFS) and overall survival (OS) were analyzed with Kaplan-Meier curves and Cox regression models. Results: 454 BC patients were included, with 106 (24%) pCR. Median follow-up was 39 months. 99 (21.8%) patients obtained a pCR both in breast and axilla (ypT0/Tis ypN0), with 4 recurrences (4%) while only 7 (1.5%) patients had isolated nodal micrometastatic disease (ypT0/Tis ypN1mic), with 2 recurrences (28%). Median DFS was not reached for the ypN0 group and was 28 months (95%CI: 21.6-34.4 months) for the ypN1mic group (HR: 16.55, 95%cI: 2.68-102.37; p = 0.003). No differences were observed for OS (p = 0.77), although 2/2 ypN1mi showed distant recurrence (2/4 for ypN0 patients). Baseline clinical and pathologic characteristics were comparable between both groups, with no differences in performance status (p = 0.45), clinical nodal stage (p = 0.48), HER2 (p = 0.32), estrogen receptors (p = 0.93), grade (p = 0.34), presence of carcinoma in situ (0.60) or clinical complete response (p = 0.42). Clinical characteristics of patients with recurrence were also similar (100%: clinically positive nodes, negative estrogen receptors, no clinical complete response). Conclusions: Residual nodal micrometastatic disease after nCT seems to be associated with a higher risk of recurrence. Although longer follow-up and larger series are needed to confirm our data, these results support the escalation of post-nCT treatment even in patients with ypN1mic and breast pCR.
Abstract 15442: Personalized Risk Stratification for Ventricular Arrhythmia in Pediatric Patients With Myocarditis via Image-Based Computational Simulations
Authors: Mark J Cartoski, Plamen Nikolov, Patrick M Boyle, Philip J Spevak, Natalia A Trayanova
Journal: Circulation (2017)

Introduction: Patients with infectious myocarditis have increased arrhythmia risk due to myocardial inflammation, edema, and fibrosis. There is no current method for arrhythmia risk stratification ...
内分泌科临床精粹(一)
Authors: 李乃适, 赵维纲
Journal: BMJ (2010)

一、经治疗血糖居高不下的2型糖尿病要警惕特殊类型糖尿病 尽管2型糖尿病在我国糖尿病患者中占绝大多数,但这也助长了对糖尿病分型鉴别的简单化倾向.当病程不太长的患者经过较正规生活方式调整并加用双胍类、甚至两类降糖药联合应用后血糖仍然居高不下时,要警惕有无特殊类型糖尿病的可能,尤其是其他内分泌疾病导致的糖尿病.如观察患者的手足有无与其身材不匹配的增大,询问女性患者有无被评价为面容变丑状况,可判断患者是否有肢端肥大症的可能。
晚发型强直性脊柱炎的临床分析
Authors: 张洁, 黄烽
Journal: BMJ (2007)

为了提高对晚发型强直性脊柱炎(LAS)的认识,对我院7例LAS患者的临床资料进行总结,结合国内报道进行综合分析,并与我院同期收治的幼年和成年发病型强直性脊柱炎患者进行对比.结果 显示LAS患者男女发病率相当,首发症状可为下肢大关节或脊柱受累,髋关节受累和肌腱端炎少,而非特异症状和肢端水肿多见.实验室各项炎性指标异常并不显著,而影像学改变明显.对治疗的反应较好。
The influence of health disparities on risk factors in patients with colorectal cancer.
Authors: Neha Hippalgaonkar, Khalid Matin
Journal: Journal of Clinical Oncology (2020)

e19006 Background: There are convincing data that suggest that lifestyle factors play a strong role in colorectal cancer. Obesity in particular is associated with higher incidence of colorectal cancer (CRC) and increased mortality. Racial and ethnic minorities are more likely to develop colorectal cancer when compared to the general population in the US, and the population in Richmond is made up of 47% of African Americans (AA), with 24% of the total persons in poverty and a median household income of $45,117, allowing us to uncover important factors that may affect the development of CRC. Purpose: We aim to uncover trends in the AA population as compared to the Caucasian population to determine the effect of health disparities in obesity-related risk factors in patients with CRC. Methods: We used the Virginia Commonwealth University (VCU) network within TriNetX, a global federated health research network that provides access to statistics in electronic medical records of diagnoses, laboratory values and vitals. We compared Caucasian and AA patients with a diagnosis of CRC from 14 different health networks in the US from 2010-2019. Results: In the TriNetX network, we found that the African American population exhibited higher rates of obesity (33% vs. 26%), irritable bowel disease (38% vs. 33%) and hypertension (71% vs. 33%) as compared to AA patients in the other 14 networks. Increased rates of diabetes (33% vs. 22%), hyperlipidemia (33% vs. 28%) and hypertension (71% vs. 56%) were found in the African American population compared to the Caucasian population in the VCU Network. Notably, we also observed increased rates of homelessness &amp; unemployment (5% vs. 3%) in the AA population. Conclusions: These data suggest that important comorbidities are more prevalent in AA populations population than in the Caucasian populations. Our findings demonstrate the fundamental importance of considering racial and socioeconomic factors when designing screening, treatment and management plans in an effort to reduce the mortality of CRC in an underserved community.
Outcomes for geriatric patients evaluated in a same-day multidisciplinary central nervous system clinic for radiation oncology and neurosurgery in a community hospital setting.
Authors: Wencesley A. Paez, Rohi Gheewala, Jerry J. Jaboin, Charles R. Thomas, Jeremy N. Ciporen, Timur Mitin
Journal: Journal of Clinical Oncology (2020)

As cancer survival increases, management of geriatric patients with central nervous system (CNS) cancers will require a patient-centric, multidisciplinary approach. Assessment of neurosurgical and radiation treatment outcomes will assist in establishing guidelines for a high-risk patient population. We previously reported on the RADIANS clinic, a novel community hospital-based multidisciplinary clinic (MDC) for CNS cancer care, providing simultaneous radiation oncology and neurosurgery evaluation in a same-day, single-setting clinic. We now provide a subset analysis of our geriatric patient population and recommendations for triage and standardization of care.Consecutive geriatric patients (age ≥65) evaluated at the RADIANS clinic for CNS disease were identified and retrospectively reviewed with IRB approval. Neurosurgical outcomes were statistically compared to predicted outcomes determined by the National Surgical Quality Improvement Program Surgical Risk Calculator. Radiation tolerance was reported.Fifty-six geriatric patients with malignant (42/56) and benign (16/56) CNS disease were evaluated. Mean distance traveled for multidisciplinary evaluation at the RADIANS clinic was 43.4 miles. We found a statically significant difference in observed outcomes compared to expected based on the NISQIP calculator (p<0.05). Local tumor control rate and progression-free survival at 90 days were 97.4% and 76.9%, respectively.This is the first report of CNS disease outcomes in geriatric patients evaluated by dual providers at a community-based MDC.
Effect of pre-marital health care on prevention transmissible disease after marriage
Authors: 黄咏梅, 程利南
Journal: BMJ (2007)

婚前保健技术服务是对准备结婚的男女双方在结婚登记前进行的一系列保健服务,是保障家庭幸福、提高出生人口素质的基础保健工作,也是生殖保健的重要组成部分.婚前保健技术由婚前医学检查、婚前卫生指导和婚前卫生咨询三部分组成.《中华人民共和国母婴保健法》中规定,婚前医学检查的重点为严重遗传性疾病、指定传染病、有关精神病和其他与结婚生育有关的疾病.本文结合我国目前常见的传染性疾病,就婚前保健对婚后传染性疾病的预防作用综述如下。
老年脑卒中后抑郁患者游离甲状腺激素的变化及临床意义
Authors: 李运刚, 李化勇, 郭秀风, 巩法莲
Journal: BMJ (2006)

采用放射免疫分析法检测老年脑卒中后抑郁(PSD)患者86例、脑卒中后不伴抑郁者(CVD组)94例以及健康对照者30例的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)的水平、逆三碘甲状腺原氨酸(Rt3).结果表明,PSD组FT3明显低于CVD组和对照组(P＜0.01),PSD组Rt3水平高于CVD组及对照组(P＜0.05).PSD组抑郁程度越重,血清FT3水平越低。
Comparison of vacuum-assisted excision with periareola incision surgery for benign breast tumor
Authors: Junfeng Hu, Xiandong Liu, Chao Li, Chao Hu
Journal: BMJ (2017)

Objective
To compare vacuum-assisted excision with periareola incision surgery for benign breast cancer.


Methods
One hundred and twenty one patients with benign breast nodules treated in our hospital from October 2014 to October 2015 were enrolled in the study, including 58 cases received vacuum-assisted excision (study group) and 63 cases received periareola incision surgery (control group). There were no differences in age[(30.2±5.4) vs. (32.1±6.2) years]and tumor diameter[(1.3±0.4) vs. (1.5±0.3)cm]between two groups.


Results
There were no severe complications in both groups. Compared with the control group, the operation time was shorter [(20.4±4.7) vs. (48.2±15.4)min, t=3.165, P=0.006], intraoperative blood loss was less[(18.4±5.7) vs. (17.2±3.7)ml , t=-0.297, P=0.672], malformation rate was lower [5.2%(3/58)vs. 22.2% (14/63), χ2=7.27, P=0.007], incidence of postoperative hematoma was higher [20.7%(10/58)vs. 6.3%(4/63), χ2=3.502, P=0.041], and the cost of surgery was more expensive(5 100±300)vs. (3 400±1 200) Yuan, t=2.181, P=0.023].


Conclusion
Comparing with conventional periareolar incision surgery, the vacuum-assisted excision has its advantages and disadvantages for treatment benign breast tumors, and two surgical modalities can be chosen accordingly.


Key words: 
Breast neolpasms; Surgery procedures, operative, mammary glands; Treatment outcome; Acuum-assisted excision; Periareola incision surgery