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Oesophageal fistula is a severe complication that may occasionally develop after chemoradiotherapy (CRT) for oesophageal cancer and is difficult to treat. A 51-year-old man who had undergone CRT for oesophageal cancer presented with haematemesis and was diagnosed with a descending aortic aneurysm and an oesophageal fistula. Thoracic endovascular aneurysm repair was performed to achieve haemostasis. After 3 days, the patient underwent subtotal oesophagectomy and cervical oesophagostomy with delivery of a pedicled omental flap to the exposed aortic stent. Six months later, ileocecal reconstruction was performed. The second patient was a 49-year-old woman who had undergone CRT 1 year previously. She complained of leg weakness and gait disorder. After a workup, she was diagnosed with perforation of the posterior wall of the cervical oesophagus with abscess formation and purulent spondylitis. After two spinal fusion surgeries, we performed tracheotomy and drained the cervical region to reduce local infection. After 7 days, she underwent pharyngolaryngoesophagectomy and reconstruction using a gastric conduit, to which a large section of the omental flap was attached. After the multi-stage surgery, oral intake became possible, and both patients were discharged. The optimal treatment strategy for post-CRT oesophageal fistula remains controversial. Radical surgery, including oesophagectomy, is the treatment of choice, although it is associated with high mortality rates. Multi-stage surgery may be useful for reducing surgical stress in moribund patients. We reported two cases involving radiation-induced oesophageal fistula successfully treated by multi-stage surgery without major complications. • Multi-stage surgery can successfully treat radiation-induced oesophageal fistula. • Multi-stage surgery allows for infection control. • Multi-stage surgery reduces surgical stress in moribund patients. • Two cases of radiation-induced oesophageal fistula were successfully treated. [ABSTRACT FROM AUTHOR]

• Funding for federal COVID-19 relief programs has run out since March 2022, resulting in the suspension of the Provider Relief Fund and the Uninsured Program. • These funding cuts have resulted in a backslide in pandemic protection, with disproportionate effects on the most vulnerable Americans. • Suspension of COVID-19 relief programs particularly risks derailing long-standing efforts to build trust and healthcare access among marginalized communities. [ABSTRACT FROM AUTHOR]

• Early allograft dysfunction (EAD) is associated with inferior graft survival. • Lactate-to-platelet ratio (LPR) can be obtained by blood tests early post-transplant. • EAD and LPR were independent predictors for 3-month graft failure. • The area under the curve of LPR and that of EAD showed no significant difference. • LPR predicts graft failure with early availability and simple calculations. Early allograft dysfunction (EAD) is a criterion to evaluate initial graft dysfunction associated with inferior graft survival and postoperative complications after liver transplantation (LT). This study defined the lactate-to-platelet ratio (LPR) as lactate level immediately post-LT/platelet count on postoperative day 1 and evaluated its association with EAD and short-term graft failure. This study reviewed 434 deceased-donor LTs from individuals with confirmed brain death between January 2008 and December 2014. The area under the curve (AUC) was used to compare the predictive capacity for 3-month graft survival between EAD and the LPR. Along with LPR, the risk factors for 3-month graft failure were analyzed by multivariate analysis. EAD was reported in 127 patients (31%). The LPR in patients with EAD was significantly higher than that in patients without EAD (9.8 vs 5.9, P <.001). In the multivariate analysis, both the LPR (per 1.0 increase) and EAD were independent risk factors for 3-month graft failure (hazard ratio [HR] =1.03, P =.03; and HR = 9.14, P =.001). The comparison of the AUCs between the LPR and EAD showed no significant difference (0.79 vs 0.78, P =.84), whereas the combination of EAD and LPR had a better predictive capacity than EAD alone (0.86 vs 0.78, P <.001). The LPR showed an inverse relationship for predicting 3-month graft survival. The LPR is a continuous parameter that enables prediction of initial graft function and estimation of the 3-month graft failure rate with the advantages of early availability and simple calculations. [Display omitted] [ABSTRACT FROM AUTHOR]