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Introduction: Luteinising hormone-releasing hormone agonist (LHRHa) injections are currently used in the treatment of advanced prostate cancer, but the frequency of injections may represent a burden to patients and healthcare services. The aim of this study was to collect real-world evidence about clinical and practical outcomes for patients with prostate cancer initiating six-monthly triptorelin, or switching from shorter-acting formulations to six-monthly triptorelin, in hospitals in the DEcapeptyl SERVice Evaluation project., Methods: Up to 2 years of data were collected retrospectively by physicians from records of 88 patients receiving six-monthly triptorelin at three centres. The primary outcome measure was the change in the number of patient-healthcare interactions (patient reviews, prostate-specific antigen (PSA) tests, and LHRHa injections) over a 24-month treatment period., Results: This analysis included 47 patients newly initiated on six-monthly triptorelin and 41 who received 12 months of a one- or three-monthly LHRHa before switching to six-monthly triptorelin. After switching to six-monthly triptorelin, there was a statistically significant reduction in patient reviews (46.8%), injections (46.8%), and PSA tests (26.6%; all P < 0.0001). The total number of patient-healthcare interactions was significantly reduced (41.5%; P < 0.0001). Based upon cost of these interactions only, the cost reduction of switching to six-monthly triptorelin was £10,214.85 (£249.14 per patient) over 12 months. At 12 months, median PSA was 1.30 ng/mL (23.50 ng/mL at diagnosis) for newly treated patients and 0.24 ng/mL (0.35 ng/mL at switch) for patients who had switched treatment. No safety issues were identified., Conclusion: Switching from one- or three-monthly LHRHa to six-monthly triptorelin significantly reduced patient-healthcare interactions and associated costs while maintaining PSA control over a 12-month treatment period. This not only translates into healthcare savings but may release men from the restriction of repeated healthcare interactions and thus improve the overall patient experience as the population of long-term prostate cancer survivors continues to increase., Funding: Ipsen Limited.

The introduction of cadaveric dissection of cerebral vasculature as a part of the neurosurgical training module would help the neurosurgical residents to understand the complex neuroanatomy of the brain vasculature and help gain confdence during the surgical procedure.To the best of our knowledge microsurgical anatomical studies of theMCA have not been done among the Northwest Indian population. Anatomical variations of MCA that have not been described before may come in as a surprise during any surgical intervention. Hence, we intend to record the anatomical variations of the MCA anatomy and its implications in contemporary vascular surgery and neurosurgical practice. The objective of this work was to study and compare the microsurgical anatomy and variations of MCA in Northwest Indian cadavers with the available literature. [ABSTRACT FROM AUTHOR]

Introduction: Revision hip arthroplasty in the presence of complex acetabular deficiencies is challenging. Cement, allograft, reconstruction rings and porous trabecular metal now provide versatile options for acetabular fixation and restoration of acetabular offset. We compare acetabular impaction bone grafting (AIBG) and trabecular metal (TM) cups at long-term follow-up. Methods: 53 patients who underwent revision hip arthroplasty were retrospectively reviewed from local joint registry data. 36 patients were revised using AIBG and 17 with TM. Median clinical follow-up was 9.57 (2.46–18.72) years and 9.65 (7.22–12.46) years, respectively. 82% of the TM group and 63% of the AIBG group were ⩾ Paprosky 2C. Re-revision was considered failure. Radiographs demonstrating 5 mm of femoral head migration and 5° of acetabular component inclination change were considered loose. Results: Patients receiving AIBG were younger (68 vs. 74 years) with a longer interval from initial arthroplasty to revision (17 vs. 13 years). Revisions in both groups were indicated most commonly for failed cementing (AIBG 88.9% vs. TM 70.5%). No TM reconstructions underwent re-revision, with only 1 failing at 6.3 years, compared with 9 AIBG re-revisions. When revising for sepsis, 33% of AIBG revisions failed. Conclusions: AIBG demonstrated high failure rates at long-term follow-up when compared to TM constructs. We recommend the use of AIBG in small cavitary defects only. We strongly advise against its use in the setting of significant bony defects and for prosthetic joint infection. [ABSTRACT FROM AUTHOR]

The efficaciousness of topical tranexamic acid use at the end of knee arthroplasty surgery to reduce blood loss and transfusion requirements has previously been shown. The aim of this study was to retrospectively assess the effectiveness of topical tranexamic acid use, comparing 155 patients undergoing hip and knee arthroplasty surgery in which tranexamic acid was routinely used, to a group of 149 patients from a similar time frame prior to the introduction of tranexamic acid use. The transfusion rate fell from 19.3% to 2.3% for hip arthroplasty patients and from 13.1% to 0% for knee arthroplasty patients; these differences were significant. We also found significant reductions in haemoglobin loss, blood loss and length of stay of 8 g/L, 244 mL and 1.0 days respectively for hip arthroplasties and 15 g/L, 527 mL and 1.2 days respectively for knee arthroplasties following the introduction of tranexamic acid., (© 2014.)

In this computational study, we describe a self-consistent trajectory simulation approach to capture the effect of neutral gas pressure on ion–ion mutual neutralization (MN) reactions. The electron transfer probability estimated using Landau–Zener (LZ) transition state theory is incorporated into classical trajectory simulations to elicit predictions of MN cross sections in vacuum and rate constants at finite neutral gas pressures. Electronic structure calculations with multireference configuration interaction and large correlation consistent basis sets are used to derive inputs to the LZ theory. The key advance of our trajectory simulation approach is the inclusion of the effect of ion-neutral interactions on MN using a Langevin representation of the effect of background gas on ion transport. For H+ − H− and Li+ − H(D)−, our approach quantitatively agrees with measured speed-dependent cross sections for up to ∼105 m/s. For the ion pair Ne+ − Cl−, our predictions of the MN rate constant at ∼1 Torr are a factor of ∼2 to 3 higher than the experimentally measured value. Similarly, for Xe+ − F− in the pressure range of ∼20 000–80 000 Pa, our predictions of the MN rate constant are ∼20% lower but are in excellent qualitative agreement with experimental data. The paradigm of using trajectory simulations to self-consistently capture the effect of gas pressure on MN reactions advanced here provides avenues for the inclusion of additional nonclassical effects in future work. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the optimal form of venous thromboembolic prophylaxis treatment in hip and knee arthroplasty patients, or on the safety and complication profile of the available chemical prophylaxis modalities. In this study we aimed to measure the return to theatre rate for any cause related to wound complications in patients undergoing total hip replacement and total knee replacement, and compare these rates between patients on oral Rivaroxaban 10mg OD and subcutaneous Enoxaparin 40mg OD in our department., Material and Methods: There were a total of 387 patients included in the study; 227 patients in group 1, who received Enoxaparin 40mg OD, and 160 patients in group 2, who received Rivaroxaban 10mg OD., Results: The primary outcome measure was re-operation rate due to wound complications. Secondary outcome measures were infection rate, incidence of deep vein thrombosis, pulmonary emboli, duration of hospital stay, change in haemoglobin and haematocrit and blood transfusion rate. In this retrospective cohort study we found that patients who received Rivaroxaban were more than twice as likely to return to theatre for wound complications compared to patients receiving Enoxaparin. Although not statistically significant, this increase is in line with previous studies. Infection rates increased from 0.9% to 1.9% after the introduction of Rivaroxaban and microbiologically confirmed superficial infections rose from 1.3% to 3.1% after Rivaroxaban was introduced in our unit. These rises were not statistically significant., Conclusion: Our study highlights the need for large randomised controlled trials to assess post-operative complications following the introduction of Rivaroxaban for post-arthroplasty thromboprophylaxis.

Introduction: In orthopaedic surgery, small bicortical circular bone defects are often produced as a result of internal fixation of fractures. The aim of this study was to determine the amount of torsional strength reduction in animal bone with a bicortical bone defect and how much residual strength remains if the bicortical bone defect was occluded., Method: Forty pig femurs were divided into four groups. Group 1 femurs were left intact. Group 2 femurs were given a 4 mm bicortical bone defect. Group 3 were prepared as in Group 2, but occluded with a 4.5 mm cortical screw. Group 4 were prepared as in Group 2, but occluded with plaster of paris. Measurements including the length of the bone, working length of the bone, mid-diaphyseal diameter and cortical thickness were recorded. All specimens were tested until failure under torsional loading. Peak torque at failure and angular deformation were recorded. One-way analysis of variance was used to test the sample groups, with a value of P < 0.05 considered to be statistically significant., Results: When compared with Group 1, all of the other groups showed a reduction in peak torque at failure point. Only the difference in peak torque between Groups 1 and 2 was statistically significant (P = 0.007). Group 2 showed the most reduction with 23.11% reduction in peak torque and 38.19% reduction in total energy absorption. No significant difference was found comparing the bone length, bone diameter and the cortical thickness., Conclusion: The presence of the defect remains the major contributing factor in long bone strength reduction. It has been shown that a 10% bicortical defect was sufficient to produce a reduction in peak torque and energy absorption under torsional loading. By occluding this defect using a screw or plaster of paris, an improvement in bone strength was achieved. These results may translate clinically to an increased vulnerability to functional loads immediately following screw removal and prior to the residual screw holes healing.

High-temperature annealing (HTA) is one of the most promising techniques to produce high-quality, cost-efficient AlN templates for further epitaxial growth of AlGaN devices. Unfortunately, the yield of this process seems to be limited due to the restricting face-to-face configuration that is typically used, in which contaminations of the template surface can occur easily. A high yield is crucial for process transfer into industry. Indeed, templates that are annealed in open-face configuration suffer from surface degradation due to excessive AlN evaporation during the course of the annealing process. To highlight the physics that are restricting the open-face approach of the process, sublimation behavior of AlN at temperatures and atmospheres typically used in HTA processes has to be examined. In this study, we use the Knudsen effusion mass spectrometry technique to confirm the previously published results on equilibrium partial pressures of species above AlN. Based on the experimentally determined data and further AlN sublimation experiments, the apparent sublimation coefficient of AlN in N2 and Ar atmospheres at HTA process conditions can be derived. Despite N2 having a stabilizing effect on AlN during HTA, the still high decomposition rates of several hundred nanometers per hour can explain the excessive damage that is typically observed if AlN/sapphire templates are annealed in an open-face configuration. Finally, based on theoretical considerations, a strategy to reduce the sublimation of AlN during HTA in open-face configuration is suggested. [ABSTRACT FROM AUTHOR]

We present the case of an apparently healthy 22-year-old female who presented with atraumatic stress fractures of both fibulae. Further investigation demonstrated that she had osteopoenia secondary to occult coeliac disease. The fractures were successfully treated non-operatively. The awareness of the prevalence of occult coeliac disease is increasing due to simpler diagnostic tests, as is its significance as a cause of secondary osteoporosis. Knowing the relationship between these two conditions will help orthopaedic surgeons treating such patients to refer them promptly to appropriate specialists.

Brachymetatarsia of the first metatarsal is an uncommon condition, but one that is amenable to treatment by lengthening via distraction osteogenesis, a process that employs 2 groups of pins of an appropriate external fixator inserted in the metatarsal to apply gradual distraction across an intervening osteotomy. We present the case of a female, aged 13 years, who presented with congenital bilateral first brachymetatarsia and left foot pain due to transfer metatarsalgia. The short and plantarflexed first ray could not accommodate both groups of fixator pins, even with the fixator set at its shortest length. An alternative strategy was devised that reduced the degree of plantarflexion using a tarsometatarsal arthrodesis, which effected subsequent lengthening through the healing fusion site. Lengthening commenced after 10 days and continued over a period of 52 days, at a rate of 0.5 mm to 1.0 mm per day. Consolidation occurred at 20 weeks with a final increase in length of 25 mm. The patient returned to vigorous sporting activity 1 year after removal of the fixator. To our knowledge, this is the first account of a metatarsal-lengthening arthrodesis at the tarsometatarsal level.

Aims: Following Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF), the choice of treatment remains a clinical challenge. This study introduces a novel classification system to guide the selection of femoral prostheses in hip arthroplasty (HA) and validates its clinical efficacy. Methods: Retrospectively, we analyzed 108 cases from three university-affiliated hospitals between December 2012 and February 2023 involving patients who underwent hip arthroplasty due to Failed Internal Fixation of Intertrochanteric Fractures (FIF-ITF). Patients were classified into three categories based on fracture healing, proximal femoral support, and the severity of femoral cortical defects, with subtypes identified. Surgical outcomes and complication rates were compared between the Classification-based Decision Group and the Non-classification Decision Group. Results: The Classification-based Decision Group did not differ significantly from the Non-classification Decision Group in operation time, blood loss, or the use of cemented stems. However, the classification system markedly reduced the risk of periprosthetic fractures intraoperatively from 22.5 to 4.4% and postoperatively from 10 to 1.4%. The Classification-based Decision Group also demonstrated higher postoperative Harris Hip Score (HHS) and Visual Analog Scale (VAS) scores. Conclusion: The proposed classification system serves as an innovative clinical tool for femoral prosthesis selection in hip arthroplasty post-FIF-ITF, effectively reducing complications and enhancing hip function in the Classification-based Decision Group, underscoring its significant clinical utility. [ABSTRACT FROM AUTHOR]

Background: There is wide variation in premature mortality rates in adults with severe mental illness (SMI) across London, with Tower Hamlets (a highly deprived and ethnically diverse area) scoring the highest. Objective: To identify examples of best practice and co‐design recommendations for improving physical health checks and follow‐up care amongst people with SMI in Tower Hamlets. Methods: Data were collected through online questionnaires (using SMI physical health best practice checklists), one‐on‐one interviews (n = 7) and focus groups (n = 3) with general practices, secondary mental health services, commissioners and leads of community services and public health programmes, experts by experience and community, voluntary and social enterprise organisations in Tower Hamlets. Data were analysed using deductive and inductive thematic analysis. Results: Twenty‐two participants representing 15 general practices (out of 32), secondary mental health services, commissioners and public health leads completed the online questionnaires. Twenty‐one participants took part in interviews and focus groups. Examples of best practice included cleaning and validating the SMI register regularly by general practices, knowing the number of patients who had been offered and/or received physical health checks, having clear pathways to community and specialist care services, using various communication methods and having a key performance indicator (KPI) for tailored smoking cessation services for people with SMI. Recommendations included adopting evidence‐informed frameworks for risk stratification and utilising the wider primary care workforce with specific training to follow up on results, offer interventions and support navigating pathways and taking up follow‐up care. Incentivising schemes were needed to deliver additional physical health check components such as oral health, cancer screening, Covid‐19 vaccination and sexual health checks. Including KPIs in other community services' specifications with reference to SMI people was warranted. Further engagement with experts by experience and staff training were needed. Conclusion: The present initiative identified best practice examples and co‐designed recommendations for improving physical health checks and follow‐up care in deprived and ethnically diverse people with SMI. Patient or Public Contribution: This initiative was supported by three experts with experience, and two community organisations, who were involved in data curation and interpretation, development of recommendations and/or dissemination activities including writing this manuscript. [ABSTRACT FROM AUTHOR]

Background: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction. Materials and Methods: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests. Results: At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site. Conclusion: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 2024;47(5):308–312.] [ABSTRACT FROM AUTHOR]

A time-dependent global model is developed for deep oscillation magnetron sputtering (DOMS) with a Cr target to characterize the plasma using the working Ar gas at a pressure of 0.8 Pa. An input of the global model is the target voltage and current waveforms at charging voltages from 260 to 400 V. The plasma densities vary synchronously with the oscillations of target power. During the on-time of a micropulse, the gas atoms are ionized first to ignite the plasma and subsequently the metal ions follow to sustain the discharge. During the off-time, the gas ions dominate the afterglow. The DOMS possesses a characteristic of alternating gas/metal discharge in the time domain. The peak values of plasma densities increase linearly with charging voltages, which is mainly attributed to the higher Cr+ ion density. The discharge transits from gas dominated to metal dominated at high charging voltage. The working gas rarefaction in DOMS discharge is enhanced at higher charging voltages. At charging voltages higher than 360 V, the metal self-sputtering comes into the runaway regime temporarily as indicated by the self-sputtering parameters exceeding unity, generating the dense and metal-rich plasma. The metal self-sputtering is promoted by gas rarefaction. The electrons tend to ionize the metal atoms after the gas atoms are depleted. The decreased grain size and elevated nano-hardness of the Cr thin films are explained by structure transition from zone I to zone T due to the efficient metal ion bombardment to the growing thin films as the charging voltage increases. [ABSTRACT FROM AUTHOR]

Background and Aims: Traditional apprenticeship‐based surgical training presents with challenges, especially in acute scenarios. Simulation provides the current standard of facilitating surgical training in a low‐risk environment but is restricted by limited accessibility and high costs. Virtual reality (VR) offers immersive three‐dimensional computer‐generated training scenarios and can connect users from various locations. We aimed to compare the performance of junior doctors to manage an acute surgical scenario using VR and mannequin‐based simulation. We hypothesised that VR would be as effective as mannequin‐based simulation in performance outcomes. Methods: This multicentre, randomised controlled pilot study was conducted with eighteen junior doctor volunteers (Foundation and Core Trainee Year 1). Ten were randomly allocated to VR and eight to mannequin‐based simulation. Participants completed questionnaires and a 15‐min pneumothorax scenario. Quantitative metrics included overall score, time‐to‐critical decisions, and academic buoyancy scores (ABS). Qualitative metrics included participants' likes and dislikes of their allocated simulation modality. Results: VR participants scored significantly higher than mannequin‐based simulation participants in overall scores (74.30% (SD ± 5.08%) vs. 59.75% (SD ± 10.14) (p = 0.04)), and technical skills aspects (77.20% (SD ± 8.01%) vs. 65.00% (SD ± 8.21%) (p = 0.01)). Mannequin‐based simulation participants initiated critical decisions faster and demonstrated a trend towards a faster mean time‐to‐completion (p = 0.06). ABS scores increased for both study groups, though was only significant for VR participants (p ≤ 0.01). VR participants liked how VR fostered independent learning but disliked the formulaic content and impaired communication‐learning compared to mannequin‐based simulation. Conclusion: Both VR and mannequin‐based simulation training are effective in training junior doctors in acute surgical scenarios but present different educational benefits. Future research should recruit a larger sample size for a full comparative randomised controlled trial. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: The authors declare no competing interests.

Purpose: The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills., Methods: We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback., Results: Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel., Conclusion: The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: For this type of study formal consent is not required, as we used a single de-identified patient for modeling a derivative model for the surgical scenario., (© 2024. CARS.)

Staff perceptions of inpatient psychiatric hospitals ultimately impact a range of organisational and care-related variables, including staff retention and quality of care for inpatients. The aim of this study was to conduct a meta-review to synthesise themes reported by staff to influence their perceptions of inpatient psychiatric hospitals. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for systematic reviews. PsycINFO, CINAHL, MEDLINE and EMBASE were systematically searched. Reviews were eligible for inclusion if they examined the perception/experience of paid staff involved in caring for adults with mental illnesses admitted to an inpatient psychiatric hospital. Eligible reviews were assessed for methodological quality and bias. Thematic synthesis was used to merge thematically similar findings into an aggregate summary. Fifteen reviews were included, from which seven themes were reliably extracted: staff and patient safety, views on inpatients' experiences, relationships on the ward, ward rules, knowledge and experience, service delivery issues and coercive measures. Confidence in the evidence underlying each theme was analysed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) criteria. Results indicate that staff perceptions of inpatient psychiatric hospitals overlap with inpatients' perspectives, particularly regarding the therapeutic relationship, coercive measures and ward safety, in addition to unique experiences. Factors identified can help guide ways to improve staff retention, satisfaction and quality of treatment., (© 2024 The Author(s). International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Introduction: A crucial long-term care resource for individuals with severe mental illness (SMI) in Taiwan is provided by psychiatric nursing homes. Given the higher incidence of physical illnesses and accidents among individuals with SMI, ensuring patient safety is an important aspect of quality care. However, there is limited literature exploring how the staff provides safe care for individuals with SMI., Aim: Investigates how the staff in a psychiatric nursing home managed residents' activities to mitigate risks and reduce physical injuries., Method: Using a qualitative approach and drawing from Foucault's concept of 'disciplinary power', data were collected from field observations and staff interviews., Results: Three themes emerged: (1) a gaze for efficiency, where checklists, timetables and spatial arrangements were used to efficiently manage residents' bodies; (2) controlling the deviant body, which entailed procedures to monitor and prevent risk behaviours and bodily signs through broad safety measures and (3) your body, my business, which described the reduced autonomy of residents over their behaviours as the responsibility largely shifted to the staff., Discussion: The predominant risk management framework, driven by safety considerations, comprises residents' autonomy and undermines compassionate caring., Implications for Practice: Risk management should actively involve both staff and residents in decision-making., (© 2024 John Wiley & Sons Ltd.)

Objectives: To develop the use of Thiel soft embalmed human cadavers (TeC) in open radical cystectomy (ORC) training for the first time, to investigate the effect of cadaveric training on surgical trainees' technical skills/performance and to determine how trainees perceive the use of cadaveric workshops., Methods: A 3-day hands-on workshop was organised. Ten trainees performed ORC on five TeC, supervised by five experts. Feedback from trainees and mentors was evaluated on a five-point Likert scale. All procedures were completed in a fully equipped surgical environment and complied with the principles outlined in the Declaration of Helsinki., Results: The workshop participants evaluated the anatomical and manipulation characteristics of the TeC as similar to real-life conditions. The colour and consistency of the urethra and ureter differed little from those in live patients. The trainees stated that the TeC were beneficial for learning the stages of ORC and urinary diversion (UD), while their self-confidence increased. In terms of realism, all steps of radical cystectomy (RC) were rated 4 out of 5 or higher on the Likert scale by both trainees and faculty., Conclusions: The use of TeC for RC und UD was perceived as favourable by trainees and faculty. The TeC demonstrated a surprising ability to mimic real-life anatomy and represent a new and effective surgical training tool., (© 2024 BJU International.)

Genome-wide association studies (GWAS) have identified many genetic loci associated with complex traits and diseases in the past 20 years. Multiple heritable covariates may be added into GWAS regression models to estimate direct effects of genetic variants on a focal trait, or to improve the power by accounting for environmental effects and other sources of trait variations. When one or more covariates are causally affected by both genetic variants and hidden confounders, adjusting for them in GWAS will produce biased estimation of SNP effects, known as collider bias. Several approaches have been developed to correct collider bias through estimating the bias by Mendelian randomization (MR). However, these methods work for only one covariate, some of which utilize MR methods with relatively strong assumptions, both of which may not hold in practice. In this paper, we extend the bias-correction approaches in two aspects: first we derive an analytical expression for the collider bias in the presence of multiple covariates, then we propose estimating the bias using a robust multivariable MR (MVMR) method based on constrained maximum likelihood (called MVMR-cML), allowing the presence of invalid instrumental variables (IVs) and correlated pleiotropy. We also established the estimation consistency and asymptotic normality of the new bias-corrected estimator. We conducted simulations to show that all methods mitigated collider bias under various scenarios. In real data analyses, we applied the methods to two GWAS examples, the first a GWAS of waist-hip ratio with adjustment for only one covariate, body-mass index (BMI), and the second a GWAS of BMI adjusting metabolomic principle components as multiple covariates, illustrating the effectiveness of bias correction. Author summary: Genome-wide association studies (GWAS) are powerful in identifying genetic variants influencing complex traits and diseases. However, adjusting for heritable covariates in GWAS may introduce collider bias when both genetic variants and confounders may causally influence these covariates. In this study, for the first time we derived the analytical form of the bias term in GWAS with multiple covariates, enabling bias estimation and correction using any MVMR method. On the other hand, many existing MVMR methods may not be robust to invalid IVs and are designed for independent samples. Since GWAS data of multiple traits are needed, overlapping samples become inevitable. Hence, while investigating the performance of many MVMR methods, we mainly adopt MVMR-cML, a novel MVMR approach robust to invalid IVs and sample overlap. Our simulations underscore that most MVMR methods effectively reduce collider bias across various scenarios. Furthermore, by accounting for correlations among GWAS statistics, as well as the linkage disequilibrium (LD) between the target SNP and IVs, we establish the consistency and asymptotic normality of the bias-corrected estimator based on MVMR-cML. The application of our bias-correction approach to two published GWAS data examples illustrates its utility and efficacy. [ABSTRACT FROM AUTHOR]

Introduction: The hands are the most common site of disability in leprosy. Hand dysfunction could result in difficulty performing activities of daily living. Therefore, hand function should be regularly assessed to ensure that any decrease in hand function could be diagnosed earlier. Methods: This study included 110 patients with leprosy from Likupang and Lembata, Indonesia. Hand function was assessed using the modified Jebsen test to measure hand function respective of the dominance. The grip and pinch strength were used as objective measures of clinical arm function. The World Health Organization (WHO) hand disability grade were used to determine the degree of impairment. Other factors such as age, sex and the type of leprosy were also considered. All factors were analysed using backward logistic regression. Results: Among the 110 participants, a decrease in the dominant (48.2%) and non-dominant (50.9%) hand functions were found. Pinch strength (OR: 3.39; 95% CI: 1.13-10.19) and age (OR: 4.91; 95% CI: 1.72-14.03) were significantly associated with hand function irrespective of the dominance. Conversely, the WHO hand disability grade (OR: 2.97; 95% CI: 1.10-8.04) and type of leprosy (OR: 0.34; 95% CI: 0.12-0.97) were significantly associated with only function of the dominant hand. Conclusion: There is a significant association of age and pinch strength with hand function regardless of the hand dominance. In contrast, the WHO hand disability grade and type of leprosy are significantly associated with the function of the dominant hand only. [ABSTRACT FROM AUTHOR]

The detrimental health effects of smoking are well-known, but the impact of regular nicotine use without exposure to the other constituents of tobacco is less clear. Given the increasing daily use of alternative nicotine delivery systems, such as e-cigarettes, it is increasingly important to understand and separate the effects of nicotine use from the impact of tobacco smoke exposure. Using a multivariable Mendelian randomisation framework, we explored the direct effects of nicotine compared with the non-nicotine constituents of tobacco smoke on health outcomes (lung cancer, chronic obstructive pulmonary disease [COPD], forced expiratory volume in one second [FEV-1], forced vital capacity [FVC], coronary heart disease [CHD], and heart rate [HR]). We used Genome-Wide Association Study (GWAS) summary statistics from Buchwald and colleagues, the GWAS and Sequencing Consortium of Alcohol and Nicotine, the International Lung Cancer Consortium, and UK Biobank. Increased nicotine metabolism increased the risk of COPD, lung cancer, and lung function in the univariable analysis. However, when accounting for smoking heaviness in the multivariable analysis, we found that increased nicotine metabolite ratio (indicative of decreased nicotine exposure per cigarette smoked) decreases heart rate (b = -0.30, 95% CI -0.50 to -0.10) and lung function (b = -33.33, 95% CI -41.76 to -24.90). There was no clear evidence of an effect on the remaining outcomes. The results suggest that these smoking-related outcomes are not due to nicotine exposure but are caused by the other components of tobacco smoke; however, there are multiple potential sources of bias, and the results should be triangulated using evidence from a range of methodologies. Author summary: Although we know that smoking tobacco negatively impacts health, we know relatively little about whether nicotine plays a role in causing poor health outcomes. When used for short periods of time, nicotine appears to have little impact on health. However, until recently, nicotine has rarely been used for long periods without accompanying exposure to tobacco smoke, so it is hard to disentangle the effects of regular nicotine use from the effects of tobacco smoke exposure. In this study, we aimed to dissect the effects of nicotine versus non-nicotine constituents of tobacco smoke on heart and lung health using multivariable Mendelian randomisation and data from a range of sources (including UK Biobank). We found that nicotine does not appear to be an independent cause of poor lung function, lung cancer, chronic obstructive pulmonary disease, or coronary heart disease, but does increase heart rate. These results support previous evidence which suggests that nicotine on its own does not directly cause poor health outcomes, with the exception of increasing heart rate. [ABSTRACT FROM AUTHOR]

Historically, total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been associated with significant perioperative blood loss and a relatively high rate of allogeneic blood transfusions. However, in recent years, tranexamic acid (TXA), a competitive inhibitor of tissue plasminogen activator, inhibiting fibrinolysis of existing thrombi, has substantially decreased the need for blood transfusion in THA and TKA. Various administration strategies have been studied, but there remains a lack of consensus on an optimal route and dosing regimen, with intravenous and topical regimens being widely used. A growing body of literature has demonstrated the safety and efficacy of TXA in primary and revision THA and TKA to reduce blood loss, allogeneic transfusions, and complications; it is associated with lowered lengths of stay, costs, and readmission rates. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G877).

Background: Flexible bronchoscopy procedures require detailed anatomical knowledge and advanced technical skills. Simulation-based training offers a patient-safe training environment that can be more efficient than patient-based training. Physical models are cheaper than virtual reality simulators and allow trainees to be acquainted with the equipment used in the clinic. The choice of a physical model for training depends on the local context. The aim of this study was to compare four different bronchoscopy models for flexible bronchoscopy training. Methods: The BronchoBoy manikin, the Koken manikin, a human cadaver, and a preserved porcine lung were included in the study. Seven physicians experienced in bronchoscopy performed a bronchoscopic airway inspection, bronchoalveolar lavage (BAL), and tissue sampling on all four models with performance evaluated by observation and participant evaluation of models by questionnaire. Results: Nineteen segments were identified in all human anatomy models, and the only significant difference found was that only the Thiel embedded cadaver allowed all participants to enter RB1 with an instrument in the working channel (p = 0.001). The Thiel embedded cadaver and the BronchoBoy manikin had low fluid return on BAL (22 and 52 ml), whereas the Koken manikin and the preserved porcine lung had high return (132 and 134 ml), (p = 0.017). Tissue samplings were only completed in the preserved porcine lung and the Thiel embedded cadaver (p < 0.001). Conclusions: An anatomically correct bronchoscopy is best simulated with the Koken manikin or the Thiel embedded cadaver. Bronchoalveolar lavage should be simulated with the Koken manikin or the preserved porcine lung. Tissue sampling procedures are best simulated using the Thiel embedded cadaver or the preserved porcine lung. [ABSTRACT FROM AUTHOR]

State-selective single-electron-capture in collisions of dressed and bare projectiles with helium atoms are investigated by means of the prior-version of the four-body formalism of the target continuum distorted-wave approximation with a long-range Coulomb effects arising from the relative motion of the scattering aggregates. Here, we choose H e 2 + and C 4 + ions as bare and dressed projectiles due to the availability of experimental data in the literature and impact energy varies from 10 to 600 keV/amu. For a dressed projectile, the passive electron plays the role of screening to the projectile nucleus. In the initial channel, the perturbation potential due to the interaction between the dressed projectile and the active electron(s), is approximated by a model potential that contains both the short-range and long-range parts. Coulomb continuum states of the active electron in the field of residual target ion as well as long-range Coulomb effects for the relative motion are incorporated in the final state wavefunction. State-selective total and projectile angular-differential cross sections for single-electron-capture have been calculated. Numerical results for state-selective total cross sections show good agreement with the available theoretical and experimental findings. Moreover, a prominent maxima and minima are observed in the projectile angular differential cross sections as impact energy decreases and its position moves to lower projectile scattering angle. Finally, the validity of the present model is critically assessed in comparison with the existing experimental data. [ABSTRACT FROM AUTHOR]

Platelet count has been associated with blood pressure, but whether this association reflects causality remains unclear. To strengthen the evidence, we conducted a traditional observational analysis in the Lifelines Cohort Study (n = 167,785), and performed bi-directional Mendelian randomization (MR) with summary GWAS data from the UK Biobank (n = 350,475) and the International Consortium of Blood Pressure (ICBP) (n = 299,024). Observational analyses showed positive associations between platelet count and blood pressure (OR = 1.12 per SD, 95% CI: 1.10 to 1.14 for hypertension; B = 0.07, 95% CI: 0.07 to 0.08 for SBP; B = 0.07 per SD, 95% CI: 0.06 to 0.07 for DBP). In MR, a genetically predicted higher platelet count was associated with higher SBP (B = 0.02 per SD, 95% CI = 0.00 to 0.04) and DBP (B = 0.03 per SD, 95% CI = 0.01 to 0.05). IVW models and sensitivity analyses of the association between platelet count and DBP were consistent, but not all sensitivity analyses were statistically significant for the platelet count-SBP relation. Our findings indicate that platelet count has modest but significant effects on SBP and DBP, suggesting causality and providing further insight into the pathophysiology of hypertension. [ABSTRACT FROM AUTHOR]

Background: Suture button fixation is frequently used to stabilize the distal tibiofibular syndesmosis in athletes sustaining an isolated ligamentous syndesmosis injury. Purpose: To report on a series of periprosthetic fibula fractures adjacent to the lateral suture button after a subsequent unrelated ankle injury or progressive stress injury after initial ankle syndesmosis stabilization using the knotless TightRope (Arthrex). Study Design: Case series; Level of evidence, 4. Methods: Eight elite athletes with periprosthetic fibula fractures and stress injuries around the lateral suture buttons were evaluated. In all athletes, the knotless TightRope had been used to stabilize an isolated ligamentous ankle syndesmotic injury, after which all patients recovered and returned to professional sports at their preinjury level. The athletes subsequently developed an acute fibula fracture or a fibula stress fracture related to the 3.7-mm drill hole in the fibula adjacent to the lateral suture buttons after a mean of 14.1 months (range, 5-29 months). The management of these complications was analyzed. Results: Five athletes sustained a periprosthetic fibula fracture in the form of undisplaced spiral Weber B injuries after a subsequent, unrelated injury. Poor healing response was noted with initial nonoperative treatment for the first 2 athletes, and surgical intervention was performed with successful union of the fracture and return to sports. The subsequent 3 athletes had early surgery with uneventful recovery. Another 3 athletes developed stress injuries adjacent to the fibula suture button without a history of acute trauma. In 2 of the 3 athletes, the position of lateral suture buttons was in the anterior third of the fibula. Initial nonoperative management yielded poor healing response, and subsequent surgical intervention was required to enable healing and return to sports. Conclusion: Nonoperative management of fractures adjacent to the fibula suture button of a knotless TightRope may lead to a delay in union. Therefore, early surgical intervention should be considered in elite athletes, whose return-to-sports time is critical. Care is needed to ensure that the fibula hole for the suture button is centrally located because the eccentric placement of the fibula hole in the anterior third of the fibula may contribute to the development of a stress reaction or stress fracture. Surgical intervention for a periprosthetic fibula stress fracture leads to satisfactory resolution of symptoms. [ABSTRACT FROM AUTHOR]

Target poisoning is prevalent in reactive magnetron sputtering and causes deleterious effects, especially in deposition using metal targets. Both the deposition rate and the stoichiometry ratio of the coatings will be compromised because of the quicker coverage of the poisoning materials on the target relative to removal by sputtering. Continuous high-power magnetron sputtering (C-HPMS) possesses merits such as more rapid sputtering than high-power impulse magnetron sputtering and better target poisoning resistance. In this work, the discharge and plasma characteristics of C-HPMS for an Al metal target in reactive O2/Ar atmospheres are investigated by modeling and alumina deposition. At a constant oxygen partial pressure, larger discharge power increases target etching significantly compared to surface combination with O2, leading to reduced surface poisoning. Besides, a higher temperature is produced near the target to produce more intense rarefaction effects and decrease the risk of target poisoning. In Al discharge, the stable deposition window in the O2/Ar ratio under 120 W/cm2 is 5 times of that under 20 W/cm2. Moreover, a large deposition rate of 112 nm/min is achieved at the poisoning-saturated point and a target/substrate distance can be increased to larger than 40 cm, thus providing more flexibility in the design of deposition parameters and hardware requirement. Our results show that high discharge intensity improves plasma density and ionization rates of reactive particles boding well for the deposition of under-stoichiometric and higher-quality amorphous Al2O3 films. The reactive C-HPMS technique has large potential in the commercial production of functional coatings and thin films. [ABSTRACT FROM AUTHOR]

Genelyn is a proprietary embalming solution used for preserving cadavers for surgical skill training (SST) and undergraduate teaching. The aim of this review is to examine the Genelyn embalming method critically by analyzing scientific publications that have employed this method for SST and undergraduate education. The systematic review process involved searching for all relevant articles in PubMed, Google Scholar, and Embase using the keywords "Genelyn," Genelyn embalming," "Genelyn embalmed cadaver," and "surgical skill training. All studies on Genelyn embalming published up to August 14, 2024, in the English language were eligible for inclusion. The literature review yielded 92 studies, 43 of which met the inclusion criteria. The Anatomical Quality Assurance (AQUA) tool from the International Evidence-Based Anatomy (iEBA) working group was used to assess and analyze the risk of bias in all the selected full-text articles. The selected studies reported that Genelyn embalming provided life-like joint range of motion, tissue pliability, and color. Cadaveric studies assessing embalming solutions typically had smaller sample sizes, and few of them compared Genelyn embalmed cadavers (GECs) with the other soft embalming solutions. Unlike Theil's embalming, Genelyn embalming is cost-effective, with easy steps for the preparation and storage of the solution and convenient handling of cadavers. Therefore, GECs serve as an efficient tool for SSTs., (© 2024 American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

English anatomical terminology has evolved over the long history of anatomical practice, with major influences from ancient Greek, classical Latin, Arabic, and post-classical Latin. Beginning in the nineteenth century, there have been various attempts to standardise and rationalise anatomical language, beginning in 1887, and culminating in the publication in 2019 of the second edition of the Terminologia Anatomica. This paper presents a brief historical overview of the development of anatomical terminology and usage in English, followed by a summary of the results of an anonymised survey of current practices that was sent out by email to anatomy educators at 45 medical schools in the United Kingdom. This is followed by personal reflections by six senior academics and/or clinicians, reviewing their extensive experience of teaching, researching, and communicating the language of anatomy within United Kingdom medical and clinical institutions., (© 2024. The Author(s), under exclusive licence to Japanese Association of Anatomists.)

Metal vapor vacuum arcs (VAs) are widely used in various fields of industry, such as circuit breakers, ion sources, electrical thrusters, and deposition systems. VAs usually originate from metal vapors eroding from the surface of a cathode, where they burn as tiny bright points, hence their name "cathode spots" (CS). Due to their high plasma density, short life span, and micrometer scale, the in situ and non-intrusive diagnostics of CS are a challenge. Numerical simulation is one method used to study CS with the aid of high-performance computing. The well-established particle-in-cell method provides solutions for the spatial-temporal electromagnetic field and the microscopic distribution functions of plasma species in phase space from which the macroscopic parameters of the plasma can be calculated. This Perspective reviews the progress in particle modeling of VAs with an emphasis on the non-stationary and non-local physical processes that are not reproduced by fluid models. Furthermore, a personal outlook on future challenges is provided: the physical modeling of plasma–electrode interactions, the collection and evaluation of collision cross sections, the trade-off between heavy computation cost and predictive ability, and the verification and validation of the simulation code. [ABSTRACT FROM AUTHOR]

Background: Blount's disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. Methods: A systematic review was conducted of studies published before January 2022. Results: In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. Conclusions: Overall, poor evidence with which to establish an optimal treatment for Blount's disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases. [ABSTRACT FROM AUTHOR]

BACKGROUND Previous studies have found associations of red blood cell (RBC) traits (hemoglobin and RBC count) with blood pressure; whether these associations are causal is unknown. METHODS We performed cross-sectional analyses in the Lifelines Cohort Study (n = 167,785). Additionally, we performed bidirectional 2 sample Mendelian randomization (MR) analyses to explore the causal effect of the 2 traits on systolic (SBP) and diastolic blood pressure (DBP), using genetic instrumental variables regarding hemoglobin and RBC identified in UK Biobank (n = 350,475) and International Consortium of Blood Pressure studies for SBP and DBP (n = 757,601). RESULTS In cross-sectional analyses, we observed positive associations with hypertension and blood pressure for both hemoglobin (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.16–1.20 for hypertension; B = 0.11, 95% CI: 0.11–0.12 for SBP; B = 0.11, 95% CI: 0.10–0.11 for DBP, all per SD) and RBC (OR = 1.14, 95% CI: 1.12–1.16 for hypertension; B = 0.11, 95% CI: 0.10–0.12 for SBP; B = 0.08, 95% CI: 0.08–0.09 for DBP, all per SD). MR analyses suggested that higher hemoglobin and RBC cause higher DBP (inverse-variance weighted B = 0.11, 95% CI: 0.07–0.16 for hemoglobin; B = 0.07, 95% CI: 0.04–0.10 for RBC, all per SD). Reverse MR analyses (all per SD) suggested causal effects of DBP on both hemoglobin (B = 0.06, 95% CI: 0.03–0.09) and RBC (B = 0.08, 95% CI: 0.04–0.11). No significant effects on SBP were found. CONCLUSIONS Our results suggest bidirectional causal relationships of hemoglobin and RBC with DBP, but not with SBP. [ABSTRACT FROM AUTHOR]

The ionization potentials and total ionization cross sections of glucose and ribose monosaccharide molecules were measured by electron impact at energies up to 70 eV. Using two methods, Hartree–Fock (HF) and density functional theory (DFT), the structure of d- and l-forms of glucose and ribose molecules were calculated using Gaussian. The energy characteristics of the molecular orbitals (MOs) were used to calculate the summarized single ionization cross sections (CS) based on the MOs by the Binary–Encounter–Bethe (BEB) and Gryzinsky (Gryz) models. By normalizing to Gryz-DFT cross sections at thresholds, at 11 eV (Glucose) and 12.65 eV (Ribose), the absolute values of the measured total ionization cross sections of these molecules were obtained. The ionization potentials of glucose and ribose molecules were evaluated from binding HOMO MOs energies and compared with the measured values: 12.25 ± 0.25 eV (Glucose) and 10.46 ± 0.25 eV (Ribose). The contributions of the higher orbitals HOMO, HOMO-1, HOMO-2 to the Gryz-DFT cross section were evaluated. [ABSTRACT FROM AUTHOR]

The single-center convergent close coupling (CCC) method has been applied to positron scattering from the oxygen atom. Cross sections have been calculated for total, elastic, momentum transfer, total ionization, inelastic, and excitation scattering processes from threshold to 5000 eV. Due to their relevance in transport studies, we also present stopping power and mean excitation energy results. Low-energy studies have been conducted to calculate scattering length, the hidden Ramsauer–Townsend minimum, and the energy of the positron virtual state. CCC-scaled complex optical potential calculations are utilized to calculate positronium-formation, direct ionization, and values between the positronium-formation and ionization thresholds. Good agreement is generally observed at high energies with past theory, electron-atomic oxygen experiment, and halved electron/positron O 2 experiment. Large discrepancies, however, have been found between current and previous calculations for positronium-formation cross section and for low-energy elastic scattering cross section. [ABSTRACT FROM AUTHOR]

Introduction: Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available. Material and methods: Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system. Results: Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22–95). The average follow-up period was 7.9 years (range 2–22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87–93]. Trabecular metal augments (93% [76–98]) and shells (97% [84–99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons). Conclusion: Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts. Clinical trial registration: PROSPERO: CRD42020223093. [ABSTRACT FROM AUTHOR]

Minimally invasive esophagectomy (MIE) has been shown to be superior to open esophagectomy with reduced morbidity, mortality, and comparable lymph node (LN) harvest. However, MIE is technically challenging. This study aims to perform a pooled analysis on the number of cases required to surmount the learning curve (LC), i.e. NLC in MIE. PubMed, Embase, Scopus, and the Cochrane Library were systematically searched for articles from inception to June 2022. Inclusion criteria were articles that reported LC in video-assisted MIE (VAMIE) and/or robot-assisted MIE (RAMIE). Poisson means (95% confidence interval [CI]) was used to determine NLC. Negative binomial regression was used for comparative analysis. There were 41 articles with 45 data sets (n  = 7755 patients). The majority of tumors were located in the lower esophagus or gastroesophageal junction (66.7%, n  = 3962/5939). The majority of data sets on VAMIE (n  = 16/26, 61.5%) used arbitrary analysis, while the majority of data sets (n  = 14/19, 73.7%) on RAMIE used cumulative sum control chart analysis. The most common outcomes reported were overall operating time (n  = 30/45) and anastomotic leak (n  = 28/45). Twenty-four data sets (53.3%) reported on LN harvest. The overall NLC was 34.6 (95% CI: 30.4–39.2), 68.5 (95% CI: 64.9–72.4), 27.5 (95% CI: 24.3–30.9), and 35.9 (95% CI: 32.1–40.2) for hybrid VAMIE, total VAMIE, hybrid RAMIE, and total RAMIE, respectively. NLC was significantly lower for total RAMIE compared to total VAMIE (incidence rate ratio: 0.52, P  = 0.032). Studies reporting NLC in MIE are heterogeneous. Further studies should clearly define prior surgical experiences and assess long-term oncological outcomes using non-arbitrary analysis. [ABSTRACT FROM AUTHOR]