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Textbook outcome is a composite measure used in surgery to define the ideal postoperative period and to assess the quality of care. The aim of this study was to analyze the incidence of textbook outcome and the factors independently associated with its achievement following surgical treatment of liver hydatid cysts. Retrospective cohort study of patients operated on for liver hydatid cysts between January 2006 and December 2021. Textbook outcome was achieved when all the following criteria were fulfilled: no mortality within 90 days, no major complications within 90 days, no hospital readmission within 90 days, and no prolonged hospital stay. Univariable and multivariable analyses were performed to identify factors associated with textbook outcome. During the study period, 296 patients underwent surgery. Textbook outcome was recorded in 65.9% (195/296). Female gender (odds ratio 2.02; P =.010), noncomplicated cyst (odds ratio 3.97, P <.001), and radical surgery (odds ratio 2.26, P =.003) were the variables associated with a higher probability of achieving textbook outcome. Textbook outcome may be a useful measure to assess the variations in surgical management between different centers, and to improve quality of care after liver hydatid cysts resection. [ABSTRACT FROM AUTHOR]

Bleeding is an intraoperative and postoperative complication of liver surgery of concern, and yet evidence to support utility and reproducibility of bleeding scales for liver surgery is limited. We determined the reproducibility of the clinician-reported validated intraoperative bleeding severity scale and its clinical value of implementation in liver surgery. In this descriptive and observational multicenter study, we assessed the performance of liver surgeons instructed on the clinician-reported intraoperative bleeding severity scale using training videos that covered all 5 grades of bleeding severity. Surgeons were stratified according to years of surgical experience and number of surgeries performed per year based on a median split in low and high values. Intraobserver and interobserver agreement was assessed using Kendall's coefficient of concordance (Kendall's W). Forty-seven surgeons from 10 hospitals in Spain participated in the study. The overall intraobserver concordance was 0.985, and the overall interobserver concordance was 0.929. For "high experience" surgeons, the intraobserver and interobserver agreement values were 0.990 and 0.941, respectively. For "low experience" surgeons, the intraobserver and interobserver agreement was 0.981 and 0.922, respectively. Regarding the annual number of surgeries, intraobserver and interobserver agreement values were 0.995 and 0.940, respectively, for surgeons performing >35 surgeries per year, with 0.979 and 0.923, respectively, for surgeons who perform ≤35 surgeries year. The clinician-reported intraoperative bleeding severity scale shows high interobserver and intraobserver concordance, suggesting it is a useful tool for assessing severity of bleeding during liver surgery; years of surgical experience and number of annual procedures performed did not affect the applicability of the clinician-reported intraoperative bleeding severity scale. [Display omitted] [ABSTRACT FROM AUTHOR]

Revisional bariatric surgery (RS) is indicated if there is weight regain or insufficient weight loss, no improvement or reappearance of co-morbidities, or previous bariatric surgery complications. It has been associated with higher postoperative morbidity. To evaluate the early postoperative complications (<30 d) of Roux-en-Y gastric bypass RS (RYGB-RS) after primary sleeve gastrectomy (SG-1) compared with primary RYGB (RYGB-1) at a bariatric surgery referral center. Department of General and Digestive Surgery of General Universitary Hospital of Alicante, Spain. Retrospective cohort study comparing RYGB-RS after SG-1 and RYGB-1 between January 2008 and March 2021. Postoperative complications, hospital stay, mortality, and readmissions were analyzed. Six hundred and twenty-eight RYGB surgeries (48 RYGB-RS, 580 RYGB-1) were studied. The mean age of patients undergoing RYGB-RS was 50 years, compared with 46 years in the RYGB-1 group (P =.017). Mean initial body mass index was 44.2 kg/m2 (RYGB-RS) versus 47.6 kg/m2 (RYGB-1; P =.004). Cardiovascular risk factors were higher in the RYGB-1 group (P <.05). Indications for RS were weight regain or insufficient weight loss (72.9%), weight regain or insufficient weight loss plus gastroesophageal reflux disease (14.6%), and gastroesophageal reflux disease (12.5%). There were no differences in the frequency of complications (RYGB-RS 22.9% vs RYGB-1 20.5%) or in their severity (Clavien–Dindo ≥IIIa; RYGB-RS 10.4% vs RYGB-1 6.4%; P >.05). There were no differences in emergency room visits (RYGB-RS at 12.5% vs RYGB-1 at 14.9%) or in readmissions (RYGB-RS at 12.5% vs RYGB-1 at 9.4%). No differences were observed between primary RYGB and revisional RYGB in early morbidity, mortality, emergencies, or readmissions. Revisional bariatric surgery is a safe procedure at referral centers and must be done by expert hands. [ABSTRACT FROM AUTHOR]

• Peginterferon beta-1a is a drug to treat multiple sclerosis (MS). • It has a longer half-life than other interferon beta formulations. • We examined levels of peginterferon beta-1a in breast milk of patients with MS. • Minimal concentrations of the drug were detected in the breast milk samples. • Highest C max was 126.2 pg/mL; estimated RID from mean concentration was 0.0054%. Peginterferon beta-1a is an interferon beta-1a formulation that has been pegylated, resulting in a longer half-life than other interferon beta formulations. We examined concentrations of peginterferon beta-1a in breast milk of lactating patients with multiple sclerosis (MS) receiving peginterferon beta-1a as their postpartum disease-modifying therapy. After completion of titration to a full dose of peginterferon beta-1a and following a single full dose peginterferon beta-1a injection (125 µg), breast milk samples (≥10 mL) were collected by 5 women on days 1–14 post injection. Peginterferon beta-1a concentrations in breast milk samples were measured by a qualified enzyme-linked immunosorbent assay (detection threshold: 15 pg/mL). Mean and median daily concentrations and median maximum concentration (C max), time of C max (T max), time of last measurable concentration (T last), area under the concentration-time curve (AUC last), and relative infant dose (RID) were determined. After receiving a single full dose peginterferon beta-1a injection, the maximum breast milk concentration recorded in an individual patient was 126.2 pg/mL (0.00013 µg/mL) on day 6. The remaining patients all had maximum breast milk concentrations <72 pg/mL. The geometric mean of C max was 48.9 pg/mL and the median T max and T last were 4 and 7 days, respectively. The median AUC last was 210.9 day*pg/mL. Among the 5 study patients, the mean breast milk concentration across all study days was 35.95 pg/mL, with an estimated RID of 0.0054% of the maternal dose. Minimal concentrations of peginterferon beta-1a were detected in the breast milk samples. These findings may be useful for clinicians considering postpartum MS treatment options. [ABSTRACT FROM AUTHOR]

Transmission of HBV infection through transfusion of HBsAg-negative blood has been documented. It is evident that low levels of HBV-DNA remain detectable in serum and liver tissue of some patients who clear HbsAg, and that the detection rate is highest in individuals who are 'anti-HBc positive alone'. This study was designed to assess the frequency and clinical significance of 'anti-HBc alone' in Lebanese blood donors. A total of 5511 blood donor samples from three major hospitals representing most regions of the country were tested for anti-HBc, amongst other screening tests. Samples positive for 'anti-HBc alone' were then tested for HBV-DNA and any positive for HBV-DNA were then genotyped and investigated for hepatitis B viral load. The study showed that 203 (3.7%) of randomly selected Lebanese blood donors were confirmed as 'anti-HBc alone'. Of these, 11 (5.4%) were HBV-DNA positive as detected by nested PCR. All samples had HBV-DNA levels below 400 copies/ml and all were genotype D. It can be concluded that HBV was present, although the circulating amount of virus was below the detectable limit for the assay used. Therefore, routine screening for anti-HBc may be required in Lebanese blood donation centres as an additional preventive measure for controlling transmission of HBV via blood transfusion. Copyright © 2007 The Hospital Infection Society [ABSTRACT FROM AUTHOR]

Summary: Transmission of HBV infection through transfusion of HBsAg-negative blood has been documented. It is evident that low levels of HBV-DNA remain detectable in serum and liver tissue of some patients who clear HbsAg, and that the detection rate is highest in individuals who are ‘anti-HBc positive alone’. This study was designed to assess the frequency and clinical significance of ‘anti-HBc alone’ in Lebanese blood donors. A total of 5511 blood donor samples from three major hospitals representing most regions of the country were tested for anti-HBc, amongst other screening tests. Samples positive for ‘anti-HBc alone’ were then tested for HBV-DNA and any positive for HBV-DNA were then genotyped and investigated for hepatitis B viral load. The study showed that 203 (3.7%) of randomly selected Lebanese blood donors were confirmed as ‘anti-HBc alone’. Of these, 11 (5.4%) were HBV-DNA positive as detected by nested PCR. All samples had HBV-DNA levels below 400 copies/ml and all were genotype D. It can be concluded that HBV was present, although the circulating amount of virus was below the detectable limit for the assay used. Therefore, routine screening for anti-HBc may be required in Lebanese blood donation centres as an additional preventive measure for controlling transmission of HBV via blood transfusion. [Copyright &y& Elsevier]

Background The multiarterial grafting survival advantage noted in the overall population undergoing coronary artery bypass grafting is not well defined in the obese. We investigated the early to late survival effects of the radial artery in left internal thoracic artery–based multiarterial bypass grafting (radial artery-multiarterial bypass grafting) versus single arterial bypass grafting (left internal thoracic artery-single arterial bypass grafting) in obese patients. Methods We analyzed 15-year Kaplan–Meier survival in 6102 patients receiving primary, left internal thoracic artery–based coronary artery bypass grafting with 2 or more grafts divided into body mass index groups: nonobese (<30 kg/m 2 ) and all-obese, comprised of mildly obese (30-35 kg/m 2 ) and morbidly obese (>35 kg/m 2 ). Risk-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of radial artery-multiarterial bypass grafting versus left internal thoracic artery-single arterial bypass grafting were derived via Cox regression and applied separately for early (<0.5 years), intermediate (0.5-5 years), and late (5-15 years) follow-up in each body mass index cohort. Propensity score matching between radial artery-multiarterial bypass grafting and left internal thoracic artery-single arterial bypass grafting cohorts within the body mass index groups was performed as a corroborating analysis. Results Radial artery-multiarterial bypass grafting was more frequently used in obese patients who were younger (62 ± 10 years; mild/morbid: 45.4%/54.4% radial artery-multiarterial bypass grafting) compared with nonobese patients (66 ± 10 years; 37.4% radial artery-multiarterial bypass grafting). Unadjusted 15-year survival was significantly better for radial artery-multiarterial bypass grafting in all body mass index groups. Multivariate analysis showed a survival benefit of radial artery-multiarterial bypass grafting over the entire 0- to 15-year study period in the all-obese cohort (HR, 0.85; 95% CI, 0.74-0.98) and was more pronounced in the mildly obese (HR, 0.79; 95% CI, 0.66-0.96) versus morbidly obese (HR, 0.88; 95% CI, 0.69-1.13). The radial artery-multiarterial bypass grafting survival benefit was realized between 0.5 and 5 years postoperatively and was comparable for all-obese (HR, 0.69; 95% CI, 0.51-0.94) and nonobese (HR, 0.68; 95% CI, 0.52-0.88) groups. Propensity score matching was confirmatory. Conclusions Radial artery-multiarterial bypass grafting confers a long-term survival advantage in both obese and nonobese patients. [ABSTRACT FROM AUTHOR]