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Objectives: To determine whether 6 months of preoperative apalutamide for intermediate‐risk prostate cancer (IRPCa) reduces the aggregate postoperative radiotherapy risk and to evaluate associations of molecular perturbations with clinical outcomes in this study cohort. Patients and Methods: Between May 2018 and February 2020, eligible patients with IRPCa (Gleason 3 + 4 or 4 + 3 and clinical T2b‐c or prostate‐specific antigen level of 10–20 ng/mL) were treated with apalutamide 240 mg/day for 6 months followed by radical prostatectomy (RP) in this single‐arm, phase II trial. The primary endpoint was presence of any adverse pathological feature at risk of pelvic radiation (pathological T stage after neoadjuvant therapy [yp]T3 or ypN1 or positive surgical margins). Translational studies, including germline and somatic DNA alterations and RNA and protein expression, were performed on post‐apalutamide RP specimens, and assessed for associations with clinical outcomes. Results: A total of 40 patients underwent a RP, and only one patient discontinued apalutamide prior to 6 months. In all, 40% had adverse pathological features at time of RP, and the 3‐year biochemical recurrence (BCR) rate was 15%, with 27.5% being not evaluable. Genomic alterations frequently seen in metastatic PCas, such as androgen receptor (AR), tumour protein p53 (TP53), phosphatase and tensin homologue (PTEN), or BReast CAncer associated gene (BRCA1/2) were underrepresented in this localised cohort. Adverse pathological features and BCR at 3‐years were associated with increased expression of select cell cycle (e.g., E2F targets: adjusted P value [Padj] < 0.001, normalised enrichment score [NES] 2.47) and oxidative phosphorylation (Padj < 0.001, NES 1.62) pathways. Conclusions: Preoperative apalutamide did not reduce the aggregate postoperative radiation risk to the pre‐specified threshold in unselected men with IRPCa. However, transcriptomic analysis identified key dysregulated pathways in tumours associated with adverse pathological outcomes and BCR, which warrant future study. Further investigation of preoperative therapy is underway for men with high‐risk PCa. [ABSTRACT FROM AUTHOR]

Summary: Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In‐process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk‐of Bias 2 tool for randomised trials and the Risk Of Bias In Non‐randomised Studies ‐ of Interventions for non‐randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non‐randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non‐pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research. [ABSTRACT FROM AUTHOR]

As part of their treatment, lung cancer patients frequently endure thoracic oncological surgery, with preoperative chemotherapeutic interventions being the common approach. However, the potential impact of these chemotherapeutic regimens on cutaneous wound healing outcomes following surgery remains the topic of considerable clinical interest. This meta‐analysis sought to evaluate comprehensively the effect of preoperative chemotherapeutic regimens on cutaneous wound healing in lung cancer patients following thoracic oncological surgery. Extensive literature searches were conducted using the leading databases PubMed, Embase, Cochrane Library and Scopus. Eight studies out of 1342 identified satisfied the inclusion criteria. Consideration was given to both randomized controlled trials (RCTs) and observational studies. Data pertaining to study characteristics, patient demographics, chemotherapeutic regimens and wound healing outcomes were extracted with great attention to detail. The examination of these varied studies provided insights into the fluctuations in rates of recovery following treatment, incidences of wound infections and frequencies of surgical complications. The research studies provided odds ratios for recovery that varied significantly in magnitude from 0.95 to 0.38, with regard to the probability of wound infection. Furthermore, a range of odds ratios for complications were disclosed, with certain odds ratios displaying narrow confidence intervals. The complexity of the effect of preoperative chemotherapy on wound closure subsequent to thoracic oncologic surgery is highlighted by our findings. The results underscore the need for individualized treatment strategies for lung cancer patients undergoing surgical procedures that strike a balance between patient safety and optimal clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Alcohol‐based skin preparations were first approved for surgical use in 1998 and have since become standard in most surgical fields. The purpose of this report is to examine incidence of surgical fires because of alcohol‐based skin preparation and to understand how approval and regulation of alcohol‐based skin preparations impacted trends in fires over time. Methods: We identified all reported surgical fires resulting in patient or staff harm from 1991 through 2020 reported to the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. We examined incidence of fires because of these preparations, trends after approval and regulation, and common causes. Results: We identified 674 reports of surgical fires resulting in harm to patients and surgical personnel, in which 84 involved an alcohol‐based preparation. The time‐adjusted model shows that from 1996 through 2006, there was a 26.4% increase in fires followed by a 9.7% decrease from 2007 to 2020. The decrease in fires was most rapid for head and neck and upper aerodigestive tract surgeries. Qualitative content analysis revealed improper surgical site preparation as well as close proximity of surgical sites to an oxygen source as the most common causes of fires. Conclusion: Since FDA approval, alcohol‐based preparation solutions have been associated with a significant percentage of surgical fires. Warning label updates from 2006 to 2012 coupled with increased awareness efforts of associated risks of alcohol‐based surgical solutions likely contributed to the decrease in fires. Improper surgical site preparation technique and close proximity of surgical sites to oxygen continue to be risk factors for fires. Level of Evidence: 4 Laryngoscope, 134:607–613, 2024 [ABSTRACT FROM AUTHOR]

Background: The systemic inflammatory response following surgery as well as that of malignant disease itself is associated with a hypercoagulable state, and thromboprophylaxis is thus recommended during postoperative management of cancer patients. However, limited information is available on the prevalence of preoperative deep vein thrombosis (DVT) and its risk factors in surgical candidates, especially those receiving operations for benign diseases. Methods: This is a retrospective observational study with data of all patients scheduled for elective general surgery between January 2011 and September 2020, undergoing lower extremity venous ultrasonography as preoperative screening for DVT. The prevalence of preoperative asymptomatic DVT was estimated and its associations with clinical variables were evaluated. Results: Among 1512 patients included in the study, 161 (10.6%) had asymptomatic DVT before surgery. DVT prevalence was 13.7% in patients with malignant disease, while it was 8.6% in those with benign disease. The site of the thrombus was distal type in 141 (87.6%) patients, most commonly in the soleal vein. Advanced age (>70 years), female sex, and decreased hemoglobin level were significantly associated with preoperative asymptomatic DVT by multivariate analysis. The odds ratio for advanced age was the highest and rose as age increased. Malignant disease was not an independent risk factor for preoperative DVT. Conclusion: This study showed the prevalence of asymptomatic DVT to be equal in patients with and without malignant disease undergoing elective general surgery. Preoperative DVT assessment is necessary regardless of the disease indicated for surgery, especially in patients with the risk factors identified in this study. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effect of reading a preoperative preparation‐themed storybook on children's preoperative fear and anxiety levels. Methods: The research design was a randomized controlled experiment. The research sample included 80 children (40 in the story group and 40 in the control group) who met the inclusion criteria. Data collection tools were collected through face‐to‐face interviews with the 'Survey Form', 'Child Fear Scale (CFS)' and 'Modified Yale Preoperative Anxiety Scale (mYPAS)'. In the research, the book named Elif Has Surgery was used as an intervention tool. In the story group, the preoperative preparation‐themed storybook was read to the child in their room at the clinic by their mother within 10 min. The control group received only clinical routine. The study was approved by the ethics committee. Results: There was a statistically significant difference between the groups in the mean scores of the CFS and mYPAS scales in the control and story groups (p < 0.05). Conclusions: This study found that reading a preoperative preparation‐themed storybook reduced children's fear and anxiety before surgery. It may be recommended to expand the use of preoperative preparation‐themed storybooks in order to prevent fear and anxiety experienced before surgery in paediatric surgery clinics. Story reading is an effective, cheap, non‐pharmacological intervention. The clinical trial registration number is NCT05478369. [ABSTRACT FROM AUTHOR]

Background: Endoscopic transpapillary naso‐gallbladder drainage (ENGBD) has been reported to be an effective treatment option for acute cholecystitis. At our institution, ENGBD was first placed for external fistula management, and endoscopic internalization by cutting was performed, shifting to endoscopic transpapillary gallbladder stenting (EGBS) after improvement of cholecystitis. However, there has been no comparative study to define which preoperative management is better: converting ENGBD to EGBS or removing ENGBD. The study aimed to compare the incidence rate of the late adverse events (AEs) related to biliary system between shifting from ENGBD to EGBS and removal of ENGBD. Methods: We retrospectively studied 122 patients who underwent ENGBD for acute cholecystitis between January 2010 and October 2022. The patients were divided into two groups: the cutting group (converting ENGBD to EGBS) and the removal group (removal of ENGBD). The short and late clinical outcomes were compared between groups. Results: Endoscopic transpapillary naso‐gallbladder drainage was successfully placed in 78.6% (96/122), and elective cholecystectomy was performed in 31 and 36 patients in the cutting and removal groups, respectively. The cumulative late‐AE rates were 6.4% and 33.3% (p =.007), with a median waiting period for elective cholecystectomy of 58 and 33 days (p =.390) in the cutting and removal groups, respectively. In the multivariate analysis, only endoscopic internalization by cutting was an independent factor affecting late AEs. Conclusion: Endoscopic internalization by cutting ENGBD after the resolution of acute cholecystitis was considered effective in reducing the risk of late AEs during the waiting period for an elective cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Growing evidences have indicated neurodevelopmental disorders in infantile esotropia (IE). However, few studies have analyzed the characteristics of large‐scale functional networks of IE patients or their postoperative network‐level alterations. Methods: Here, individuals with IE (n = 32) and healthy subjects (n = 30) accomplished the baseline clinical examinations and resting‐state MRI scans. A total of 17 IE patients also underwent corrective surgeries and completed the longitudinal clinical assessments and resting‐state MRI scans. Linear mixed effects models were applied for cross‐sectional and longitudinal network‐level analyses. Correlation analysis was performed to assess the relationship between longitudinal functional connectivity (FC) alterations and baseline clinical variables. Results: In cross‐sectional analyses, network‐level FC were apparently aberrant in IE patients compared to controls. In longitudinal analyses, intra‐ and internetwork connectivity were observed with significant alterations in postoperative IE patients compared to the preoperative counterparts. Longitudinal FC changes are negatively correlated to the age at surgery in IE. Conclusions: Obviously, altered network‐level FC benefiting from the corrective surgery serves as the neurobiological substrate of the observed improvement of stereovision, visuomotor coordination, and emotional management in postoperative IE patients. Corrective surgery should be performed as early as possible to obtain more benefits for IE in brain function recovery. [ABSTRACT FROM AUTHOR]

Rationale: Preoperative care is one of the main areas in which to address low‐value care. A detailed definition of what low‐value care is in this period of the surgical care journey paves the way for new scientific research, clinical improvements, and reduction of unnecessary costs in this field. Aims and Objective: To identify how low‐value care in low‐risk preoperative population has been defined in the scientific literature and propose a low‐value care framework with potential consequences in this setting. Methods: Scoping review of theoretical studies and peer‐reviewed papers, including reviews, commentaries, or expert opinions, were considered eligible for inclusion. The following databases were consulted: MEDLINE (via PubMed), EMBASE, and SCOPUS (from inception to July 24, 2021), using a structured search with the keywords "low value care", "clinical waste", "preoperative", and "elective procedures." Two independent reviewers performed study selection and data extraction. The definition of low‐value care in the preoperative period and their consequences were described after extracting previous low‐value care concepts and summarising the contents. Also, a visual framework was built with this information. Results: From 1519 publications identified in the initial searches, 22 underwent full‐text assessment, and 11 conceptual studies were included in the review. A total of four studies (36%) presented a general low‐value care definition, and all studies report some situations considered low‐value care in the preoperative field of low‐risk surgeries. The most common example of preoperative low‐value care, listed in nine studies (81%), was having asymptomatic patients undergo screening tests before surgery. The main clinical and nonclinical consequences of low‐value care in the preoperative phase included false‐positive results from exams as well as psychological distress, increased costs, and delay in surgery. Conclusions: Revisiting and integrating previous definitions of low‐value care in low‐risk surgery into a scoping review is a starting point for de‐implementing unnecessary care and promoting improvements in surgical pathways. [ABSTRACT FROM AUTHOR]

Preoperative clinical MRI protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this second part, we review magnetic resonance spectroscopy (MRS), chemical exchange saturation transfer (CEST), susceptibility‐weighted imaging (SWI), MRI‐PET, MR elastography (MRE), and MR‐based radiomics applications. The first part of this review addresses dynamic susceptibility contrast (DSC) and dynamic contrast‐enhanced (DCE) MRI, arterial spin labeling (ASL), diffusion‐weighted MRI, vessel imaging, and magnetic resonance fingerprinting (MRF). Evidence Level: 3. Technical Efficacy: Stage 2. [ABSTRACT FROM AUTHOR]

Preoperative clinical magnetic resonance imaging (MRI) protocols for gliomas, brain tumors with dismal outcomes due to their infiltrative properties, still rely on conventional structural MRI, which does not deliver information on tumor genotype and is limited in the delineation of diffuse gliomas. The GliMR COST action wants to raise awareness about the state of the art of advanced MRI techniques in gliomas and their possible clinical translation or lack thereof. This review describes current methods, limits, and applications of advanced MRI for the preoperative assessment of glioma, summarizing the level of clinical validation of different techniques. In this first part, we discuss dynamic susceptibility contrast and dynamic contrast‐enhanced MRI, arterial spin labeling, diffusion‐weighted MRI, vessel imaging, and magnetic resonance fingerprinting. The second part of this review addresses magnetic resonance spectroscopy, chemical exchange saturation transfer, susceptibility‐weighted imaging, MRI‐PET, MR elastography, and MR‐based radiomics applications. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Background: Three‐dimensional (3D) contrast‐enhanced T1‐weighted flow‐sensitive black‐blood (CE‐T1WI FSBB) is a newly developed black blood sequence by adding motion probing gradient pulses to gradient echo (GRE) sequences, which has important value for the preoperative assessment of tumor brain blood supply vessels and intratumoral microbleeds. Purpose: To compare 3D CE‐T1WI FSBB and 3D contrast‐enhanced fast spin echo (FSE) sequence for T1WI for preoperative assessment of blood vessels and microbleeds in brain tumors and to investigate the correlation between visible vessels and microbleeds. Study type: Prospective. Subjects: One hundred and seventy‐five patients with brain tumors, 65 were male, 110 were female. Including histologically confirmed 73 meningiomas, 23 schwannomas, 20 gliomas, 7 hemangioblastomas, 5 metastases, 2 lymphomas, 2 hemangiopericytomas, 2 germ cell tumors, 1 craniopharyngioma, and 1 cholesteatoma. Field Strength/Sequence: A 3‐T, CE‐T1WI FSBB, GRE; 3‐T, CE‐T1WI, FSE. Assessment: Three neuroradiologists counted the number of intratumoral vessels on CE‐T1WI and CE‐T1WI FSBB images separately, and they counted the number of intratumoral microbleeds on CE‐T1WI FSBB images. Brain tumors were classified into grade I, grade II, and grade IV according to the World Health Organization (WHO) grading. Differences in the ability of CE‐T1WI FSBB and CE‐T1WI to display intratumoral vessels were compared. The mean counts of three observers were used to study the correlation between vessels and microbleeds. Statistical Tests: Two‐way random intraclass correlation coeficient (ICC) was used for inter‐reader agreement regarding intratumoral vessel and microbleed counts, and the linear regression analysis (with F‐test) was used to study the correlation between intratumoral vessels and microbleeds based on CE‐T1WI FSBB (α = 0.05). Results: Inter‐reader agreements for intratumoral vessel count on CE‐T1WI (ICC = 0.93) and CE‐T1WI FSBB (ICC = 0.92), and the agreement for intratumoral microbleed count on CE‐T1WI FSBB (ICC = 0.99) were excellent. There were statistically significant differences in intratumoral vessel counts between CE‐T1WI and CE‐T1WI FSBB using Mann–Whitney U ‐test: image readers could identify more intratumoral vessels on CE‐T1WI FSBB images, particularly for meningiomas, schwannomas, gliomas, and WHO grade I tumors. The number of intratumoral vessels had a significant positive effect on the number of intratumoral microbleeds (microbleeds = 5.024 + 1.665 × vessels; F = 11.51). Data Conclusion: More intratumoral vessels could potentially be identified using a 3D CE‐T1WI FSBB sequence compared to a CE‐T1WI sequence, and the number of intratumoral vessels showed a positive linear relationship with the number of intratumoral microbleeds, which might suggest that brain tumors with rich blood supply were more prone to intratumoral microbleeds. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Mounting evidence suggests that recovery begins before the surgical incision. The presurgery phase of recovery, namely the preparation for optimal surgical recovery, can be reinforced with prehabilitation. Prehabilitation is the approach of enhancing the functional capacity of the individual to enable them to withstand a stressful event. With this narrative review, we apply the Wilson and Cleary conceptual model of patient outcomes to specify the complex and integrative relationship of health factors that limit functional capacity before surgery. To have the greatest impact on patient outcomes, prehabilitation programs require individualised and coordinated care from medical, nutritional, psychosocial and exercise services. Key points: 1.Many biological and physiological factors influence functional capacity.2.Some of the biological and physiological factors that limit function cannot be corrected with exercise alone.3.Prehabilitation programs that identify and address the root cause(s) for poor functional capacity with multimodal treatment may produce positive outcomes more consistently. [ABSTRACT FROM AUTHOR]

Background: Preoperative anemia is common and associated with adverse postoperative outcomes. Assessment of hemoglobin concentrations may facilitate optimization prior to surgery. However, phlebotomy‐based hemoglobin measurement may contribute to patient discomfort and iatrogenic blood loss, which makes non‐invasive hemoglobin estimation attractive in this setting. Study Design and Methods: This is a prospective study of adult patients presenting for preoperative evaluation before elective surgery at a tertiary care medical center. The Masimo Pronto Pulse CO‐Oximeter was utilized to estimate blood hemoglobin concentrations (SpHb), which were then compared with hemoglobin concentrations obtained via complete blood count. Receiver operating curves were used to identify SpHb values maximizing specificity for anemia detection while meeting a minimum sensitivity of 80%. Results: A total of 122 patients were recruited with a median (interquartile range) age of 66 (58, 72) years. SpHb measurements were obtained in 112 patients (92%). SpHb generally overestimated hemoglobin with a mean (± 1.96 × standard deviation) difference of 0.8 (−2.2, 3.9) g/dL. Preoperative anemia, defined by hemoglobin <12.0 g/dL in accordance with institutional protocol, was present in 22 patients (20%). The optimal SpHb cut‐point to identify anemia was 13.5 g/dL: sensitivity 86%, specificity 81%, negative predictive value 96%, and positive predictive value 53%. Utilizing this cut‐point, 60% (73/122) of patients could have avoided phlebotomy‐based hemoglobin assessment, while an anemia diagnosis would have been missed in <3% (3/122). Conclusion: The use of SpHb devices for anemia screening in surgical patients is feasible with the potential to reliably rule‐out anemia despite limited accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effects of preoperative high‐intensity interval training (HIIT) compared to usual care on tumour natural killer (NK)‐cell infiltration in men with localised prostate cancer (PCa), as NK‐cell infiltration has been proposed as one of the key mechanisms whereby exercise can modulate human tumours. Patients and Methods: A total of 30 patients with localised PCa undergoing radical prostatectomy (RP) were randomised (2:1) to either preoperative aerobic HIIT four‐times weekly (EX; n = 20) or usual care (CON; n = 10) from time of inclusion until scheduled surgery. Tumour NK‐cell infiltration was assessed by immunohistochemistry (CD56+) in diagnostic core needle biopsies and corresponding prostatic tissue from the RP. Changes in cardiorespiratory fitness, body composition, blood biochemistry, and health‐related quality of life were also evaluated. Results: The change in tumour NK‐cell infiltration did not differ between the EX and CON groups (between‐group difference: −0.09 cells/mm2, 95% confidence interval [CI] –1.85 to 1.66; P = 0.913) in the intention‐to‐treat analysis. The total number of exercise sessions varied considerably from four to 30 sessions. The per‐protocol analysis showed a significant increase in tumour NK‐cell infiltration of 1.60 cells/mm2 (95% CI 0.59 to 2.62; P = 0.004) in the EX group. Further, the total number of training sessions was positively correlated with the change in NK‐cell infiltration (r = 0.526, P = 0.021), peak oxygen uptake (r = 0.514, P = 0.035) and peak power output (r = 0.506, P = 0.038). Conclusion: Preoperative HIIT did not result in between‐group differences in tumour NK‐cell infiltration. Per‐protocol and exploratory analyses demonstrate an enhanced NK‐cell infiltration in PCa. Future studies are needed to test the capability of exercise to increase tumour immune cell infiltration. [ABSTRACT FROM AUTHOR]

Background: Preoperative anxiety is a common issue in surgery. Preoperative anxiety may lead to increased mortality, pain and dissatisfaction with surgery. Melatonin is a drug with only mild adverse effects and has previously been shown to reduce anxiety and pain in the perioperative setting. The aim of study was to investigate the anxiolytic effect of melatonin in the preoperative setting.Methods: This study was a randomised, double-blinded, placebo-controlled clinical trial. Included patients were allocated in the ratio 1:1 to either the placebo group or the melatonin group. Patients received 10 mg melatonin or placebo the evening before surgery, 2 h before surgery, immediately after surgery and the evening after surgery. Preoperative anxiety was examined 1 h before surgery, using the State Trait Anxiety Inventory (STAI) questionnaire, along with a Visual Analogue Scale (VAS) of anxiety. Furthermore, participants filled out a sleep log each morning, where we examined sleep quality, comfort and drowsiness.Results: Sixteen patients received placebo treatment and 17 patients received melatonin. Median state anxiety on the STAI scale at baseline was 27 (interquartile range [IQR] 22-34) for the melatonin group and 27 (IQR 23-31) for the placebo group. In the primary outcome of preoperative anxiety 1 h before surgery, the median state anxiety on the STAI scale was 27 (IQR 24-34) for the melatonin group and 28 (24-33) for the placebo group, p = .814. VAS anxiety was median 7 (0-28) for the melatonin group and median 7 (1-13) for the placebo group, p = .813. Furthermore, there were no statistically significant differences between the two groups in the secondary outcomes of sleep quality and consumption of analgesics.Conclusion: Melatonin did not reduce preoperative anxiety in patients undergoing hernia repair. Preoperative anxiety levels were low, which limits the generalisability of our findings. [ABSTRACT FROM AUTHOR]

Aim: Evaluate feasibility and outcomes of a multimodal prehabiliation program in patients with stage I‐III colorectal cancer (CRC) awaiting surgery. Methods: Patients scheduled for elective CRC resection at Concord Repatriation General Hospital were recruited from pre‐admission clinic between January and November 2018. Participants received a 2‐4 week prehabilitation program consisting of supervised exercise sessions, nurse‐led phone support, and written nutritional information. Participants were assessed at baseline, pre‐surgery, and 4 weeks post‐surgery. Results: Twenty‐two patients participated in the program: 55% male; median age 73 (56‐86) years. Six (28%) required an interpreter. At baseline, 19 of 22 (86%) had at least one comorbidity. Median intervention length was 11.5 days (range 7‐29). Participants attended 79% of scheduled exercise sessions (range 33‐100%, mean 3.5 sessions) and 66% of nurse support calls (range 0‐100%, mean 2.6 sessions). Between baseline and pre‐surgery, participants reported increasing mean unsupervised moderate‐intensity aerobic exercise from 17 (range 0‐210) to 73 minutes/week (range 0–276) and mean vigorous‐intensity aerobic exercise from 0 to 24 minutes/week (range 0‐300). Resistance exercise sessions increased from 0.6 to 2.6 times/week. Mean 6‐minute walk test distance increased by 48 meters (435‐483 m) and 30‐second "sit to stand" by 1.6 repetitions. Small improvements were seen in global quality of life and fatigue. Nutritional status and body composition remained unchanged. All participants were satisfied/strongly satisfied with the program and would recommend it to others. Conclusion: Our multimodal prehabilitation program was feasible in CRC patients inclusive of those from non‐English speaking backgrounds, with improvement in functional capacity before CRC surgery. [ABSTRACT FROM AUTHOR]

Background: Cyclic motor patterns (CMPs) are the most common motor pattern in the distal colon. This study used high‐resolution (HR) colonic manometry to quantify trends in distal colonic motor activity before elective colonic surgery, determine the effect of a preoperative carbohydrate load, and compare this with a meal response in healthy controls. Methods: Fiber‐optic HR colonic manometry (36 sensors, 1 cm intervals) was used to investigate distal colonic motor activity in 10 adult patients prior to elective colonic surgery, 6 of whom consumed a preoperative carbohydrate drink (200 kCal). Data were compared with nine healthy volunteers who underwent HR colonic manometry recordings while fasted and following a 700 kCal meal. The primary outcome was the percentage of recording occupied by CMPs, defined as propagating contractions at 2–4 cycles per minute (cpm). Secondary outcomes included amplitude, speed, and distance of propagating motor patterns. Results: The occurrence of CMPs progressively increased in time periods closer to surgery (p = 0.001). Consumption of a preoperative drink resulted in significantly increased CMP occurrence (p = 0.04) and propagating distance (p = 0.04). There were no changes in amplitude or speed of propagating motor patterns during the preoperative period. The increase in activity following a preoperative drink was of similar magnitude to the colonic meal response observed in healthy controls, despite the lesser caloric nutrient load. Conclusion: Distal colonic CMP increased in occurrence prior to surgery, amplified by ingestion of preoperative carbohydrate drinks. We hypothesize that anxiety, which is also known to rise with proximity to surgery, could play a contributing role. [ABSTRACT FROM AUTHOR]

Objectives: To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality.Methods: A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS-2 tool was used to assess the quality of the included studies. Mixed-effects diagnostic meta-analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR-) test and diagnostic odds ratio (DOR).Results: Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR- and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83-92%), 97% (95% CI, 95-98%), 30.8 (95% CI, 17.6-54.1), 0.12 (95% CI, 0.08-0.17) and 264 (95% CI, 113-614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79-91%), 96% (95% CI, 94-97%), 21.0 (95% CI, 13.4-33.1), 0.15 (95% CI, 0.09-0.23) and 144 (95% CI, 70-297). For computed tomography, the respective values were 93% (95% CI, 84-97%), 95% (95% CI, 81-99%), 20.3 (95% CI, 4.3-94.9), 0.07 (95% CI, 0.03-0.19) and 280 (95% CI, 28-2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87-95%), 98% (95% CI, 96-99%), 37.1 (95% CI, 21.1-65.4), 0.08 (95% CI, 0.05-0.14) and 455 (95% CI, 196-1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS-2 tool.Conclusions: The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first-line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To optimize prediction for intestinal invasion of epithelial ovarian cancer. It is important to achieve debulking surgery to improve prognosis in ovarian cancer; intestinal resection is adopted if the cancer is invaded and resectable, but the preoperative evaluation method of intestinal invasion is still controversial. Methods: Patients (n = 174) who underwent primary debulking surgery for epithelial ovarian cancer were recruited for retrospective study; 28 and 146 patients were classified into the invasion and non‐invasion groups, whether they needed intestinal resection or not. We collected clinical data including evaluation of computed tomography (CT), magnetic resonance imaging (MRI), and barium contrast radiography, and analyzed their accuracy. Results: The sensitivity and specificity for intestinal invasion were 33.3% and 98.6%, 42.9% and 98.6%, and 66.7% and 93.9% in CT, MRI, and barium contrast radiography, respectively. CT and MRI combined showed a sensitivity of 58.3% and specificity of 96.9%; all three methods combined was the most sensitive combination, showing a sensitivity of 79.2% and specificity of 90.8%. Conclusion: Combination of CT, MRI, and barium contrast radiography predicts intestinal invasion with the highest sensitivity. These three modalities, however, could not predict all intestinal invasion. Patients should be informed of the possibility of unexpected extensive resection. Synopsis: Combination of CT, MRI, and barium contrast radiography give the best prediction of intestinal invasion in ovarian cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture. Methods: From March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis. Results: The incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046). Conclusions: In view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed. [ABSTRACT FROM AUTHOR]

Background: Hip fracture is a common, painful injury with increasing global incidence. Patients require optimal acute pain management. Systematic reviews have investigated the postoperative use of epidural analgesia and found that it may have advantages over systemic analgesia. It is of interest to determine whether pre‐operative use of epidural analgesia is also advantageous. We conducted a systematic review and meta‐analyses on the effect of epidural analgesia on pre‐operative pain management in hip fracture patients. Methods: We included randomized controlled trials comparing pre‐operatively initiated epidural analgesia with any other method of analgesia, in adults aged ≥55 years scheduled for hip fracture surgery. The main outcome was pre‐operative pain at rest. Electronic searches of four medical databases were performed. Two authors independently screened for eligibility, extracted data, and assessed risk of bias. We conducted meta‐analyses and assessed the certainty of the evidence by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Three articles were included, with 179 randomized patients. All studies compared epidural analgesia with systemic analgesia, one additionally with 3‐in‐1‐block. Meta‐analyses of pre‐operative pain measurements resulted in a mean difference of −5.85 95% CI [−14.90; 3.19] on a 0‐100 Visual Analogue Scale with a p‐value of 0.17 and a very low certainty of evidence according to the GRADE rating. Conclusions: We did not find a difference in pre‐operative pain at rest between epidural analgesia and any other method of pre‐operatively initiated analgesia. The studies were few, of low quality and the difference between the two interventions remains unknown. [ABSTRACT FROM AUTHOR]

A role for incisional biopsy in preoperative prognostication is increasingly being advocated in oral tongue squamous cell carcinomas (OTSCC). Biopsies at two locations were compared, and prognostic factors in biopsies and their corresponding resections were evaluated. A total of 138 OTSCC biopsy slides from Finland and Saudi Arabia were compared for size (horizontal and vertical) and invasive front. The Finnish cases were assessed for tumor stroma ratio (TSR) and tumor‐infiltrating lymphocytes (TILs) using light microscopy and digital image analysis assessment and compared. Furthermore, TSR, TILs, and previously analyzed budding and depth of invasion (BD) score in biopsies were compared with their evaluation in the corresponding resections. Fifty‐nine percent of Finnish and 42% of Saudi Arabian biopsies were ≥ 5 mm deep, while 98% of Saudi Arabian and 76% of Finnish biopsies were ≥ 5 mm wide. Assessment of invasion front was possible in 72% of Finnish in comparison with 40% of Saudi Arabian biopsies. There was 86.8% agreement between TSR and 75% agreement between TIL evaluation using light microscopy and digital assessment. Significant agreement was obtained on comparing the TSR (p = 0.04) and BD (p < 0.001) values in biopsies and resections. Biopsies of ≥ 5 mm depth from representative OTSCC areas are essential for prognostic information. Clinical pathologists are advised to assess BD score and TSR for prognostic features in such biopsies. [ABSTRACT FROM AUTHOR]

Introduction: We aimed at evaluating the performance of a new prothrombin time (PT) reagent (STA‐NeoPTimal) with two other PT reagents (STA‐Neoplastine R and STA‐Neoplastine CI Plus) and the reference PT reagent used in our laboratory (ReadiPlasTin). Methods: Evaluation consisted in intra‐ and interassay precision assessment, determination of sensitivity to unfractionated heparin (UFH) or enoxaparin in spiked samples and to direct oral anticoagulants (DOACs) in patients (n = 43). Method comparison of the 4 PT reagents, factor II, V, VII and X assays was tested on normal (n = 20) and abnormal samples: VKA (n = 47), preoperative (n = 23), liver failure (n = 12) and burned patients (n = 37). Results: Analytical performance met manufacturers' criteria for all reagents. All PT reagents gave correlation coefficients >0.8 and even >0.9 in many situations. In some VKA samples, differences ≥ 0.5 INR units were found in samples within and above therapeutic ranges. For burned patients, PT correlations were good but with some minimal bias (<5.0%) while factor assays gave very consistent results (R >.8 and mainly >0.9). As expected, poor responsiveness of the PT to DOAC concentrations was observed with all four assays. Conclusion: The STA‐NeoPTimal showed comparable performance to ReadiPlasTin, making it suitable for VKA control, detection of factors II, V, VII, X deficiency and assessment of liver disease coagulopathy. However, for patients receiving VKA, some significant differences were observed. We confirmed the inability of the PT assay to detect residual DOAC concentrations. Finally, burned patients results showed that recombinant thromboplastins were less sensitive to factor deficiencies in comparison to extraction thromboplastins. [ABSTRACT FROM AUTHOR]

Objective: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic.Methods: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented.Results: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (P = .92).Discussion: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities.Implications For Practice: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays. [ABSTRACT FROM AUTHOR]

Background: In Norway, 6000 patients were operated on due to hip fracture in 2016. Hip fracture results in increased suffering and often in a dramatic change in an older person's life. The experience of suffering in patients with hip fracture, or nursing staff's perception of it in the preoperative period, is sparsely studied. The perspective of the study was based on caring sciences. Aim: The aim of this study was to gain a deeper understanding of subjective experiences of suffering among elderly hip‐fracture patients during the preoperative period, seen from the patients' and nurses' perspective. Methodological approach: A Q‐methodological approach was used. Forty statements (Q‐sample), based on interviews and theory, were ranked in a forced‐choice distribution curve from 'mostly agree' to 'mostly disagree', followed by postinterviews. Nine patients and five nurses participated. A by‐person factor analysis in the form of principal component analysis with varimax and hand rotation was conducted. Results: Three factors, also called viewpoints, emerged as follows: (i) 'Feeling safe through presence, trust and hope'; (ii) 'Feeling safe occurs when the patient is seen, met and informed'; and (iii) 'Feeling alone and angry at oneself'. A polarisation between participants occurred, since the youngest patients (median age 73), the oldest patients (median age 90) and the nurses were represented in each specific factor. Conclusion: There exist differences between how the nursing staff, the youngest and the oldest elderly patients experienced the preoperative period and what can enhance or alleviate their suffering. Where the youngest elderly communicated safety through trust and relatives' presence, the oldest elderly communicated insecurity in relation to staff and experienced severe pain and loneliness. Nursing staff and one patient emphasised the importance of seeing the patient in the first meeting to establish a feeling of security. [ABSTRACT FROM AUTHOR]

Background: Currently, botulinum toxin A (BTA) is mainly used in the treatment of muscle spasms and in cosmetic procedures, and its cosmetic indications are expanding rapidly. There have been sporadic reports focused on the preoperative usage of BTA complementing plastic surgery. We briefly summarize the current experience of BTA complementing plastic surgery in China based on clinical experience. Methods: We reported a brief review of the preoperative use of BTA as an accessory to plastic surgery (blepharoplasty, chin augmentation, mandibular angle ostectomy, rhinoplasty, hyaluronic acid fillers injection for wrinkle reduction) based on previous studies and our experience. Results: Preoperative treatment with BTA in plastic surgery helps surgeons operate and results in better cosmetic results. Conclusions: Preoperative BTA treatment can reduce the occurrence of surgical complications as well as improve the surgical results in some plastic surgeries. The procedure is suitable for clinical application and worth promoting. [ABSTRACT FROM AUTHOR]

Background: It is engrained in medical training that routine blood screening prior to arthroplasty is necessary for optimal patient care. There is little evidence to support their utility and the aggregate cost to the health system. The purpose of this study was to evaluate preoperative blood screening by identifying the frequency of an abnormal result and to examine the influence of age, gender and body mass index on the frequency of abnormal blood pathology. Methods: This is a retrospective review of 1000 patients from a single centre who underwent elective primary hip or knee arthroplasty from 2015 to 2017. Abnormal blood results were identified and clinically relevant intervals were created for routine markers. Results: A total of 939 patients had available pathology results with 84% identified as having an abnormal result and 47% having a clinically important range. Abnormal liver function tests and ferritin were most common. With increasing age, there was a significant increase in rates of abnormal clinically important range, renal dysfunction, abnormal haemoglobin and erythrocyte sedimentation rate. Males and patients with body mass index >40 had an increased rate of abnormal results, particularly liver function tests. Conclusion: The ordering of preoperative investigations prior to lower limb arthroplasty is recommended by the National Institute for Health and Care Excellence guidelines, alleviating concern of post‐operative complications and covering medicolegal issues. Our study determined a high frequency of abnormal results, justifying routine blood screening is recommended prior to surgery, particularly for the elderly, males and obese patients. [ABSTRACT FROM AUTHOR]

Background: Induction of anesthesia can be stressful: Up to 60% of children suffer significant anxiety immediately before surgery. Anxiety is associated with higher postoperative analgesia requirements, higher incidence of emergence delirium, and detrimental effects on sleep and behavior. Child Life preparation includes role‐play, expectation‐setting, and teaching coping strategies. Aim : The aim of this trial was to determine whether preoperative Child Life preparation reduces anxiety prior to intravenous induction of anesthesia. Methods: Children aged 3‐10 years, with no known preexisting anxiety and no preoperative anxiolytics, undergoing elective day surgery lasting ≤ 2 hours, were enrolled in a randomized controlled trial. Each child's baseline anxiety was assessed in the anesthetic care unit, using the modified Yale Preoperative Anxiety Scale—Short Form (mYPAS‐SF, observational scores from 22.9, minimal anxiety, to 100, maximal anxiety) as the primary outcome. The child was randomly assigned to intervention (minimum 15 minutes Child Life preparation) or control (standard practice without Child Life preparation). Participants entered the operating room with one parent. A researcher (blinded to group allocation) scored the child's operating room anxiety using mYPAS‐SF, up to the first attempt at intravenous cannulation. Results: Fifty‐nine children completed the study, aged median [interquartile range] 5 [3‐7] years. Baseline mYPAS‐SF anxiety was 29.2 [22.9‐37.5] for all children, and operating room anxiety was 29.2 [22.9‐49.0]. Operating room anxiety was higher than baseline in 16/31 (52%) children in the control group and 6/28 (21%) in the Child Life preparation group. ANCOVA revealed a significant effect of baseline mYPAS‐SF anxiety and group on operating room anxiety (F = 10.31, P <.001, adjusted R2 =.24); individual parameter estimates indicated that Child Life preparation reduced operating room anxiety by 13.8 (95% CI 4.4‐23.1) points compared to control, P =.005. Conclusion: A brief, targeted Child Life preparation session had a statistically significant effect on reducing preoperative anxiety prior to intravenous induction of anesthesia in young children, with no known preexisting anxiety. This effect may be clinically important and suggests that Child Life can be a valuable component of pediatric surgical care. Further research is required in specific populations. [ABSTRACT FROM AUTHOR]

Background: Preoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6 hours from solids and nonhuman milk, 4 hours from breast milk, and 2 hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child. Aims: This prospective, mixed‐methods study aims to explore the experiences of pediatric patients undergoing preoperative fasting in Leeds General Infirmary. It also aims to investigate fasting durations of these patients and factors which influence these. Methods: Over 2 weeks, surveys were distributed to all parents of elective pediatric patients and completed prior to their child being called to theater. Children over the age of six were offered a child survey, which had been specifically developed for the study, with visual Likert scales and an area for free text. The gathering of children's comments about their experience of preoperative fasting is unique to this study. Results: Seventy‐one parent surveys and 48 child surveys were completed, with a mean patient age of 8.3 years (SD 4.1). The mean preoperative fasting time for food was 11.7 hours (SD 4.4) and 6.9 hours (SD 5.0) for fluids. Fasting times were far in excess of the minimums recommended, negatively impacting patient experience with 34% reporting being hungry/very hungry and 19% thirsty/very thirsty. Most children's comments suggested that they coped well with the fasting; however, several children reported feelings of sadness and anxiety. Conclusion: Preoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this retrospective study was to evaluate the clinical and oncological results of combination treatment of short‐term preoperative denosumab (the receptor activator of nuclear factor kappa‐B ligand inhibitor) with surgery in unresectable or recurrent cases of giant cell tumor of the bone (GCTB). Methods: Between 2016 and 2018, 11 eligible patients (1 man, 10 women, mean age 38.1 years) with grade 3 GCTB were treated with a combination of short‐term (six doses) preoperative denosumab and surgery in a single institution. The clinical, radiological, and pathological alteration after the denosumab treatment were compared. The oncological results of the combination therapy were also recorded. Meanwhile, adverse effects or complications of denosumab, if any, were reported. Results: The median follow‐up time after surgical procedure was 30 months (range 13–45 months). After 3–4 denosumab injections, pain relief was observed in all patients. In two spine patients, the neurological status improved after four doses of treatment. Intraoperatively, the margin of the tumor became clear and the intensity of the tumor increased while the blood supply around and within the lesion decreased. Within the lesion, the typically soft and loose tissue were replaced by the tough and dense fibro‐osseous tissue. The mean diameter of the lesion before and after treatment was 61.55 ± 22.49 mm and 51.81 ± 21.12 mm, respectively, and the T‐score was 1.02 (P = 0.32). Variable calcification was observed at the periphery and within the lesion. A total of three patients experienced local recurrence in this study. In the resection group, only one extremity patient had soft tissue recurrence that was treated with en‐bloc excision. In the curettage group, two of three sacral tumor patients had local occurrence. Both refused re‐operation and restarted the monthly denosumab injection thereafter, and the lesions remained stable at the final follow up. Finally, no adverse effects or complications related to denosumab treatment were found. Conclusion: For the unresectable or recurrent GCTB cases, short‐term (six doses) preoperative use of denosumab improved clinical symptoms, decreased the tumor size, and increased the tumor density. The changes in tumors, in turn, simplified the tumor removal manipulation and, subsequently, decreased the local recurrence for the resection surgery. For the curettage, the denosumab‐induced changes had mixed impacts, and shorter term (fewer than six doses) usage may be more appropriate. Our six‐dose regime was deemed safe, while the safety of long‐term use remains unknown. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma of the inferior vena cava is a rare malignant tumor originating from smooth muscle cells of the vascular media. Its preoperative diagnosis by conventional noninvasive examinations such as abdominal ultrasonography, X-ray computed tomography, and magnetic resonance imaging, may be difficult because of their nonspecific findings. We present the case of a 72-year-old woman with leiomyosarcoma of the inferior vena cava diagnosed by intravascular ultrasonography. [ABSTRACT FROM AUTHOR]

Objective: The low pre‐ and intraoperative diagnostic rates in follicular thyroid carcinoma (FTC) often lead to inadequate surgical resection and necessitate further completion surgery. Therefore, the preoperative prediction of FTC in thyroid nodules is essential. Design and Patient: Patients were categorized into two data sets: the modelling data set, which included 3649 patients admitted to our centre between January 2014 and December 2016, and the validation data set, which included 1253 patients admitted between January and December 2017. Patient data from the FTC and non‐FTC groups were initially included in a modelling data set to establish a preoperative prediction model. This model was subsequently employed in a validation data set for external validation of the predictive value. The positivity rate for FTC predicted by the model was compared with that of the intraoperative frozen sections. Results: The preoperative serum thyroglobulin level, nodule diameter, calcification status, solidity and blood supply were selected as predictors for the model. The regression equation was as follows: Y = 0.010 × (thyroglobulin level) + 0.556 × (nodule diameter) + 0.675 × (calcification status) + 2.355 × (nodule component) + 1.072*(blood flow) − 9.787. The model positively predicted FTC at values of Y ≥ −4.11. The accuracy, sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the prediction model were 89.2%, 90.2%, 87.7%, 39.2 and 0.11, respectively. External validation of the model demonstrated acceptable results. The positive prediction rate of the model was 90.7% (78/86), which was significantly higher than that of the intraoperative frozen sections (10.5% [9/86]; P < 0.0001). Conclusions: We successfully established and validated a simple and reliable preoperative prediction model for FTC using the preoperative thyroglobulin level and ultrasonographic features of the thyroid nodules. This model may improve the preoperative evaluation of FTC in clinical settings and facilitate the development of a reasonable surgical programme for FTC. [ABSTRACT FROM AUTHOR]

Background: Pulmonary function is not routinely assessed in patients without respiratory disease and symptoms before surgery, even if they are smokers. We aimed to check whether the new spirometric reference values of the worldwide Global Lung Initiative (GLI) affected the preoperative assessment of lung function in allegedly lung‐healthy patients compared with the still commonly used old predicted values. Methods: Two hundred nineteen allegedly lung‐healthy non‐smokers, past and current smokers were examined by spirometry before elective surgery. The obtained values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC were transformed into z‐scores according to the GLI guidelines. A comparison between the new and old reference values was performed. FEV1 was used for the grading of airway obstruction. Results: One hundred eighty‐three subjects performed the ventilation manoeuvre according to the GLI recommendations and were analysed. Most non‐smokers and past smokers met the new references ranges for spirometric values. Only z‐scores of FEV1/FVC distinguished among all three patient groups, FEV1 between smokers and the other two groups and FVC did not discriminate the groups, irrespective of the reference values used. Airway obstruction was identified in 24% of asymptomatic smokers by z‐scores of FEV1/FVC but in only 14% by the old predicted values. In elderly smokers (>60 years), the corresponding values rose to 50% and 30%. Old predicted values of FEV1 underestimated the degree of airway obstruction mainly in middle‐aged smokers. Conclusion: Allegedly lung‐healthy current smokers showed a higher proportion of preoperatively reduced lung function when z‐scores were used, especially in elderly subjects. [ABSTRACT FROM AUTHOR]

Aim: To compare ferric carboxymaltose (FCM) with iron sucrose (IS) for the effective and timely treatment of preoperative iron deficiency anemia (IDA) in women with menorrhagia. Methods: This open‐label, multicenter, two‐arm study randomized patients to receive either a single dose of FCM or multiple doses of IS. The primary endpoint was the proportion of patients who achieved hemoglobin (Hb) levels ≥10 g/dL within 2 weeks after the first administration. Secondary endpoints included mean Hb levels, time to reach Hb ≥10 g/dL and quality of life (QoL). Results: In total, 101 patients (FCM n = 52; IS n = 49) were randomized to the study treatments. FCM was as effective as IS in achieving Hb ≥10 g/dL within 2 weeks after the first administration (78.8% vs 72.3%). The time to reach Hb ≥10 g/dL was significantly shorter in the FCM group than in the IS group (7.7 days vs 10.5 days). Mean Hb levels were higher in the FCM‐treated patients than in the IS‐treated patients with borderline significance. QoL scores did not differ between the two groups. Conclusion: Ferric carboxymaltose is as effective as IS in correcting preoperative IDA among patients with menorrhagia. The added benefits of FCM over IS included significant rapid correction of IDA, replenishment of iron stores and reduced hospital visits. [ABSTRACT FROM AUTHOR]

Summary: Background: Accurate measurement of preoperative anxiety is important for pediatric surgical patients' care as well as for monitoring anxiety‐reducing interventions. The modified Yale Preoperative Anxiety Scale‐short form is well validated for this purpose in children aged 2 years and above, but not in younger children. Aims: We aimed to validate the Dutch version of the modified Yale Preoperative Anxiety Scale‐short form for measuring preoperative anxiety in children less than 2 years old. Methods: Two investigators independently assessed infants' anxiety at the holding area and during induction of anesthesia with the modified Yale Preoperative Anxiety Scale‐short form and the COMFORT‐Behavior scale—live and from video observations. Construct validity and responsiveness of both scales were tested with Pearson correlation coefficient. Internal consistency of the modified Yale Preoperative Anxiety Scale‐short form was assessed using Cronbach's α, and inter‐rater reliability and intra‐rater reliability were tested using the intraclass correlation coefficient and Cohen's linearly weighted kappa. Hypotheses for sufficient inter‐rater reliability (r > 0.60) and validity (r > 0.65) had been formulated a priori in line with the COSMIN guidelines. Results: Behavior of 129 infants (89.1% male) with a median age of 6.5 months (range 0.9‐16.5 months) was observed. The correlations between the modified Yale Preoperative Anxiety Scale‐short form and COMFORT‐Behavioral scale were strong at the holding area and at induction of anesthesia, as were the correlation of change scores between the holding area and induction. Internal consistency of the modified Yale Preoperative Anxiety Scale‐short form was excellent at both the holding area and at induction of anesthesia. Inter‐rater reliability was good to excellent on scale level and moderate to good on item level. Conclusion: These findings support the validity and reliability of the Dutch version of the modified Yale Preoperative Anxiety Scale‐short form in children less than 2‐years‐old. [ABSTRACT FROM AUTHOR]

Background: Cefazolin is used as standard preoperative prophylaxis for a variety of surgical procedures that involve the skin. In contrast, vancomycin is recommended for a minority of patients, specifically those with an IgE‐mediated allergy to beta‐lactams and considered in patients with known colonization with methicillin‐resistant Staphylococcus aureus or at high risk for such. Vancomycin, however, has been overprescribed, has nephrotoxicity risk, and may be less effective due to its inferior coverage of methicillin‐susceptible S. aureus and lack of Gram‐negative coverage. This study was performed to assess whether vancomycin use was associated with an increased incidence of cardiovascular implantable electronic device infection (CIEDI) as compared to that of cefazolin or other antistaphylococcal beta‐lactam antibiotics. Methods: The VA Informatics and Computing Infrastructure database, which included all veterans who underwent CIED placement or revision between 2008 and 2015, was used. A logistic regression model was constructed to estimate the adjusted odds of CIEDI. Results: Overall, 10,454 CIED procedures were included, and 98% of them were performed in men with a mean age of 71 ± 12 years. The logistic regression analysis showed that vancomycin use alone or in combination with other antibiotics was associated with an increased risk of CIEDI (odds ratio 2.99 [1.76–5.06], P‐value < 0.001), after controlling for other effects. Conclusions: Our study revealed that among patients who received surgical site infection prophylaxis for CIED placement or revision, there was: (1) an unanticipated high rate of vancomycin use, and (2) a threefold increase in the incidence of subsequent CIEDI among vancomycin recipient [ABSTRACT FROM AUTHOR]

Introduction: Abnormal cervical cytology in patients with endometrial cancer (EC) has been associated with poor outcome. The aim of this study was to evaluate whether cervical cytology could contribute to an improved preoperative identification of high‐grade EC (serous, clear cell, carcinosarcoma, high‐grade endometrioid EC) in final histology. Methods: A retrospective cohort study was performed in five hospitals in the Netherlands. A total of 554 patients with EC that underwent primary surgical treatment between 2002 and 2010 were included. Primary outcome was defined as the contribution of abnormal cervical cytology in the preoperative identification of high‐grade EC. As secondary outcome, recurrence‐free survival (RFS) and disease‐specific survival were determined based on preoperative cervical cytology, and compared to the currently established risk factors: myometrial invasion, high‐grade and lymph vascular space invasion. Results: Abnormal cervical cytology was present in 45.1%. For patients with preoperative inconclusive and high‐grade histology, the presence of abnormal cervical cytology contributed to an improved identification of high‐grade EC in final histology (odds ratio [OR] 6.40 [95% confidence interval {CI}: 1.92‐21.26]; OR 2.86 [95% CI: 1.14‐7.14]), respectively. Patients with abnormal cervical cytology had a significant worse 5‐year median RFS. Abnormal cervical cytology was independently related to RFS (hazard ratio 1.67 [95% CI: 1.04‐2.68]) and disease‐specific survival (hazard ratio 3.15 [95% CI: 1.74‐5.71]). Conclusions: Abnormal cytology contributes to the preoperative identification of patients with high‐grade EC, and is associated with compromised outcome. Future studies are warranted to determine whether cervical cytology could be incorporated into preoperative prediction models for lymph node metastasis. [ABSTRACT FROM AUTHOR]

Background Children often starve for longer than recommended by current preoperative fasting guidelines. Aims We studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children. Methods Preoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6-4-2 fasting regimen. This group was compared with a cohort in the same unit 1 year after transitioning to a 6-4-0 fasting regimen. The latter includes no limitations on clear fluid intake until the child is called to theater. A third cohort from a unit in which the 6-4-0 fasting regimen has been implemented for over a decade was also studied for comparison. Results Patients fasting according to the 6-4-2 fasting regimen (n = 66) had a median fasting time for clear fluids of 4.0 h and a 33.3% incidence of fasting more than 6 h. After transitioning to the 6-4-0 fasting regimen (n = 64), median duration of fasting for clear fluids decreased to 1.0 h, and the incidence of fasting more than 6 h decreased to 6.3%. In the second unit (n = 73), median fasting time was 2.2 h and the proportion of patients fasting more than 6 h was 21.9%. Conclusion The introduction and implementation of the 6-4-0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting. [ABSTRACT FROM AUTHOR]

An ameloblastoma is a benign but locally aggressive epithelial odontogenic neoplasm. It represents 10% of all tumours of the jawbone. In 80% of cases it is localised to the mandibular molar region and ascending ramus area, and is frequently associated with an unerupted tooth. It presents most commonly in the 3rd and 4th decades of life. This article reports an unusual presentation and management of a unicystic ameloblastoma in a child orthodontic patient with a literature review. [ABSTRACT FROM AUTHOR]

Objectives To determine how often outpatient physician visits detect sleep apnea ( SA) in older persons in the United States. Design Retrospective Analysis. Setting US non hospital and hospital based clinics. Participants US physicians. Measurements National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 1993 to 2011 were used to assess the frequency of physicians' coding diagnoses of SA in persons aged 65 and older. Which specialties are most likely to report SA, the most-common comorbid conditions reported with SA, and the likelihood of reporting SA in patient visits for dementia and preoperative care were assessed. Results From 1993 to 2011, physicians reported SA in 0.3% of all office visits in persons aged 65 and older. SA reported in visits increased from 130,000 in 1993 to 2,070,000 in 2011, with an annual per capita visit reporting rate of 0.07% to 0.74%. In older populations, the proportion of documented SA visits by specialists rose, and that of primary care providers decreased. Older adults with a diagnosis of SA had higher average number of comorbidities than those without SA (1.8 vs 1.3). Reporting SA was low in visits with a diagnosis of dementia and classified as a preoperative visits. Conclusion In two nationwide surveys, SA reporting by physicians in elderly adults was 16 as greater in 2001 as in 1993, although reporting of SA remains infrequent (<1% of visits) even in vulnerable populations. [ABSTRACT FROM AUTHOR]

Short-term very-low-energy diets ( VLEDs) are used in clinical practice prior to bariatric surgery, but regimens vary and outcomes of a short intervention are unclear. We examined the effect of 2 VLEDs, a food-based diet ( FD) and a meal-replacement plan ( MRP; LighterLife UK Limited, Harlow, UK), over the course of 2 weeks in a randomized controlled trial. We collected clinical and anthropometric data, fasting blood samples, and dietary evaluation questionnaires. Surgeons took liver biopsies and made a visual assessment of the liver. We enrolled 60 participants of whom 54 completed the study ( FD, n = 26; MRP, n = 28). Baseline demographic features, reported energy intake, dietary evaluation and liver histology were similar in the 2 groups. Both diets induced significant weight loss. Perceived difficulty of surgery correlated significantly with the degree of steatosis on histology. There were reductions in the circulating inflammatory mediators C-reactive protein, fetuin- A and interleukin-6 between baseline (pre-diet) and post-diet. The diets achieved similar weight loss and reduction in inflammatory biomarkers. There were no significant differences in perceived operative difficulty or between patients' evaluation of diet satisfaction, ease of use or hunger frequency. Non-alcoholic fatty liver disease histology assessments post-diet were also not significantly different between diets. The results of this study show the effectiveness of short-term VLEDs and energy restriction, irrespective of macronutrient composition, although the small sample size precluded detection of subtle differences between interventions. [ABSTRACT FROM AUTHOR]

Background Aspirin is widely used for the secondary prevention of ischemic stroke and cardiovascular disease. Perioperative aspirin may decrease thrombotic morbidity, but may also increase hemorrhagic morbidity. In particular, liver resection carries risks of bleeding, leading to higher risks of hemorrhagic morbidity. Our institution has continued aspirin therapy perioperatively in patients undergoing liver resection. This study examined the safety and feasibility of liver resection while continuing aspirin. Methods We retrospectively evaluated 378 patients who underwent liver resection between January 2010 and January 2016. Patients were grouped according to preoperative aspirin prescription: patients with aspirin therapy (aspirin users, n = 31); and patients without use of aspirin (aspirin non-users, n = 347). Results Aspirin users were significantly older ( P < 0.001), with a higher proportion of males ( P < 0.001) and higher frequencies of hypertension ( P = 0.004) and diabetes mellitus ( P < 0.001). No significant differences were observed in intraoperative parameters. Although the frequency of major morbidity tended to be higher among aspirin users than among aspirin non-users, no significant difference was identified. No postoperative hemorrhage was seen among aspirin users. Conclusions Liver resection can be safely performed while continuing aspirin therapy without increasing hemorrhagic morbidity. Our results suggest that interruption of aspirin therapy is unnecessary for patients undergoing liver resection. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX model in the preoperative discrimination between benign ovarian (including tubal and para-ovarian) tumors, borderline ovarian tumors (BOT), Stage I ovarian cancer (OC), Stage II-IV OC and ovarian metastasis in a gynecological oncology center in Brazil.Methods: This was a diagnostic accuracy study including 131 women with an adnexal mass invited to participate between February 2014 and November 2015. Before surgery, pelvic ultrasound examination was performed and serum levels of tumor marker CA 125 were measured in all women. Adnexal masses were classified according to the IOTA ADNEX model. Histopathological diagnosis was the gold standard. Receiver-operating characteristics (ROC) curve analysis was used to determine the diagnostic accuracy of the model to classify tumors into different histological types.Results: Of 131 women, 63 (48.1%) had a benign ovarian tumor, 16 (12.2%) had a BOT, 17 (13.0%) had Stage I OC, 24 (18.3%) had Stage II-IV OC and 11 (8.4%) had ovarian metastasis. The area under the ROC curve (AUC) was 0.92 (95% CI, 0.88-0.97) for the basic discrimination between benign vs malignant tumors using the IOTA ADNEX model. Performance was high for the discrimination between benign vs Stage II-IV OC, BOT vs Stage II-IV OC and Stage I OC vs Stage II-IV OC, with AUCs of 0.99, 0.97 and 0.94, respectively. Performance was poor for the differentiation between BOT vs Stage I OC and between Stage I OC vs ovarian metastasis with AUCs of 0.64.Conclusion: The majority of adnexal masses in our study were classified correctly using the IOTA ADNEX model. On the basis of our findings, we would expect the model to aid in the management of women with an adnexal mass presenting to a gynecological oncology center. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background Information transfer to patients is an integral part of modern medicine. Internet-based alternatives represent a new and attractive way for information transfer. Methods The study used a prospective observer-blinded design. Children (3-12 years) and parents were instructed to get further preoperative information either through an interactive web-based platform, the Anaesthesia-Web, or conventional brochure material until day of outpatient surgery. On the day of surgery, children and parents were separately asked six different questions. The primary end-point was to compare the total question score in children between the two information options (maximum score = 36). Secondary aims were the total question score for parents and the influence of age, sex, and time between the preoperative visit and day of surgery. Results A total of 125 children were recruited, of which 103 were included in the final analysis (the Anaesthesia-Web group, n = 49; the brochure material group, n = 54). At the predetermined interim analysis, the total question score in children was found to be substantially higher in the Anaesthesia-Web group than in the brochure material group (median score: 27; IQR: 16.5-33 and median score: 19.5; IQR: 11.25-27.75, respectively, P = 0.0076). The median difference in score was 6; 95% CI: 0-9. The total question score in parents was also higher in the Anaesthesia-Web group than in the brochure material group. Increasing child age was associated with a higher total question score in both groups. Sex did not influence the total question score in the Anaesthesia-Web group, whereas girls scored better than boys in the brochure material group. Conclusions Children in the age range 3-12 years of age as well as their parents do better attain preoperative information from an interactive web-based platform compared to conventional brochure material. [ABSTRACT FROM AUTHOR]

Conventional image registration utilizing brain voxel information may be erroneous in a neurosurgical setting due to pathology and surgery-related anatomical distortions. We report a novel application of an automated image registration procedure based on skull segmentation for magnetic resonance imaging (MRI) scans acquired before, during and after surgery (i.e., perioperative). The procedure was implemented to assist analysis of intraoperative brain shift in 11 pediatric epilepsy surgery cases, each of whom had up to five consecutive perioperative MRI scans. The procedure consisted of the following steps: (1) Skull segmentation using tissue classification tools. (2) Estimation of rigid body transformation between image pairs using registration driven by the skull segmentation. (3) Composition of transformations to provide transformations between each scan and a common space. The procedure was validated using locations of three types of reference structural landmarks: the skull pin sites, the eye positions, and the scalp skin surface, detected using the peak intensity gradient. The mean target registration error (TRE) scores by skull pin sites and scalp skin rendering were around 1 mm and <1 mm, respectively. Validation by eye position demonstrated >1 mm TRE scores, suggesting it is not a reliable reference landmark in surgical scenarios. Comparable registration accuracy was achieved between opened and closed skull scan pairs and closed and closed skull scan pairs. Our procedure offers a reliable registration framework for processing intrasubject time series perioperative MRI data, with potential of improving intraoperative MRI-based image guidance in neurosurgical practice. Hum Brain Mapp 37:3530-3543, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The experience of surgery can be extremely stressful for children and their family members. Many children’s hospitals offer a formal surgical preparation program to patients and their families, usually led by a child life specialist. However, smaller hospitals or ambulatory surgery centers may not be able to use this approach to preparing children for surgery. In this scenario, the perioperative nurse is in the ideal position to provide developmentally appropriate surgical preparation and education at the bedside. Knowledge of normal child development and age-appropriate diversional activities are necessary to implement an effective surgical preparation program. This age-appropriate preparation can help facilitate a positive medical experience that can reduce anxiety and affect the child’s and his or her family’s view of future medical encounters. [ABSTRACT FROM AUTHOR]

Background Although some studies have investigated the potential predictors of perioperative mortality, there are few specifically for pediatrics. Objective The aim of the retrospective study was to analyze potential preoperative risk factors and to develop a pediatric preoperative risk prediction score ( PRPS), and to predict postoperative ICU admission and the incidence of perioperative death in pediatric patients. Methods Patients who postoperatively admitted to ICU or died (occurred within 30 days after the surgery) from 263 607 pediatric surgical patients with age from 1 day to 14 years old in eight centers in China from October 2010 to September 2013 were retrospectively analyzed. About 5500 non- ICU admission and death patients were randomly selected from those 263 607 patients as controls for analysis comparison. Independent risk factors and a risk model were derived from these analyses, and were further assessed with the likelihood ratio test and the area under the receiver operating characteristic ( ROC) curve. Results There were 1812 ICU admission or death patients but 187 patients' records are incomplete. There were 487 patients with incomplete records among 5500 controls. Collectively, data from 6626 patients were enrolled in final analyses. With multiple logistic regression analysis, age, ASA physical status, SpO2, prematurity, and unfasted status were found to be independent predictors for critical patients. The AUC value of 0.905 indicated excellent predictive performance between critical and noncritical predictors. Conclusions Our study revealed that age, ASA physical status, SpO2, prematurity, and unfasted status are risk factors to predict postoperative ICU admission and death in pediatric patients. [ABSTRACT FROM AUTHOR]

Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention. [ABSTRACT FROM AUTHOR]

Background There is no consensus on the impact of preoperative embolization (EMB) on the surgical outcomes of carotid body tumor (CBT) resections. Methods A systematic review and a meta-analysis were conducted to clarify the role of preoperative EMB in patients undergoing surgical removal of CBTs. Results Fifteen studies with a total number of 470 patients met the inclusion criteria. The results of the meta-analysis showed that there is no significant difference in estimated blood loss, operative time, length of hospital stay, or risks of cranial nerve injury, vascular injury, and stroke between the EMB and nonembolization (NEMB) groups. Conclusion This systemic review and meta-analysis demonstrate that preoperative EMB does not confer any operative or postoperative advantage in patients scheduled for CBT surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2386-E2394, 2016 [ABSTRACT FROM AUTHOR]