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Background: Coronary artery bypass grafting (CABG) is often performed with hypothermic cardiopulmonary bypass (CPB) to reduce metabolic demands and protect the myocardium. However, hypothermia can increase bleeding risks and other complications. Methods: This is a prospective, multi-center, randomized controlled trial. From September 2023 to December 2024, a total of 336 eligible patients planning to undergo on-pump CABG will be enrolled. All participants will be randomly divided into mild hypothermia CPB group (target oxygenator arterial outlet blood temperature at 32–33℃) or normothermia CPB group (target oxygenator arterial outlet blood temperature at 35–36℃). The primary endpoint is Universal Definition of Perioperative Bleeding (UDPB) class 2–4. Secondary endpoints are class of UDPB, levels of coagulation and inflammatory factors, in-hospital mortality, perioperative related complications, ICU length of stay, and hospital length of stay. Discussion: This clinical trial aims to compare the effects of different target temperature during CPB on postoperative bleeding and to explore optimal temperature strategy to provide new clinical evidence. Trial registration: Chictr.org.cn: ChiCTR2300075405. The trial was prospectively registered on 4 September 2023. [ABSTRACT FROM AUTHOR]

Background: Robotic computer-assisted implant surgery (r-CAIS) is a revolutionary innovation in oral implantation; however, the clinical feasibility of r-CAIS for immediate implant placement (IIP) in posterior teeth has not been verified. Thus, this study aimed to evaluate the accuracy of r-CAIS for IIP in posterior tooth regions. Methods: Patients with posterior teeth to be extracted and indicated to undergo r-CAIS were evaluated. The patients had positioning markers installed in the oral cavity and underwent cone-beam computed tomography (CBCT). Subsequently, minimally invasive tooth extractions were performed, and an individualised surgical plan was generated in the robotic software. After marker registration, implantation surgery was performed by the robotic arm under the supervision and assistance of the surgeons. Finally, the deviations between the planned and placed implants were evaluated based on preoperative and postoperative CBCT data. Results: A total of 12 patients were evaluated. No adverse events occurred during the surgery. The mean global coronal, global apical, and angular deviations were 0.46 ± 0.15 mm (95%CI:0.36 to 0.56 mm), 0.46 ± 0.14 mm (95%CI:0.37 to 0.54 mm), and 1.05 ± 0.55° (0.69 to 1.40°), respectively. Conclusions: Under the limited conditions of this study, the r-CAIS exhibited high accuracy in posterior teeth IIP surgery. Further multicentre randomised controlled studies are required to confirm the feasibility of this technology. [ABSTRACT FROM AUTHOR]

Background: Endovascular recanalization is a feasible option for treating symptomatic non-acute middle cerebral artery occlusion (MCAO) patients. Hence, we aimed to establish a new angiographic scoring to grade the recanalization difficulty of MCAO to determine the suitable patients for endovascular treatment. Methods: We retrospectively analyzed a total of 113 consecutive recurrent symptomatic non-acute MCAO patients who underwent endovascular recanalization from July 2015 to August 2021 in four Chinese comprehensive stroke centers. All patients were reappraised using a new angiographic scoring based on the stump morphology, the MCA occlusion length, MCA bend, and the distal vascular bed of MCAO. We used the final results to establish the patients' outcomes. Results: The total successful recanalization and perioperative complication rates were 83.2% (94/113) and 15.9% (18/113), respectively. No deaths occurred within 30 days. Moreover, 96.9, 90, 87.5, 52.6, and 50% of the patients achieved recanalization with scores of 0, 1, 2, 3, and 4 (p < 0.001), respectively. However, the perioperative complication rate showed the opposite trend. (3.1% vs. 7.5% vs. 6.3% vs. 52.6% vs. 50%; p < 0.001). The median time of successful microwire crossing of the occlusion lesion (TMO) in the score 0 group was shorter than the other groups (2 min, 9 min, 8.5 min, 14 min, and 20 min; p < 0.001). When a score of 2 was used as the optimal cut-off point, the sensitivity and specificity were 86.2 and 63.2%, respectively. Conclusion: The new angiographic scoring can effectively predict the successful recanalization rate, perioperative complication rate, and TMO of endovascular recanalization for non-acute MCAO. It can also be used as an effective clinical evaluation tool to determine the suitable non-acute MCAO patients for recanalization, especially with a score = 2. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery is associated with a lower morbidity than open surgery. No recent data compared kidney cancer surgery in the French population using the National Health Insurance database (PMSI-MCO). Aims: We explore and compare the surgical morbidity rates between laparoscopic and open laparotomy for kidney cancer. Methods: The initial length of stay and complications parameters during the three postoperative months were described for renal cancer in every French center in 2018. We compared Relative Risks (RR [95% CI]) between laparoscopic and open surgery for both radical and partial nephrectomy. Results: Among 8,162 patients, 3,525 had a radical nephrectomy, 978 open, 2,547 laparoscopic surgeries; 4,637 patients had partial nephrectomies, 1,778 open 2,859 laparoscopic surgeries. For radical surgery, the most common complications were urinary infections (7.8%), acute renal failure (8.9%), sepsis (8.4%), bleeding (9.3%), and postoperative anemia (5.9%); the RR for laparoscopic versus open surgery were respectively 0.68 [0.54;0.86], 0.71 [0.57;0.88], 0.69 [0.55;0.86], 0.83 [0.66;1.03], 0.56 [0.43;0.73]. For partial nephrectomies, the most common complications were urinary infections (7.7%), bleeding (11.6%), and postoperative anemia (5.8%), with RR of 0.71 [0.58;0.87], 0.61 [0.52;0.71], and 0.64 [0.51;0.81]. The mean length of stay was 7.7 for open radical nephrectomy, 6.3 for laparoscopic radical nephrectomy, 7.5 for open partial nephrectomy, and 5 for laparoscopic partial nephrectomy. Conclusions: The laparoscopic approach had fewer postoperative complications and a shorter length of stay than open surgery for partial and radical nephrectomy. The PMSI analysis provided an exhaustive description of surgical practice for kidney cancer and surgical complications in France. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Purpose: To compare long-term intraocular lens (IOL) decentration and tilt following femtosecond laser-assisted cataract surgery (FLACS) and conventional surgery using swept-source anterior segment ocular coherence tomography (SS-ASOCT). Methods: In this retrospective cross-sectional study, all patients underwent FLACS or conventional cataract surgery. Those with a minimum of 12-months follow-up since surgery were included. Patients with surgical complications were excluded. Demographics, preoperative ocular measurements (axial length, anterior chamber depth), and postoperative measurements [corrected distance visual acuity (CDVA), autorefraction, keratometry, IOL type] were collected. Postoperative IOL tilt and decentration were compared using SS-ASOCT between patients with FLACS and conventional cataract surgery. Subgroup analysis was conducted to analyze tilt and decentration by haptic type (single-piece vs. three-piece). Results: A total of 188 eyes were included [110 (58.5%) in the FLACS group and 78 (41.5%) in the conventional group]. No differences were observed between the FLACS and conventional groups regarding preoperative parameters. FLACS resulted in less IOL decentration compared to conventional cataract surgery (170 μm vs. 240 μm, p = 0.002). No statistically significant differences were observed between the FLACS and conventional groups in the magnitude and axis of IOL tilt. Both groups had a trend of IOL tilt toward the inferotemporal aspects. Moreover, no difference regarding postoperative CDVA, spherical equivalent, and keratometric astigmatism was observed. Conclusions: FLACS resulted in significantly better long-term IOL centration than conventional surgery with manual capsulotomy. No significant difference in IOL tilt or postoperative CDVA was observed between FLACS and conventional cataract surgery. [ABSTRACT FROM AUTHOR]

Introduction: Selecting the optimal radial head prosthesis to treat radial head fractures, especially in the context of complex elbow injuries like terrible triad, Monteggia, and Essex Lopresti, can be challenging, as there is currently no consensus in the field that favors a particular design. This study investigated the safety and performance of a Polished Stem Radial Head Prosthesis (PS RHP) compared to other modern RHP designs. Materials and methods: A systematic review was conducted according to PRISMA guidelines to capture data on a Polished Stem Radial Head Prosthesis (PS RHP) and other Radial Head Prostheses (RHPs). Functional scores, range of motion, complications, and revisions were extracted from published literature and analyzed in parallel with the percentage of complex injuries. Comparison of functional outcomes between groups were based on minimum clinically important differences (MCIDs). Results: There were 16 articles reporting on 711 cases of the PS RHP and 23 articles reporting on 605 cases of other RHPs included in the systematic literature review. Functional scores and range of motion were similar amongst the groups. The PS RHP design achieved a comparable revision rate as other RHPs despite a higher number of terrible triad injuries. Notably, the PS RHP group showed a significantly lower rate of instability (1.0%) than other RHPs (3.4%) (p < 0.05). Other complication rates were similar amongst the two groups. Conclusions: The PS RHP group had higher rates of terrible triads at baseline compared to the other RHPs group. Regardless of greater injury complexity, the clinical outcomes of the PS RHP group were favorable and resulted in a significantly lower rate of postoperative instability as compared to other RHPs. [ABSTRACT FROM AUTHOR]

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

This study assessed the clinical safety and efficacy of elliptical thin-flap LASIK with a low–pulse energy femtosecond laser in 3 thickness subgroups (85, 90, and 100 μm). A total of 80 patients who underwent bilateral LASIK surgery at Taiwan between April and September 2019 were retrospectively enrolled. Elliptical corneal flaps with wide temporal hinges and inverted-angled side cuts were created. Target flap thickness was calculated on the basis of residual stromal bed thickness and percent tissue altered. Before flap creation, an optical coherence tomography image for visualization of the precut flap position was obtained with the built-in camera. At postoperative month 1, the overall mean logMAR uncorrected distance visual acuity (UDVA) was − 0.04 ± 0.07 (20/18 Snellen), with 96% of eyes achieving UDVA of 20/20 or better. Postoperative mean manifest spherical equivalent was − 0.37 ± 0.42 D at 1 month. The visual and refractive outcomes in each of the 3 subgroups were similar. The achieved flap thicknesses were found to be highly predictable and consistent in the respective thickness subgroups. Optical coherence tomography–guided thin-flap LASIK performed with the low–pulse energy femtosecond laser was found to be safe with no intraoperative or postoperative complications. [ABSTRACT FROM AUTHOR]

Asymptomatic carotid stenosis (ACS) carries a 4.7% risk of ipsilateral stroke if left untreated. Carotid endarterectomy (CEA) is a surgical intervention that has demonstrated efficacy in reducing stroke risk among symptomatic elderly. However, literature on its efficacy in preventing stroke in patients with ACS remains limited. Our systematic review summarizes evidence on the safety and efficacy of CEA in the asymptomatic elderly. PubMed and Scopus were searched to identify articles that described outcomes after CEA for ACS in patients aged ≥ 65 years old. Articles that did not report outcomes specific to the asymptomatic elderly were excluded. Outcomes of interest were technical success, stroke, death, myocardial infarction and post-operative complications. The Newcastle Ottawa Scale (NOS) was used to perform a qualitative assessment for risk of bias and studies with NOS ≥ 6 were considered high quality. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. After a title and abstract screen, followed by a full-text review, 7 studies reporting outcomes in 76,404 patients were included. Five studies were retrospective and two were prospective. Among studies that reported criteria for intervention in ACS patients, 2 studies performed CEA for 70% stenosis and one performed CEA for 60% stenosis. One study reported outcomes for all ranges of stenosis (mild: 0–50%, moderate: 50–79% and severe: 80–99%). Clinical outcomes varied among included studies, with rates of death stroke and myocardial infarction ranging from 0.39 to 6.1%, 0.5–1.2% and 0.9-3%, respectively. The decision to perform CEA in patients with ACS is made after outweighing risks and benefits of surgery based on various factors like age, comorbidities and frailty. At present, evidence is largely limited to retrospective studies that utilized nationwide databases. Prospective studies and randomized controlled trials could help characterize the risk of CEA in this cohort. [ABSTRACT FROM AUTHOR]

Purpose: The robot-assisted laparoscopic (RALUVR) and open (OUVR) approaches have both been described for ureterovesical reimplantation to treat benign lower ureteral pathologies. Thus, we aimed to compare the perioperative and functional outcomes of RALUVR vs. OUVR. Methods: We performed a retrospective comparative study including all consecutive patients treated with RALUVR or OUVR for benign lower ureteral pathologies between January 2013 and December 2022 at our center. Logistic regression analyses were used to assess the predictors of complication ≥ Clavien-Dindo (CD) III within 90 days, prolonged length of stay (LOS), and 90-day overall success. The Kaplan-Meier method and Cox regression analyses were used to assess vesicoureteral reflux-free (VU-RFS) and stenosis-free (SFS) survivals. Results: Overall, 44 patients underwent RALUVR (n = 19; 43%) and OUVR (n = 25; 57%). In univariable logistic regression analyses, the use of RALUVR vs. OUVR was not significantly associated with postoperative complications ≥ CDIII (OR = 0.98; 95% CI=[0.17–5.09]; p = 0.98), and 90-day overall success (OR = 1.43; 95% CI=[0.24–11.28]; p = 0.7). Despite a shorter median LOS after RALUVR vs. OUVR (4 vs. 10 days, respectively; p < 0.001), multivariable logistic regression analysis showed no impact of the surgical approach on prolonged LOS (OR = 0.51, 95% CI=[0.03–13.86]; p = 0.65). No significant difference was observed in 2-year VU-RFS (72.9% vs. 100%, respectively; p = 0.2) and 2-year SFS between the RALUVR and OUVR groups (85.7% vs. 87.7%, respectively; p = 0.8). In Cox regression analysis, the use of RALUVR vs. OUVR was not significantly associated with VU-RFS (HR = 4.26; 95% CI=[0.38–47.84]; p = 0.24) or SFS (HR = 1.32; 95% CI=[0.22–8.01]; p = 0.76). Conclusion: We observed that RALUVR provides similar perioperative and functional outcomes as compared to OUVR, except for potentially shorter LOS. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS). Materials and methods: RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022 A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared. Results: The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient's demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively). Conclusion: In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH). Methods: A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients. Results: The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001). Conclusion: After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH. [ABSTRACT FROM AUTHOR]

IntroductionCase reportConclusion:We report an unusual case of cochlear implant complication and eventual explantation secondary to an allergic reaction to silicone.A 62-year-old man who underwent cochlear implantation for asymmetric hearing loss developed an allergic response to the implant within a few weeks of the surgery. This led to subsequent explantation. Patch testing using the various parts of the implant revealed a hypersensitive response to the silicone component of the receiver stimulator. There have only been 6 reported cases of cochlear implant explantation secondary to allergic reactions to cochlear implants. The inflammatory reaction has been to the silicone component of the cochlear implant found in the silicone used in Cochlear America’s implants.Although rare, it’s important to be aware of delayed hypersensitivity reactions to the silicone component of a cochlear implant. Attention should be made to associate symptoms such as pruritis, urticaria and loss of hair as symptoms and signs of possible allergic reaction to the implanted component. Steroids may help to alleviate symptoms; however, symptoms have been shown to recur after cessation of steroids. Treatment requires the removal of the device. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV.A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2‐year follow‐up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non‐complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV.There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding‐on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7‐CSVL were independent predictors of postoperative complications when selecting L3 as the LIV.Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications. [ABSTRACT FROM AUTHOR]

Infection of native tissues or implanted devices is common, but clinical diagnosis is frequently difficult and currently available noninvasive tests perform poorly. Immunocompromised individuals (for example transplant recipients, or those with cancer) are at increased risk. No imaging test in clinical use can specifically identify infection, or accurately differentiate bacterial from fungal infections. Commonly used [18F]fluorodeoxyglucose (18FDG) positron emission computed tomography (PET/CT) is sensitive for infection, but limited by poor specificity because increased glucose uptake may also indicate inflammation or malignancy. Furthermore, this tracer provides no indication of the type of infective agent (bacterial, fungal, or parasitic). Imaging tools that directly and specifically target microbial pathogens are highly desirable to improve noninvasive infection diagnosis and localization. A growing field of research is exploring the utility of radiometals and their chelators (siderophores), which are small molecules that bind radiometals and form a stable complex allowing sequestration by microbes. This radiometal-chelator complex can be directed to a specific microbial target in vivo, facilitating anatomical localization by PET or single photon emission computed tomography. Additionally, bifunctional chelators can further conjugate therapeutic molecules (e.g., peptides, antibiotics, antibodies) while still bound to desired radiometals, combining specific imaging with highly targeted antimicrobial therapy. These novel therapeutics may prove a useful complement to the armamentarium in the global fight against antimicrobial resistance. This review will highlight current state of infection imaging diagnostics and their limitations, strategies to develop infection-specific diagnostics, recent advances in radiometal-based chelators for microbial infection imaging, challenges, and future directions to improve targeted diagnostics and/or therapeutics. [ABSTRACT FROM AUTHOR]

Background: For renal hilar angiomyolipoma, general surgical resection is often quite challenging. The aim of this study is to evaluate the safety and efficacy of an innovative robot-assisted laparoscopic strategy that combines tumor enucleation with tumor aspiration in the treatment of renal hilar angiomyolipoma. Methods: The clinical data of 38 patients with renal hilar angiomyolipoma who went through robotic tumor enucleation combined with tumor aspiration in the Department of Urology, the Affiliated Hospital of Nanjing University Medical School, from December 2019 to December 2022 were retrospectively analyzed. The basic characteristics, the perioperative variables, intraoperative procedures, and postoperative complications were all recorded. Patients were followed up to evaluate the angiomyolipoma recurrence and the renal function by urologic CT or ultrasound and renal function tests. Results: All surgeries were successfully completed without conversion to radical nephrectomy or open surgery. One patient developed urinary extravasation 10 days after surgery, and was readmitted to the hospital for transurethral ureteral stenting considering the injury of the renal collecting system. The median operative time was 181.5 (123.8-206.3) min, the warm ischemia time was 20.0 (17.3–24.0) min, the blood loss was 125 (100.0-262.5) ml, and no patients received blood transfusion during and after surgery. The median hospitalization time was 7.0 (6.0–9.0) days, and the duration of indwelling drainage tube was 2.0 (2.0–3.0) days. The serum creatinine (Scr) on the first day, 3 months, and 6 months after surgery were 55.5 (50.8–62.8) µmol/L, 55.5 (48.0–62.0) µmol/L and 54.0 (51.8–63.5) µmol/L, respectively, and there was no significant difference compared with the preoperative level 56.0 (47.8–60.3) µmol/L. All patients were followed up after surgery, and the urinary CT scan or renal color doppler ultrasound, and renal function were reexamined. The median follow-up time of all patients was 19.0 (14.75-33.0) months, and no local recurrence of angiomyolipoma was seen in all patients. Conclusions: The surgical strategy of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration is safe and effective in the treatment of renal hilar angiomyolipoma. [ABSTRACT FROM AUTHOR]

Purpose: This is a retrospective study of one-stage anterior sagittal sphincter saving anorectoplasty (ASSSARP) for repairing rectovestibular fistula (RVF) including operative details and postoperative complications, functional and cosmetic outcome. Patients and methods: Records of 41 cases of RVF, managed between April 2010 and September 2019 by one-stage ASSSARP, were reviewed. Preoperative preparation, both early and late postoperative care & complications, hospital stay, and functional & cosmetic outcomes were reported. Results: The mean age was 6.6 months. Vaginal tear occurred in 5/41 cases, and distal rectal tears in 4/41 cases. Thirteen patients suffered mild superficial wound inflammation; while Skin dehiscence; occurred in five patients. No colostomy or redo was needed. The mean hospital stay was 6.1 days. Mean follow-up was 43.13 months; (Range; 24–100 months). Subclinical anal stricture was detected in six patients. Constipation occurred in 14 cases. Soiling grade I occurred in five patients. Thirty-two patients reached past the age of three years; two of whom showed cough/diarrhea incontinence. Conclusion: One-stage ASSSARP is safe and gives functional and cosmetic results comparable to other techniques. It provides better access during RVF repair. The avoidance of muscle incision protects against muscle breakdown, if infection sets in, and thus against incontinence. It avoids the morbidity, cost and psychological burden of performing a three-stage repair. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to assess the feasibility and safety of monitored anesthesia care (MAC) versus intubated general anesthesia (IGA) for patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). Methods: This prospective observational study included patients scheduled for cardiac surgery involving CPB at our institution between April 2012 and February 2017. The enrolled patients were categorized into MAC and IGA groups. MAC involved local anesthesia at the sternotomy site, sedation with dexmedetomidine, analgesia with remifentanil/sufentanil, and electroacupuncture (EA). Eleven patients underwent MAC, and 13 patients received IGA. There were no instances of conversion from MAC to IGA, and both groups exhibited no major complications. The demographic characteristics, baseline parameters, and operative variables were comparable between the two groups. Results: Intraoperative opioid consumption was significantly lower in the MAC group compared to the IGA group (P < 0.001). The time to oral intake of liquids was significantly shorter in the MAC group (2.14 ± 0.90 h) compared to the IGA group (22.31 ± 3.33 h) (P < 0.001). Furthermore, the intensive care unit length of stay (ICU-LOS) and perioperative vasoactive-inotropic score (VIS) were significantly reduced in the MAC group compared to the IGA group (P < 0.001). Conclusions: MAC emerges as a safe and viable alternative to general anesthesia for specific patient groups undergoing cardiac surgery with CPB. Furthermore, it may enhance postoperative recovery and minimize postoperative complications compared to IGA. [ABSTRACT FROM AUTHOR]

Infection is a devastating post-surgical complication, often requiring additional procedures and prolonged antibiotic therapy. This is especially relevant for craniotomy and prosthetic joint infections (PJI), both of which are characterized by biofilm formation on the bone or implant surface, respectively, with S. aureus representing a primary cause. The local tissue microenvironment likely has profound effects on immune attributes that can influence treatment efficacy, which becomes critical to consider when developing therapeutics for biofilm infections. However, the extent to which distinct tissue niches influence immune function during biofilm development remains relatively unknown. To address this, we compare the metabolomic, transcriptomic, and functional attributes of leukocytes in mouse models of S. aureus craniotomy and PJI complemented with patient samples from both infection modalities, which reveals profound tissue niche-dependent differences in nucleic acid, amino acid, and lipid metabolism with links to immune modulation. These signatures are both spatially and temporally distinct, differing not only between infection sites but evolving over time within a single model. Collectively, this demonstrates that biofilms elicit unique immune and metabolic responses that are heavily influenced by the local tissue microenvironment, which will likely have important implications when designing therapeutic approaches targeting these infections. Here, Van Roy et al. show that Staphylococcus aureus biofilm elicits unique metabolic and immune signatures in different tissue niches that evolve over time. [ABSTRACT FROM AUTHOR]

Background: Refeeding syndrome (RFS) and starvation-associated injuries are significant complications in malnourished patients. Severe weight loss after obesity surgery is frequently associated with malnutrition, consequently increasing the likelihood of RFS and starvation-related injuries as postoperative complications. RFS and starvation-induced injury in a single patient has rarely been reported. In this paper, we present, for the first time, a case of hepatic injury attributed to both refeeding syndrome and starvation-induced hepatic injury in a malnourished woman following bariatric surgery. Case Report: A 27-year-old female patient was admitted to the hospital for severe malnutrition after sleeve gastrectomy. Her body mass index (BMI) dropped from 37.2 kg/m² to 12.4 kg/m² 1 year after surgery. After nutritional supplementation, her liver enzymes levels increased significantly, with severe hypophosphatemia suggesting the development of RFS. During the calorie restriction treatment for RFS, the patient unexpectedly exhibited the recurrent increase of liver enzyme levels and severe reduction in body weight, albumin, and hemoglobin, which is considered to be caused by starvation-induced injury during the treatment of RFS. Following precise nutritional re-supplementation, her liver enzyme levels were dramatically decreased, with significant elevated hemoglobin and albumin levels at discharge and during the follow-up visit. Conclusions: Chronic malnutrition and extreme weight loss can occur following bariatric surgery. Our report highlights the potential for RFS and starvation-related liver injuries as postoperative complications for high-risk patients after bariatric surgery. Liver injury can occur in both RFS and starvation-induced hepatitis. Nutrition initiation and supplementation should be carefully balanced in high-risk patients during nutritional treatments. [ABSTRACT FROM AUTHOR]

Background: Following ablative surgery, the reconstruction of oral cavity defects is essential to ensure optimal function and aesthetically acceptable outcomes. The purpose of this study was to retrospectively analyze the effectiveness and complication rates of the sublingual gland flap (SGF) in oral soft tissue reconstruction. The procedure for harvesting SGF and the strengths and limitations of the flap are discussed. Materials and Methods: The study group consisted of 13 patients suffering from oncological diseases who underwent soft tissue reconstruction with SGF. The patient's medical charts were evaluated based on histopathological aspects, postoperative complications, and outcomes. Reconstruction of the floor of the mouth was performed in 8 patients (61.5%) and lower gingiva in 5 patients (38.5%), respectively. Results: Complete epithelialization with closure of the defect was achieved within an average of 2 weeks. The observation period ranged from 1 to 33 months, with an average duration of 11.5 months. Partial flap necrosis and ranula occurred in one patient (7.7%). Furthermore, postoperative bleeding was observed in one patient (7.7%), and wound dehiscence and abscess formation were noted in another (7.7%). Locoregional recurrence of the cancer was observed in one case (7.7%). Conclusions: The SGF is effective for achieving successful reconstruction of small‐ and medium‐sized defects in the lower gingiva and floor of the mouth. The complication rate is relatively low. [ABSTRACT FROM AUTHOR]

Background: Colonic stenosis is a rare postoperative complication of ovariohysterectomy in cats, leading to dyschezia and fecal diameter reduction. In cats, while there are reports of colonic stenosis after midline approach ovariohysterectomy, there are no specific reports of flank approach ovariohysterectomy. Case presentation: This report describes a severe case of a one-year-old British shorthair female cat presenting with gastrointestinal signs, including dyschezia and reduced fecal diameter, three weeks after flank approach ovariohysterectomy. Despite abdominal radiography, proctography with barium sulfate, colonoscopy, CT, and hematological analysis, the cause of colonic stenosis remained unclear. During exploratory laparotomy, an annular tissue band was found encircling the descending colon, resulting in severe local stenosis. After excision of the tissue band, the presenting clinical signs of the cat were rapidly improved. This result suggests that colonic stenosis caused by tissue band should be considered when diagnosing postoperative complications in flank approach ovariohysterectomy in cats. Conclusion: Colon stenosis due to annular tissue band restriction should be considered one of the differentials for postoperative complications in flank approach ovariohysterectomy in cats. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory. [ABSTRACT FROM AUTHOR]

Introduction: Cancer, malnutrition, and surgery negatively impact patient's immune system. Despite standardized surgical technique and the development of new perioperative care protocols, morbidity after cystectomy remains a serious challenge for urologists. Most common postoperative complications, such as infections and ileus, often lead to longer length of stay and worse survival. The immune system and its interaction with the gut microbiota play a pivotal role in cancer immunosurveillance and in patient's response to surgical stress. Malnutrition has been identified as an independent and modifiable risk factor for both mortality and morbidity. Immunonutrition (IN) may improve the nutritional status, immunological function, and clinical outcome of surgical patients. Aims of the study are (1) to evaluate the impact of IN on morbidity and mortality at 30 and 90 days after cystectomy and (2) to determine immune and microbiota signature that would predict IN effect. Methods: This is a randomized, multicentric, controlled, pragmatic, parallel-group comparative study, supported by the Swiss National Science Foundation. A total of 232 patients is planned to be enrolled between April 2023 and June 2026. Three participating centers (Lausanne, Bern, and Riviera-Chablais) have been selected. All patients undergoing elective radical and simple cystectomy will be randomly assigned to receive 7 days of preoperative IN (Oral Impact®, Nestlé, Switzerland) versus standard of care (control group) and followed for 90 days after surgery. For the exploratory outcomes, blood, serum, urine, and stool samples will be collected in patients treated at Lausanne. In order to determine the impact of IN on immune fitness, patients enrolled at Lausanne will be vaccinated against influenza and the establishment of the vaccine-specific immune response will be followed. Analysis of the microbiota and expression of argininosuccinate synthetase 1 as potential biomarker will also be performed. Discussion and conclusion: Strengths of the INCyst study include the randomized, multicenter, prospective design, the large number of patients studied, and the translational investigation. This study will challenge the added value of preoperative IN in patients undergoing cystectomy, assessing the clinical effect of IN on the onset of postoperative morbidity and mortality after cystectomy. Furthermore, it will provide invaluable data on the host immune response and microbiota composition. Trial registration: ClinicalTrials.gov NCT05726786. Registered on March 9, 2023. [ABSTRACT FROM AUTHOR]

Introduction: Despite advantages for patients with ulcerative colitis, Crohn's disease, and familial adenomatous polyposis, restorative proctocolectomy with ileal pouch-anal anastomosis carries a risk of pouch failure, necessitating pouch excision. The traditional open approach is associated with potential complications. Robotic and laparoscopic techniques are emerging, but comparative outcome data are limited. Methods: We conducted a retrospective study of consecutive adult patients undergoing robotic, laparoscopic, and open ileal pouch excision at Mayo Clinic, Rochester, MN, between January 2015 and December 2023. We analyzed data on patient characteristics, perioperative variables, and postoperative outcomes, focusing on short-term complications. Statistical analysis included appropriate tests. Results: The study included 123 patients: 23 underwent robotic-assisted pouch excision, 12 laparoscopic, and 82 open. The robotic approach had the longest median operative time (334 ± 170 min, p = 0.03). However, it demonstrated significantly lower estimated blood loss than open (150 ± 200 ml vs. 350 ± 300 ml, p = 0.002) and laparoscopic surgery (250 ± 250 ml, p = 0.005). Robotic and laparoscopic groups required fewer preoperative ureteral stents than the open group (p = 0.001). Additionally, the robotic approach utilized fewer pelvic drainages (p < 0.0001) and had a lower rate of lysis of adhesions > 60 min compared to open surgery (p = 0.003). Robotic procedures had significantly lower 30-day postoperative complications than the open approach (30.4% vs. 65.9%, p = 0.002) while also demonstrating fewer 30-day reoperations than the laparoscopic group (p = 0.04). Conclusions: Robotic-assisted pouch excision offered significant benefits, including decreased EBL, reduced need for preoperative ureteral stents, and significantly fewer 30-day postoperative complications compared to open surgery. [ABSTRACT FROM AUTHOR]

Background: Surgical resection is integral for the treatment of neuroblastoma, the most common extracranial solid malignancy in children. Safely locating and resecting primary tumor and remote deposits of disease remains a significant challenge, resulting in high rates of complications and incomplete surgery, worsening outcomes. Intraoperative molecular imaging (IMI) uses targeted radioactive or fluorescent tracers to identify and visualize tumors intraoperatively. GD2 was selected as an IMI target, as it is highly overexpressed in neuroblastoma and minimally expressed in normal tissue. Methods: GD2 expression in neuroblastoma cell lines was measured by flow cytometry. DTPA and IRDye® 800CW were conjugated to anti-GD2 antibody to generate DTPA-αGD2-IR800. Binding affinity (Kd) of the antibody and the non-radiolabeled tracer were then measured by ELISA assay. Human neuroblastoma SK-N-BE(2) cells were surgically injected into the left adrenal gland of 3.5-5-week-old nude mice and the orthotopic xenograft tumors grew for 5 weeks. 111In-αGD2-IR800 or isotype control tracer was administered via tail vein injection. After 4 and 6 days, mice were euthanized and gamma and fluorescence biodistributions were measured using a gamma counter and ImageJ analysis of acquired SPY-PHI fluorescence images of resected organs (including tumor, contralateral adrenal, kidneys, liver, muscle, blood, and others). Organ uptake was compared by one-way ANOVA (with a separate analysis for each tracer/day combination), and if significant, Sidak's multiple comparison test was used to compare the uptake of each organ to the tumor. Handheld tools were also used to detect and visualize tumor in situ, and to assess for residual disease following non-guided resection. Results: 111In-αGD2-IR800 was successfully synthesized with 0.75-2.0 DTPA and 2–3 IRDye® 800CW per antibody and retained adequate antigen-binding (Kd = 2.39 nM for aGD2 vs. 21.31 nM for DTPA-aGD2-IR800). The anti-GD2 tracer demonstrated antigen-specific uptake in mice with human neuroblastoma xenografts (gamma biodistribution tumor-to-blood ratios of 3.87 and 3.88 on days 4 and 6 with anti-GD2 tracer), while isotype control tracer did not accumulate (0.414 and 0.514 on days 4 and 6). Probe accumulation in xenografts was detected and visualized using widely available operative tools (Neoprobe® and SPY-PHI camera) and facilitated detection ofputative residual disease in the resection cavity following unguided resection. Conclusions: We have developed a dual-labeled anti-GD2 antibody-based tracer that incorporates In-111 and IRDye® 800CW for radio- and fluorescence-guided surgery, respectively. The tracer adequately binds to GD2, specifically accumulates in GD2-expressing xenograft tumors, and enables tumor visualization with a hand-held NIR camera. These results encourage the development of 111In-αGD2-IR800 for future use in children with neuroblastoma, with the goal of improving patient safety, completeness of resection, and overall patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Spontaneous intracerebral hemorrhage (SICH) is a severe stroke with high mortality and disability rates. Endoscopic surgery is an increasingly widely used minimally invasive method for the treatment of SICH. However, the impact of fever on patient outcomes remains unclear. Methods: We retrospectively included patients aged 18 years or older with supratentorial SICH confirmed by CT, who underwent endoscopic hematoma evacuation within 48 h of symptom onset. The primary outcome was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes included hospital and neurosurgical intensive care unit (NSICU) stays, and perioperative complications. We analyzed the association between postoperative fever (highest temperature within 24 h after surgery) and these outcomes using multivariate analysis, generalized additive models, and segmented regression analysis. Results: Of the 56 patients, 38 had favorable outcomes (mRS ≤ 3) and 18 had unfavorable outcomes (mRS > 3) at 3 months. A threshold effect at 38.2 °C was observed between postoperative body temperature and clinical outcomes. The mean age was 56 years (SD = 9) for the > 38.2 °C group and 58 years (SD = 8) for the ≤ 38.2 °C group, with a similar proportion of male patients (63% vs. 69%, P = 0.635). Patients with postoperative fever had larger hematoma volumes (65 vs. 56 mL; P = 0.008). Other characteristics were similar between the groups. Postoperative fever (> 38.2 °C) was independently associated with a 4.99-fold increased risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P = 0.040), which remained significant after excluding patients with postoperative complications (adjusted RR = 16.03, 95% CI = [1.69 to 417.24]; P = 0.033). The association was consistent across subgroups with different Glasgow Coma Scale scores, hematoma volumes, and intraventricular extension. Postoperative fever was also associated with longer NSICU stays (3.1 vs. 2.3 days; P = 0.023), longer hospital stays (17.2 vs. 13.6 days; P = 0.010), more residual hematoma, and greater edema volume. Different antipyretic therapies did not affect outcomes. Conclusions: This study identifies a temperature threshold (38.2 °C) associated with poor outcomes in SICH patients undergoing endoscopic surgery. Further research is needed to mitigate postoperative fever and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Laser assisted in situ keratomileusis (LASIK) surgery is the leading and most performed refractive surgery nowadays. A possible complication of LASIK surgery is infectious keratitis which can lead to disastrous corneal damage and result in permanent loss of vision. LASIK procedures have become increasingly accessible, and the demand for refractive surgery has risen among patients, challenging the medical field to improve the prevention of post-operative infections. Nevertheless, a wide range of pathogens have been described as responsible for post-LASIK keratitis. However, non-tuberculous mycobacterial keratitis remains an infrequent occurrence and is poorly described in the literature. To the best of our knowledge, this is the first ever reported case of post-LASIK keratitis caused by Mycobacterium wolinskyi. We describe the clinical and microbial characteristics, leading to its challenging treatment choice. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy (MPCNL) with flexible ureteroscopic lithotripsy (FURL) in the treatment of single upper ureteral stones with a diameter of 1–2 cm and high hardness. This study retrospectively analyzed 89 patients diagnosed with a single upper ureteral stone with a 1–2 cm diameter and a computed tomography value > 1000 Hounsfield units. A propensity score matching system matched this study with factors to minimize the effect of baseline differences between patients. Ultimately, 29 patients in each of the two groups were successfully matched. The stone-free rate was marginally higher in the MPCNL group than in the FURL group (93.10% vs. 86.21%), although the difference did not reach statistical significance (P = 0.666). Furthermore, the mean operative time in the MPCNL group, although slightly longer than that in the FURL group, did not demonstrate a statistically significant difference (P = 0.833). However, patients in the MPCNL group exhibited a significantly more substantial decrease in hemoglobin than those in the FURL group (P < 0.001) and a substantially more extended postoperative hospital stay (P < 0.001). Regarding perioperative complications, the incidence of moderate pain was higher in the MPCNL group than in the FURL group (P = 0.037). The difference in overall complication rates between the two groups did not reach statistical significance (P = 0.108). MPCNL and FURL are efficacious surgical procedures for treating single upper ureteral stones with a 1–2 cm diameter and high hardness. [ABSTRACT FROM AUTHOR]

Background: Despite coalition resection being the preferred treatment for talocalcaneal coalition (TCC), postoperative complications, suboptimal functional recovery, and recurrence risks remain challenges. Although current TCC classification systems guide personalized surgical plans, the impact of middle and posterior facet coalitions on TCC resection surgery's effectiveness is still poorly understood. Therefore, this study aims to compare the clinical outcomes of TCC patients with and without involvement of the subtalar joint's (STJ) middle and posterior facets undergoing coalition resection to explore the potential impact of these coalitions on surgical outcomes. Methods: We conducted a retrospective study on 115 patients who underwent coalition resection surgery due to symptomatic TCC between November 2009 and February 2023. According to preoperative CT scan results, patients were divided into an isolated posterior facet coalition (P-type) group and a middle-posterior facet coalition (MP-type) group. Demographic characteristics (including age, sex, body mass index (BMI), follow-up time, and medical history duration), pre-and postoperative assessments (including Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Pain Interference (PI) and Physical Function (PF) scores from the Patient-Reported Outcomes Measurement Information System (PROMIS)), as well as postoperative self-assessment of efficacy (excellent, good, fair, poor) and hindfoot stiffness, were compared between the two groups. Postoperatively, TCC recurrence was evaluated through imaging follow-up examinations. Results: 69 patients meeting the inclusion criteria were included, with 30 patients in the P-type group and 39 in the MP-type group. There were no statistically significant differences between the two groups in demographic characteristics (P<0.05). There were also no statistically significant differences between the two groups in preoperative VAS score, AOFAS score, PI score, and PF score. However, postoperatively, there were statistically significant differences between the two groups in VAS score (1(1,1.5) vs. 2(1,2), P<0.01), AOFAS score (92.5(87,96.5) vs. 82(69.5,87), P<0.01), PI score (39(39,43) vs. 39(39,51), P = 0.014), PF score (73(61,73) vs. 55(51,73), P = 0.001), fair or poor outcome (4(13%) vs. 14(35.9%), P = 0.034), and hindfoot stiffness (3(10.3%) vs. 16(37.2%), P = 0.011). There was no statistically significant differences in the recurrence rate between the two groups postoperatively (0(0%) vs. 3(7.69%), P = 0.252). Conclusion: Even with complete coalition resection during surgery and rehabilitation following standardized protocols, the surgical outcomes in MP-type TCC patients are still inferior to those in P-type patients. [ABSTRACT FROM AUTHOR]

Background: This study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults. Methods: From April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up. Results: All patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma. Conclusion: The combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Halo-pelvic traction (HPT) is acknowledged for enhancing pulmonary function and reducing neurological complications in severe and rigid scoliosis and kyphoscoliosis. While its role in improving coronal balance is established, its impact on sagittal kyphosis remains under-researched. This study aims to assess HPT's effects on sagittal alignment in these conditions. Methods: A retrospective review of 37 patients with severe and rigid scoliosis or kyphoscoliosis was conducted to evaluate HPT's efficacy. The analysis focused on the impact of HPT on coronal and sagittal parameters, pulmonary function tests (PFTs) and complications. Radiographic assessments included main cobb angle in coronal, sagittal major kyphosis. Results: HPT was applied for an average of 2.9 months, significantly reducing the primary coronal curve from 127.7°±30.3° to 74.9°±28.3° (P < 0.05), achieving a 41.3% correction rate. Sagittal kyphosis correction was more pronounced, with angles decreasing from 80.4°±26.4° to 41.3°±24.4° (P < 0.05), resulting in a 48.6% correction rate. Pulmonary function tests showed improvements in forced vital capacity (FVC) (from 1.32 ± 0.91 to 1.55 ± 0.83) and forced expiratory volume in 1 s (FEV1) (from 1.03 ± 0.76 to 1.28 ± 0.72), with percentage predicted values also increasing (FVC%: 40.4%±24.3–51.4%±23.1%; FEV1%: 37.8%±25.2–48.1%±22.7%; all P < 0.05). Conclusion: HPT effectively reduces spinal deformity severity and improves pulmonary function in patients with severe and rigid scoliosis and kyphoscoliosis. Sagittal kyphosis correction was notably greater than coronal scoliosis correction. The correlation between PFT improvements and coronal curve adjustments suggests that correcting the coronal Cobb angle is pivotal for pulmonary function enhancement. [ABSTRACT FROM AUTHOR]

Background: The purpose of this research was to evaluate the efficacy of Narcotrend (NT) monitoring on cognitive dysfunction in patients undergoing anesthesia blockade for gastrointestinal tumors and its effect on cerebral oxygen metabolism and inflammatory response. Methods: Patients preparing to undergo resection of gastrointestinal tumor resection were included and randomly divided into a control group (depth of anesthesia assessed by physician experience) and a research group (depth of anesthesia monitored by NT). HR and MAP were monitored at the preoperatively (T0), 12 h postoperative (T1), 24 h postoperative (T2), and 48 h postoperative (T3) stages. MMSE score was recorded to assess changes in cognitive function. Intracerebral oxygenation indicators (CjvO2, CERO2, and rSO2) were assessed by a blood gas analyzer. ELISA assay was conducted to explore the serum inflammatory indexes (CRP, IL-1β, and TNF-α) and neurological function indicators (NSE and MBP). Results: MAP was higher in the research group than in the control group at T1 and T2 (P < 0.05). MMSE scores at T1, T2, and T3 stages were higher in the research group than in the control (P < 0.05). The incidence of POCD was also lower in the research group compared with the control (P < 0.05). CjvO2, CERO2, and rSO2 were significantly higher (P < 0.05) and were positively correlated with the MMSE scores. Postoperative serum inflammatory indexes were significantly elevated in both groups, but more significantly in the control group (P < 0.05). Both neurological function indicators were usually reduced after surgery, but the reduction was more significant in the research group (P < 0.05). Conclusion: NT monitoring of anesthetic depth has a less physical impact on patients with gastrointestinal tumor anesthetic block, reduces the degree of postoperative POCD, and has significant clinical value. [ABSTRACT FROM AUTHOR]

Background: Pediatric central nervous system tumors are the most common solid tumors in children and leading cause of cancer-related morbidity and mortality. Various factors may influence the practice of blood transfusion during this tumor diagnosis. The primary aim of this study was to determine the factors that may influence intraoperative blood transfusion in pediatric patients undergoing surgery for intracranial tumors and to predict patients who may require blood transfusion. Methods: A retrospective study was performed in all pediatric patients younger than 15 years who underwent craniotomy for brain tumor removal from January 2018 to December 2023 in our institution. Preoperative, intraoperative and postoperative data were collected from medical and store anesthesia records. The predictors of intraoperative blood transfusion were determined using multivariate logistic regression. Results: A total of 138 patients were enrolled in the study, of whom 62 (44.9%) required intraoperative blood transfusion. In multivariate regression analysis age < 4 years and operating time > 490 min were determined as independent variables in terms of need for intraoperative blood transfusion. It was determined that the need for transfusion was higher in patient who were operated on urgently and patients with comorbidities (p = 0.023, p = 0.005). Conclusion: In conclusion, the findings obtained in this study suggest that age and surgical duration are independent risk factors for intraoperative blood transfusion in pediatric patients undergoing surgery for intracranial tumors. Particularly, in younger patients and prolonged surgeries, closer monitoring and awareness may enhance early detection, leading to the prevention of complications. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Surgical quality improvement (QI) plays a critical role in optimizing patient outcomes and reducing healthcare costs. QI programs focusing specifically on thyroid cancer surgical care are lacking. This study aimed to (a) select and introduce surgical quality indicators for thyroid cancer and (b) identify areas for QI at the state‐level.A multidisciplinary team of thyroid cancer and QI experts selected 10 thyroid cancer‐specific quality indicators and assessed the quality of thyroid cancer surgical care compared to current national guidelines. Analysis of the first year (January–December 2023) of data collection was performed using descriptive statistics.The thyroid cancer quality indicators included preoperative cytology, postoperative pathology, staging, cancer size, margin status, extrathyroidal extension, lymph nodes, postoperative complications within 30 days, documented follow‐up treatment, and documented surveillance plans. 112 surgeons performed 360 thyroidectomies for thyroid cancer at 51 hospitals. Preoperative cytology was not performed in 34.3% (n = 103) of cases with thyroid cancer on final pathology. When the extent of surgery was evaluated by papillary cancer size, 50.0% (n = 38) of patients with <1 cm cancers underwent total thyroidectomy, and 13.8% (n = 4) with >4 cm underwent thyroid lobectomy. Positive margins were found in 16.2% (n = 53). Postoperatively, 19.2% (n = 69) of patients lacked documented follow‐up, and 18.6% (n = 67) lacked thyroid cancer surveillance plans.Establishing a dedicated QI program for thyroid cancer provides a previously unharnessed opportunity to enhance the quality of thyroid cancer surgical care. Statewide surgical quality collaboratives offer a model for establishing thyroid cancer QI initiatives across diverse healthcare settings in other states and countries. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsThe aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction.This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months.All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases.This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effectiveness of a novel method for anastomosis reinforcement to minimize the occurrence of anastomotic complications after surgical resection of rectal and sigmoid cancer. Methods: We recruited 378 patients who underwent laparoscopic rectal anterior resection of rectal cancer and sigmoid cancer in SYSUCC. The occurrence rates of intraoperative bleeding, operation time, and postoperative anastomotic complications were compared between the treatment group receiving anastomotic reinforcement and the control group without anastomotic reinforcement. Results: The incidence of anastomotic leakage in the treatment group was significantly lower than that in the control group (1.59% vs. 11.64%, p < 0.001). Following the application of inverse probability of treatment weighting (IPTW) to adjust for factors influencing the occurrence of anastomotic leakage, the incidence of anastomotic leakage remained significantly lower in the treatment group compared to the control group (2.54% vs. 12.08%, p < 0.001). Conclusion: The circumferential continuous anastomosis reinforcing suture method, recommended for laparoscopic surgery for rectal and sigmoid cancer, has the potential to effectively minimize the occurrence of anastomotic complications. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the complications and long-term survival outcomes in patients who underwent radical gastrectomy for gastric cancer, as well as to identify the risk factors associated with postoperative complications. After conducting a comprehensive search within the medical records system, a total of 2508 patients who underwent radical gastrectomy and met the inclusion criteria were enrolled. Of the 2508 patients, 301 were diagnosed with postoperative complications. The pathological data, postoperative recovery, and survival outcome were compared between complication and control group. Subsequently, univariate and multivariate logistic regression analyses were conducted to identified the risk factors. According to the Clavien-Dindo grading criteria for postoperative complications, the proportions of grade I, II, III, IV, and V complications following radical gastrectomy were observed to be 28.2%, 42.9%, 19.6%, 8.0%, and 1.3%, respectively. The presence of postoperative complications significantly prolonged the duration of gastrointestinal decompression (P < 0.001), catheter retention (P < 0.001), fasting (P < 0.001), and hospitalization (P < 0.001). Additionally, it had a detrimental impact on survival outcomes. Age > 65years [odds ratio (OR) = 1.378, P = 0.020], presence of diabetes (OR = 2.042, P < 0.001), operative duration > 215 min (OR = 1.450, P = 0.006), intraoperative blood loss > 275 ml (OR = 1.474, P = 0.004), and Roux-en-Y anastomosis for both whole stomach (OR = 1.567, P = 0.021) and distal gastric cancer (OR = 2.083, P = 0.003) were identified as independent risk factors for postoperative complications. This study analyzed the complications and survival outcomes following radical gastrectomy, and investigated the predictors for postoperative complications, thereby providing valuable guidance on the prevention and management of surgical complications in gastric cancer. [ABSTRACT FROM AUTHOR]

Tongue pressure (TP) decreases significantly after esophagectomy in esophageal cancer patients (ECPs). Meanwhile, 2 weeks of gum-chewing training (GCT) significantly increased TP in healthy university students. We examined whether perioperative GCT would decrease the proportion of patients exhibiting a decline in TP at 2 weeks postoperatively, and prevent postoperative complications, in thoracic ECPs (TECPs). This was a single-center interventional study, and nonrandomized study with a historical control group (HCG). TECPs who underwent first-stage radical esophagectomy were recruited. Thirty-two patients of 40 in the gum-chewing group (GCG) were completed perioperative GCT in 3 times daily. Propensity score matching was performed with covariates related to TP including preoperative age, sex, body mass index, and the repetitive saliva swallowing test result, and yielded a matched cohort of 25 case pairs. Eleven GCG patients [44.0%] exhibited significantly lower TP at 2 weeks postoperatively than before esophagectomy was significantly fewer than that of 19 patients [76.0%] in the HCG. The median number of fever days (> 38 °C) in the 2 weeks after esophagectomy in the GCG was significantly fewer than those in the HCG. Perioperative GCT may prevent postoperative TP decline and postoperative dysphagia-related complications after esophagectomy. [ABSTRACT FROM AUTHOR]

Background: There has been a progressive increase in the use of percutaneous cholecystostomy (PC) in acute cholecystitis (AC) over the last decades due to population aging, and the support of guidelines (Tokyo Guidelines (TG), World Society of Emergency Surgery (WSES) Guidelines) as a valid therapeutical option. However, there are many unanswered questions about the management of PCs. An international consensus on indications and PC management using Delphi methodology with contributions from experts from three surgical societies (EAHPBA, ANS, WSES) have been performed. Methods: A two-round Delphi consensus, which included 27 questions, was sent to key opinion leaders in AC. Participants were asked to indicate their 'agreement/disagreement' using a 5-point Likert scale. Survey items with less than 70% consensus were excluded from the second round. For inclusion in the final recommendations, each survey item had to have reached a group consensus (≥ 70% agreement) by the end of the two survey rounds. Results: 54 completed both rounds (82% of invitees). Six questions got > 70% and are included in consensus recommendations: In patients with acute cholecystitis, when there is a clear indication of PC, it is not necessary to wait 48 h to be carried out; Surgery is the first therapeutic option for the TG grade II acute cholecystitis in a patient suitable for surgery; Before PC removal a cholangiography should be done; There is no indication for PC in Tokyo Guidelines (TG) grade I patients; Transhepatic approach is the route of choice for PC; and after PC, laparoscopic cholecystectomy is the preferred approach (93.1%). Conclusions: Only six statements about PC management after AC got an international consensus. An international guideline about the management of PCs are necessary. [ABSTRACT FROM AUTHOR]

Background: Pectus excavatum is the most common chest wall deformity, with the Nuss procedure being the preferred surgical approach for correction. However, the decision to use thoracoscopic assistance remains challenging. This study aimed to evaluate the perioperative outcomes of thoracoscopic-assisted versus non-thoracoscopic-assisted minimally invasive repair of pectus excavatum (TA-MIRPE vs. NTA-MIRPE). Methods: A comprehensive search was conducted across PubMed, Medline, Embase, WOS, and CBM databases for studies published from 2010 to the present related to this topic. Meta-analysis was performed using RevMan 5.0 and STATA 15.0, with primary comparisons focusing on postoperative complications and the incidence of poor incision healing. Results: Eighteen studies involving a total of 5933 patients were included in the analysis, with 1670 undergoing non-thoracoscopic surgery and 4263 receiving thoracoscopic surgery. The meta-analysis revealed that, compared to the NTA-MIRPE group, the TA-MIRPE group had longer operation times [SMD = 1.71, 95% CI (1.14, 2.28), P < 0.001] and extended postoperative hospital stays [SMD = 0.12, 95% CI (0.04, 0.20), P = 0.004]. However, the TA-MIRPE group showed a lower incidence of postoperative complications [OR = 0.48, 95% CI (0.35, 0.65), z = 4.63, P < 0.001] and higher patient satisfaction [OR = 1.88, 95% CI (1.32, 2.67), z = 3.51, P < 0.001]. Conclusion: While TA-MIRPE is associated with longer operation times and hospital stays, it offers greater patient satisfaction, reduces postoperative complications, and enhances surgical safety. [ABSTRACT FROM AUTHOR]

Introduction: Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old. Material and method: A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60 years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6 months and one subacromial corticosteroid injection. Results: Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66 years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60 years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment. Conclusion: The arthroscopic repair of RCTs in patients 60 years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal. [ABSTRACT FROM AUTHOR]

This study aimed to design sustained released biodegradable calcium carbonate nanoparticles loaded with chlorhexidine (CHX-loaded NPs) and to investigate the early osteogenic differentiation and antimicrobial effects on the important bacteria involved in infections of dental implants. The microemulsion method was used to prepare the calcium carbonate nanoparticles loaded with chlorhexidine. The prepared nanoparticles were characterized using conventional methods. The release pattern determination and the biodegradation test were performed for the prepared nanoparticles. For the early osteogenic differentiation test of the prepared nanoparticles, alkaline phosphatase (ALP) activity was detected in human dental pulp stem cells (HDPSCs). The antimicrobial effects of the nanoparticles were evaluated against Escherichia coli, Streptococcus mutans, Enterococcus faecalis, Staphylococcus aureus, and Pseudomonas aeruginosa. The sizes of free calcium carbonate nanoparticles and CHX-loaded NPs were 105 ± 1.63 and 118 ± 1.47 nm and their zeta potentials were − 27 and − 36, respectively. A 50% degradation of nanoparticles was achieved after 100 days. These nanoparticles showed a two-stage sustained release pattern in vitro. Microscopic images revealed that the morphology of free calcium carbonate nanoparticles primarily took on a spherical calcite form, while CHX-loaded NPs predominantly exhibited a cauliflower-like vaterite polymorph. The nanoparticles increased the activity of ALP in cells in two weeks significantly (p < 0.05). Antimicrobial and antibiofilm results showed an efficient effect of the prepared nanoparticle against the studied bacteria. Calcium carbonate nanoparticles are an efficient multifunctional vector for chlorhexidine and can be used as a bioactive antibacterial agent against various oral microorganisms to prevent implant infections. [ABSTRACT FROM AUTHOR]

Introduction: Stallion castration is a standard procedure with a risk of post-surgical complications. Castration induces an acute phase response (APR). Serum Amyloid-A (SAA) is a well-studied major acute phase protein (APP), that has been shown to be a good marker for the development of post-surgical complications. The current gold standard for reducing the APR after castration is Flunixin-Meglumin, which is a nonsteroidal anti-inflammatory drug (NSAID) inhibiting COX1/2. In contrast, Traumeel LT ad us. vet. can modulate the APR by induction of the inflammation resolution. The aim of this study was to compare the effect of Flunixin-Meglumin and Traumeel LT ad us. vet. on the acute phase response. Material and methods: A total of 60 stallions were recruited and 54 stallions entered the study with 27 stallions in each treatment group. The stallions were treated pre- and postoperatively with either Flunixin-Meglumin (FL) or with Traumeel LT ad us. vet. (TR). Blood was taken before and 24 h, 48 h and 72 h after castration. The following main parameters were assessed: SAA, fibrinogen, iron, white blood cells, neutrophils, Interleukin1ß, and cortisol. Wound healing and pain were assessed at 8 time points. Results: The main variable SAA was increased after surgery reaching a mean value of 122 µg/ml in the FL group and a mean SAA of 226 µg/ml in the TR group 48 h after surgery, reaching a significant difference only at the 24 h timepoint (p = 0.03). All stallions had the highest pain summary score 8 hours after surgery, with decreasing values thereafter. The pain scores were not statistically different at any time point. In the FL group five stallions developed a suture dehiscence compared to only one stallion in the TR group (p = 0.001). Discussion: Within the limitations of this study, Traumeel LT ad us. vet. seems to have proresolving effects on the inflammation induced by surgery making it a valuable treatment to reduce the APR induced by castration. Due to its different mode of action, Traumeel LT ad us. vet. might be an alternative treatment option if gastrointestinal side effects or renal side effects of NSAIDs should be avoided. Further studies are needed combining Traumeel LT ad us. vet. and Flunixin. [ABSTRACT FROM AUTHOR]

Introduction: To mitigate gastroparesis as well as other post-operative complications, we undertook a prospective multicenter study to assess the feasibility, safety, and efficacy in the short-term outcomes of laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation. Methods: A prospective descriptive study on 37 patients with laparoscopic and thoracoscopic whole stomach esophagectomy with preoperative pyloric balloon dilatation from January 2019 to March 2023. The perioperative indications, clinical data, intra-operative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results: In our study, all patients were male, with dysphagia as the predominant symptom (45.9%). Esophageal cancer incidence was similar between middle and lower thirds. Nodules were the primary finding on esophagoscopy (48.6%). Preoperative pyloric dilation averaged 31.2 min without complications. Surgical duration ranged from 225 to 400 min (mean 305). Gastric tube fluid volume averaged 148.9 ± 110.66 ml per day. Among 34 post-operative cases underwent gastric transit scans, most had non-dilated stomachs with efficient pyloric drug circulation. Three cases required prolonged ventilation, precluding pyloric circulation scans. Four patients developed chylous fistula, one requiring chest tube embolization. Recurrent laryngeal nerve damage occurred in 10.8% of cases. Conclusion: After evaluating esophageal cancer patients undergoing laparoscopic whole-stomach esophagectomy with preoperative pyloric balloon dilatation, it was found that this procedure is safe, effective, and significantly reduces postoperative gastroparesis and related complications. [ABSTRACT FROM AUTHOR]

Background: Coronary artery bypass grafting is associated with a high occurrence of postoperative cardiopulmonary complications. Preliminary evidence suggested that enhanced recovery after surgery can effectively reduce the occurrence of postoperative cardiopulmonary complications. However, enhanced recovery after surgery with systematic integration of cardiopulmonary rehabilitation (ERAS-CaRe) into for Coronary artery bypass grafting has not been evaluated so far. We thus design the ERAS-CaRe randomized-controlled trial to evaluate possible superiority of embedding cardiopulmonary rehabilitation in ERAS over ERAS alone as well as to investigate effects of differential timing of cardiopulmonary rehabilitation within enhanced recovery after surgery (pre-, post-, perio-operative) on post-operative cardiopulmonary complications following Coronary artery bypass grafting surgery. Methods: ERAS-CaRe is a pragmatic, randomized-controlled, parallel four-arm, clinical trial. Three hundred sixty patients scheduled for Coronary artery bypass grafting in two Chinese hospitals will be grouped randomly into (i) Standard enhanced recovery after surgery or (ii) pre-operative ERAS-CaRe or (iii) post-operative ERAS-CaRe or (iv) perio-operative ERAS-CaRe. Primary outcome is the occurrence of cardiopulmonary complications at 10 days after Coronary artery bypass grafting. Secondary outcomes include the occurrence of other individual complications including cardiac, pulmonary, stroke, acute kidney injury, gastrointestinal event, ICU delirium rate, reintubation rate, early drainage tube removal rate, unplanned revascularization rate, all-cause mortality, ICU readmission rate, plasma concentration of myocardial infarction-related key biomarkers etc. Discussion: The trial is designed to evaluate the hypothesis that a cardiopulmonary rehabilitation based enhanced recovery after surgery program reduces the occurrence of cardiopulmonary complications following Coronary artery bypass grafting and to determine optimal timing of cardiopulmonary rehabilitation within enhanced recovery after surgery. The project will contribute to increasing the currently limited knowledge base in the field as well as devising clinical recommendations. Trial registration: The trial was registered at the Chinese Clinical Trials Registry on 25 August 2023 (ChiCTR2300075125; date recorded: 25/8/2023, https://www.chictr.org.cn/). [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the clinical effects of perioperative steroid hormone usage in hepatectomy patients through a comprehensive systematic review and meta-analysis. Prospective randomized controlled trials (RCTs) investigating the perioperative use of steroid hormones in hepatectomy patients were systematically searched using various databases, including PubMed, Medline, Embase, the Cochrane Library, the Chinese Biomedical Literature Database, Wanfang Data, and the CNKI database. Two researchers independently screened and extracted data from selected studies. Data analysis was performed using RevMan 5.3 software. The results revealed significantly lower levels of total bilirubin (standard mean difference [SMD] = −0.7; 95% CI: −1.23 to −0.18; and p = 0.009), interleukin-6 (SMD = −1.02; 95% CI: −1.27 to −0.77; and p < 0.001), and C-reactive protein (SMD = −0 .65; 95% CI: −1 .18 to −0.11; and p = 0.02) on postoperative day 1 (POD 1), as well as a reduced incidence of postoperative complications in the steroid group compared to the placebo group. No significant differences were observed between the two groups regarding alanine aminotransferase (ALT) levels, aspartic aminotransferase (AST) levels, or specific complications such as intraabdominal infection (p = 0.72), wound infection (p = 0.1), pleural effusion (p = 0.43), bile leakage (p = 0.66), and liver failure (p = 0.16). The meta-analysis results indicate that perioperative steroid usage can effectively alleviate liver function impairment and inflammation response following hepatectomy while improving patient prognosis. [ABSTRACT FROM AUTHOR]

Postoperative cognitive dysfunction (POCD) poses a significant threat to patients undergoing anesthesia and surgery, particularly elderly patients. It is characterized by diminished cognitive functions post surgery, such as impaired memory and decreased concentration. The potential risk factors for POCD include age, surgical trauma, anesthetic type, and overall health condition; however, the precise mechanisms underlying POCD remain elusive. Recent studies suggest that neuroinflammation might be a primary pathogenic factor. NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasomes are implicated in exacerbating POCD by promoting the release of inflammatory factors and proteins that initiate pyroptosis, further influencing the disease process. The regulation of NLRP3 inflammasome activity, including its activation and degradation, is tightly controlled through multiple pathways and mechanisms. In addition, autophagy, a protective mechanism, regulates the NLRP3 inflammasome to control the progression of POCD. This review reviews recent findings on the role of the NLRP3 inflammasome in POCD pathogenesis and discusses therapeutic strategies aimed at reducing NLRP3 sources, inhibiting cellular pyroptosis, and enhancing autophagy. [ABSTRACT FROM AUTHOR]

Background: Hip fracture is a common event in older adults, leading to an increased risk of mortality, disability, and higher healthcare costs. Early in-hospital rehabilitation after surgery within orthogeriatric units may improve outcomes with limited incident complications even in the oldest old. We aimed to determine the prevalence and predictors of non-adherence to early rehabilitation in the orthogeriatric unit of an Italian tertiary hospital and its impact on outcomes and setting at discharge. Methods: Retrospective observational single-centered cohort study. Patients aged ≥ 65 years admitted to the orthogeriatric unit for hip fracture who underwent surgery between April 2019 and October 2020 were considered eligible if able to walk autonomously or with assistance and independent in at least 2 Basic Activities of Daily Living. Along with sociodemographic and geriatric variables, characteristics of surgery and rehabilitation, in-hospital complications and functional outcomes at discharge were collected. The primary outcome was non-adherence to the early in-hospital rehabilitation program. Results: Among 283 older patients (mean age 82.7 years, 28.6% male), non-compliance with physical therapy was assessed in 49 cases (17.3%), characterized by worse pre-fracture clinical, cognitive, and functional status and showing worse outcomes in terms of mobilization at discharge. After multivariable analysis, non-adherence was independently associated with the onset of delirium (OR 5.26, 95%CI 2.46–11.26; p < 0.001) or infections after surgery (OR 3.26, 95%CI 1.54–6.89; p < 0.001) and a systolic blood pressure at admission < 120 mmHg (OR 4.52, 95%CI 1.96–10.43, p < 0.001). Conclusions: Pre-fracture poor cognitive and functional status, along with lower systolic blood pressure, seem to make some patients more vulnerable to in-hospital complications (mainly delirium and infections) and negatively affect the adherence to physical therapy and, by consequence, clinical outcomes of rehabilitation. [ABSTRACT FROM AUTHOR]