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Introduction Central nervous system (CNS) tumors account for around 1 to 2% of all neoplasms, commonest of them being gliomas. Gliomas constitute a large, heterogenous group of tumors known for a wide variation in clinical presentation, gross and microscopic features, and biologic behavior. Squash cytology can be a great asset in the intraoperative diagnosis of CNS pathology. In this article, we correlate it with the histopathology of gliomas. Methods A prospective analytical study was conducted at the Department of Neuropathology, Super-Speciality Hospital, NSCB Medical College, Jabalpur, India. A total of 75 samples were collected for intraoperative squash cytology. The biopsy samples were collected subsequently after surgery for histopathological correlation. Statistical analysis was done using SPSS software to calculate the sensitivity, specificity, and diagnostic accuracy of squash cytology. Results Of the total 75 patients clinically and radiologically suspected of having gliomas, 43 (57.33%) were males to give a male-to-female ratio of 1.34:1. The mean age at presentation was 36.50 ± 16.87 years. Right-sided tumors were more common. The most common location was the frontal lobe (46.66%). Concordance with squash cytology was found in 81.33% of cases. Sensitivity, specificity, and diagnostic accuracy of squash cytology in the diagnosis of gliomas were found to be 98.61, 66.66, and 97.33%, respectively. Conclusion Squash cytology is a rapid, inexpensive, and accurate diagnostic method for intraoperative diagnosis of gliomas that can guide the surgeon on the extent of tumor resection. [ABSTRACT FROM AUTHOR]

Tonsillectomy is one of the most commonly performed surgical procedures worldwide. Postoperative pain remains a significant problem for patients undergoing tonsillectomy and is the most typical reason for readmission after the procedure. We conducted the present study to investigate the efficacy of a single dose of dexamethasone administered intravenously before tonsillectomy on postoperative pain in a group of patients undergoing cold dissection tonsillectomy, using a standardised anaesthetic and surgical procedure.It was a prospective study done in the Department of ENT in a tertiary care centre in eastern India, from 1 st September 2017 to 31 st August 2019 (2 years). Subjects included in the study were patients who attended the OPD of ENT of the tertiary care centre in eastern India, with a history of throat pain,difficulty in deglutition, mouth breathing, snoring. Tonsillectomy operation was recommended to the patients who fit the inclusion criteria. A hundred patients were selected for the study and divided randomly into two groups. Patients in group A (50 patients) were administered preoperative intravenous dexamethasone (0.15 mg/kg)after the induction of anaesthesia, and Group B patients (50 patients)were not administered dexamethasone along with other drugs.RESULTS: A hundred patients were enrolled after excluding the patients not fulfilling the selection criteria. The majority of patients were female, with the majority patients between 9–19 years. There was a noteworthy decreased mean pain score postoperatively of Group A on the first, third, and fifth day. (p-value = < 0.001).The results of this study suggest that a single preoperative injection of dexamethasone for patients undergoing tonsillectomy by cold dissection method significantly reduced postoperative pain. [ABSTRACT FROM AUTHOR]

Suprasellar extension, cavernous sinus invasion, and involvement of intracranial vascular structures and cranial nerves are among the challenges faced by surgeons operating on giant pituitary macroadenomas. Intraoperative tissue shifts may render neuronavigation techniques inaccurate. Intraoperative magnetic resonance imaging can solve this problem, but it may be costly and time consuming. However, intraoperative ultrasonography (IOUS) allows for quick, real-time feedback and may be particularly useful when facing giant invasive adenomas. Here, we present the first study examining technique for IOUS-guided resection specifically focusing on giant pituitary adenomas. To describe the use of a side-firing ultrasound probe in the resection of giant pituitary macroadenomas. We describe an operative technique using a side-firing ultrasound probe (Fujifilm/Hitachi) to identify the diaphragma sellae, confirm optic chiasm decompression, identify vascular structures related to tumor invasion, and maximize extent of resection in giant pituitary macroadenomas. Side-firing IOUS allows for identification of the diaphragma sellae to help prevent intraoperative cerebrospinal fluid leak and maximize extent of resection. Side-firing IOUS also aids in confirmation of decompression of the optic chiasm via identification of a patent chiasmatic cistern. Furthermore, direct identification of the cavernous and supraclinoid internal carotid arteries and arterial branches is achieved when resecting tumors with significant parasellar and suprasellar extension. We describe an operative technique in which side-firing IOUS may assist in maximizing extent of resection and protecting vital structures during surgery for giant pituitary adenomas. Use of this technology may be particularly valuable in settings in which intraoperative magnetic resonance imaging is not available. [ABSTRACT FROM AUTHOR]

Simple Summary: Intraoperative Flow Cytometry (iFC) is a new technique that can help assess the malignancy grade, diagnose tumor type, and evaluate resection margins during solid tumor surgery. This study focuses on the role of iFC in grading gliomas and evaluating resection margins. iFC can analyze tissue samples within 5–6 min and was utilized to evaluate samples from patients with gliomas who underwent surgery over an 8-year period. The study found that high-grade gliomas had a significantly higher tumor index than low-grade gliomas. A cut-off value of 17% in the tumor index was identified as being able to accurately differentiate low- from high-grade gliomas. All low-grade gliomas were diploid, while 22 high-grade gliomas were aneuploid. iFC was also able to verify the presence of malignant tissue in every case when evaluating glioma margins. The study concludes that iFC is a promising intraoperative technique for glioma grading and resection margin assessment. Background: Intraoperative Flow Cytometry (iFC) is a novel technique for the assessment of the grade of malignancy and the diagnosis of tumor type and resection margins during solid tumor surgery. Herein, we set out to analyze the role of iFC in the grading of gliomas and the evaluation of resection margins. Material and Methods: iFC uses a fast cell cycle analysis protocol (Ioannina Protocol) that permits the analysis of tissue samples within 5–6 min. Cell cycle analysis evaluated the G0/G1 phase, S-phase, mitosis, and tumor index (S + mitosis phase fraction) and ploidy status. In the current study, we evaluated tumor samples and samples from the peripheral borders from patients with gliomas who underwent surgery over an 8-year period. Results: Eighty-one patients were included in the study. There were sixty-eight glioblastoma cases, five anaplastic astrocytomas, two anaplastic oligodendrogliomas, one pilocytic astrocytoma, three oligodendrogliomas and two diffuse astrocytomas. High-grade gliomas had a significantly higher tumor index than low grade gliomas (median value 22 vs. 7.5, respectively, p = 0.002). Using ROC curve analysis, a cut-off value of 17% in the tumor index could differentiate low- from high-grade gliomas with a 61.4% sensitivity and 100% specificity. All low-grade gliomas were diploid. From the high-grade gliomas, 22 tumors were aneuploid. In glioblastomas, aneuploid tumors had a significantly higher tumor index (p = 0.0018). Twenty-three samples from glioma margins were evaluated. iFC verified the presence of malignant tissue in every case, using histology as the gold standard. Conclusion: iFC constitutes a promising intraoperative technique for glioma grading and resection margin assessment. Comparative studies with additional intraoperative adjuncts are necessary. [ABSTRACT FROM AUTHOR]

Airborne biologic particles (ABPs) can be measured intraoperatively to evaluate operating room (OR) sterility. Our study examines the role of OR size on air quality and ABP count in primary total hip arthroplasty (THA). We analyzed primary THA procedures done within 2 ORs measuring 278 ft2 and 501 ft2 at a single academic institution from April 2019 to June 2020. Temperature, humidity, and ABP count per minute were recorded with a particle counter intraoperatively and cross-referenced with surgical data from the electronic health records using procedure start and end times. Descriptive statistics were used to evaluate differences in variables. P -values were calculated using t-test and chi-squared test. A total of 116 primary THA cases were included: 18 (15.5%) in the "small" OR and 98 (84.5%) in the "large" OR. Between-group comparisons revealed significant differences in temperature (small OR: 20.3 ± 1.23 C versus large OR: 19.1 ± 0.85 C, P <.0001) and relative humidity (small OR: 41.1 ± 7.24 versus large OR: 46.9 ± 7.56, P <.001). Significant percent decreases in ABP rates for particles measuring 2.5 um (−125.0%, P =.0032), 5.0 um (−245.0%, P =.00078), and 10.0 um (−413.9%, P =.0021) were found in the large OR. Average time spent in the OR was significantly longer in the large OR (174 ± 33 minutes) compared to the small OR (151 ± 14 minutes) (P =.00083). Temperature and humidity differences and significantly lower ABP counts were found in the large compared to the small OR despite longer average time spent in the large OR, suggesting the filtration system encounters less particle burden in larger rooms. Further research is needed to determine the impact this may have on infection rates. [ABSTRACT FROM AUTHOR]

Purpose: Patients with congenital central hypoventilation syndrome (CCHS) have autonomic dysfunction and lack ventilatory responses to hypoxemia and hypercarbia and thus are prone to adverse events during general anesthesia. The objective of this study was to describe the perioperative outcomes of patients with CCHS who were undergoing diaphragm pacer (DP) implantation surgeries under general anesthesia. Methods: A retrospective cohort study was conducted on patients with CCHS who underwent DP implantation surgeries at CHLA between January 2000 and May 2016. Charts were reviewed for demographics, PHOX2B genotype, ventilatory support, comorbidities, anesthesia administered, and perioperative courses. Results: Of 19 patients with CCHS (58% female) mean age at surgeries was 8.6 ± 5.8 years. Seventeen patients were ventilator-dependent during sleep only; two were ventilator dependent 24 h per day. Mean surgery duration was 3.1 ± 0.5 h. Seventeen patients were extubated to PPV via tracheostomy in the OR. Two patients were extubated to NPPV on postoperative day (POD) 1. Mean transition time to home ventilator or NPPV was 3.0 ± 2.2 days, and mean hospital stay was 5.0 ± 2.1 days. One patient premedicated without ventilatory support developed hypoxemia and hypoventilation. Ten patients (52%) had intraoperative events such as bradycardia, hypotension, significant hypoxemia, and bronchospasm. Fifteen patients had postoperative events. Hypoxemia, pneumonia, and atelectasis accounted for most of perioperative complications. One patient experienced seizure on POD 2 due to hypercarbia. Conclusion: Patients with CCHS are vulnerable to the cardiorespiratory effects of sedative and anesthetic agents. Therefore, they require vigilant monitoring and optimal ventilatory support in the perioperative period. [ABSTRACT FROM AUTHOR]

Transfusion decisions are guided by clinical factors and measured hemoglobin (Hb). Time required for blood sampling and analysis may cause Hb measurement to lag clinical conditions, thus continuous intraoperative Hb trend monitoring may provide useful information. This multicenter study was designed to compare three methods of determining intraoperative Hb changes (trend accuracy) to laboratory determined Hb changes. Adult surgical patients with planned arterial catheterization were studied. With each blood gas analysis performed, pulse cooximetry hemoglobin (SpHb) was recorded, and arterial blood Hb was measured by hematology (tHb), arterial blood gas cooximetry (ABGHb), and point of care (aHQHb) analyzers. Hb change was calculated and trend accuracy assessed by modified Bland-Altman analysis. Secondary measures included Hb measurement change direction agreement. Trend accuracy mean bias (95% limits of agreement; g/dl) for SpHb was 0.10 (- 1.14 to 1.35); for ABGHb was - 0.02 (- 1.06 to 1.02); and for aHQHb was 0.003 (- 0.95 to 0.95). Changes more than ± 0.5 g/dl agreed with tHb changes more than ± 0.25 g/dl in 94.2% (88.9-97.0%) SpHb changes, 98.9% (96.1-99.7%) ABGHb changes and 99.0% (96.4-99.7%) aHQHb changes. Sequential changes in SpHb, ABGHb and aHQHb exceeding ± 0.5 g/dl have similar agreement to the direction but not necessarily the magnitude of sequential tHb change. While Hb blood tests should continue to be used to inform transfusion decisions, intraoperative continuous noninvasive SpHb decreases more than - 0.5 g/dl could be a good indicator of the need to measure tHb.

Purpose of reviewMajor adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review.Recent findingsDeep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug use during general anesthesia and postoperative delirium.SummaryUnlike ECG monitoring, the EEG under general anesthesia has not been designated as a standard monitor by anesthesiologist societies around the world. The processed EEG technology has been commercially available for more than 25 years and EEG technology has significantly facilitated its intraoperative use. It is time to consider EEG as a standard anesthesia monitor during surgery.

Study designRetrospective analysis.ObjectiveTo assess the impact of mean arterial blood pressure (MAP) during surgical intervention for spinal cord injury (SCI) on motor recovery.SettingLevel-one Trauma Hospital and Acute Rehabilitation Hospital in San Jose, CA, USA.MethodsTwenty-five individuals with traumatic SCI who received surgical and acute rehabilitation care at a level-one trauma center were included in this study. The Surgical Information System captured intraoperative MAPs on a minute-by-minute basis and exposure was quantified at sequential thresholds from 50 to 104 mmHg. Change in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor score was calculated based on physiatry evaluations at the earliest postoperative time and at discharge from acute rehabilitation. Linear regression models were used to estimate the rate of recovery across the entire MAP range.ResultsAn exploratory analysis revealed that increased time within an intraoperative MAP range (70-94 mmHg) was associated with ISNCSCI motor score improvement. A significant regression equation was found for the MAP range 70-94 mmHg (F[1, 23] = 5.07, r2 = 0.181, p = 0.034). ISNCSCI motor scores increased 0.039 for each minute of exposure to the MAP range 70-94 mmHg during the operative procedure; this represents a significant correlation between intraoperative time with MAP 70-94 and subsequent motor recovery. Blood pressure exposures above or below this range did not display a positive association with motor recovery.ConclusionsHypertension as well as hypotension during surgery may impact the trajectory of recovery in individuals with SCI, and there may be a direct relationship between intraoperative MAP and motor recovery.

BackgroundCognitive changes after anesthesia and surgery represent a significant public health concern. We tested the hypothesis that, in patients 60 yr or older scheduled for noncardiac surgery, automated management of anesthetic depth, cardiac blood flow, and protective lung ventilation using three independent controllers would outperform manual control of these variables. Additionally, as a result of the improved management, patients in the automated group would experience less postoperative neurocognitive impairment compared to patients having standard, manually adjusted anesthesia.MethodsIn this single-center, patient-and-evaluator-blinded, two-arm, parallel, randomized controlled, superiority study, 90 patients having noncardiac surgery under general anesthesia were randomly assigned to one of two groups. In the control group, anesthesia management was performed manually while in the closed-loop group, the titration of anesthesia, analgesia, fluids, and ventilation was performed by three independent controllers. The primary outcome was a change in a cognition score (the 30-item Montreal Cognitive Assessment) from preoperative values to those measures 1 week postsurgery. Secondary outcomes included a battery of neurocognitive tests completed at both 1 week and 3 months postsurgery as well as 30-day postsurgical outcomes.ResultsForty-three controls and 44 closed-loop patients were assessed for the primary outcome. There was a difference in the cognition score compared to baseline in the control group versus the closed-loop group 1 week postsurgery (-1 [-2 to 0] vs. 0 [-1 to 1]; difference 1 [95% CI, 0 to 3], P = 0.033). Patients in the closed-loop group spent less time during surgery with a Bispectral Index less than 40, had less end-tidal hypocapnia, and had a lower fluid balance compared to the control group.ConclusionsAutomated anesthetic management using the combination of three controllers outperforms manual control and may have an impact on delayed neurocognitive recovery. However, given the study design, it is not possible to determine the relative contribution of each controller on the cognition score.

Intraoperative diagnosis is essential for providing safe and effective care during cancer surgery1. The existing workflow for intraoperative diagnosis based on hematoxylin and eosin staining of processed tissue is time, resource and labor intensive2,3. Moreover, interpretation of intraoperative histologic images is dependent on a contracting, unevenly distributed, pathology workforce4. In the present study, we report a parallel workflow that combines stimulated Raman histology (SRH)5-7, a label-free optical imaging method and deep convolutional neural networks (CNNs) to predict diagnosis at the bedside in near real-time in an automated fashion. Specifically, our CNNs, trained on over 2.5 million SRH images, predict brain tumor diagnosis in the operating room in under 150 s, an order of magnitude faster than conventional techniques (for example, 20-30 min)2. In a multicenter, prospective clinical trial (n = 278), we demonstrated that CNN-based diagnosis of SRH images was noninferior to pathologist-based interpretation of conventional histologic images (overall accuracy, 94.6% versus 93.9%). Our CNNs learned a hierarchy of recognizable histologic feature representations to classify the major histopathologic classes of brain tumors. In addition, we implemented a semantic segmentation method to identify tumor-infiltrated diagnostic regions within SRH images. These results demonstrate how intraoperative cancer diagnosis can be streamlined, creating a complementary pathway for tissue diagnosis that is independent of a traditional pathology laboratory.

Introduction: Intraoperative consultation examinations are required by surgeons from pathologists for immediate important decisions regarding the optimal extent of surgery. Surgeons particularly want to know whether a lesion is malignant or not. Both frozen section (FS) and touch impression cytology serve this purpose well. Both provide accurate results in minutes while the patient is under anesthesia. The surgeon then modifies his surgical plan based on the intraoperative consultation from pathologist. Objectives: The objective of this study is to access the role of imprint cytology (IC) and FS in diagnosis of tumors of different organs, to correlate IC and FS findings with histopathological diagnosis and to determine their diagnostic accuracy. Materials and Method: This present prospective cross-sectional study was done in the pathology department of BKL Walawalkar Rural Medical College, Dervan, Chiplun, for a period of one and a half year. A total of 161 surgical specimens from various organs were studied using IC and FS. The results of both the techniques were compared with the gold standard histopathological diagnosis. Results: Statistical correlation of IC and FS with histopathology shows that true positive cases on IC are 88.7% and on FS are 85.1%. Sensitivity, specificity, and diagnostic accuracy of IC and FS are 95.7%, 81.8%, 94.7% and 93.2%, 78.9%, 92%, respectively. Combined diagnostic accuracy is 93.5%. Conclusion: IC and FSs are interdependable intraoperative diagnostic modalities. IC is a simple, accurate, rapid, and cost-effective diagnostic tool, intraoperatively. FS preserves crisp cellular and nuclear detail and also closely approximates permanent histopathology sections. Thus, a combination of IC and FS helps in achieving high diagnostic accuracy rates and in distinguishing benign and malignant lesions.

Background: The perfusion index (PI) is a noninvasive hemodynamic parameter measured by a pulse oximeter that reflects the peripheral perfusion. This study aimed to correlate the perfusion index with noninvasive hemodynamic parameters during periods of stress in neurosurgical cases. Patients and Methods: Fifty-five American Society of Anesthesiologists physical status I and II patients scheduled for elective supratentorial surgeries under general anesthesia were recruited. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and PI were noted before induction, before and after intubation, skull pin insertion, skin incision, and craniotomy. Correlations between PI and HR, SBP, and DBP were assessed. Sensitivity, specificity, and positive and negative predictive values were calculated for SBP, DBP, and PI taking HR as the gold standard. Results: Intubation, skull pins, and incision produced significant increases in HR, SBP, DBP, and a significant decrease in PI when compared to pre-procedure values. Changes in PI were more pronounced (P < 0.001). A negative correlation was seen between PI and HR, SBP, and DBP (r = −0.22, −0.13, −0.18, respectively, P < 0.001). The area under the receiver operator characteristic curve is 0.75 for the PI criterion to predict stress response with a sensitivity of 81% (CI 76.99%–85.03%) and specificity of 59.92% (CI 56.35%–63.39%). Conclusion: PI correlated significantly with conventional hemodynamic markers during periods of stress. However, PI showed higher sensitivity, but lower specificity than SBP and DBP.

Context: Central nervous system lesions are diverse and remain one of the most challenging domains for neuropathologists. Intraoperative cytological diagnosis is now a universally accepted technique in diagnosis of central nervous system (CNS) lesions. Aims: 1) To analyze and compare cytomorphological features of CNS lesions in intraoperative squash smears with histopathology, immunohistochemistry, and preoperative radiological diagnosis and 2) to determine the diagnostic accuracy, sensitivity, and specificity of intraoperative squash cytology. Settings and Design: Prospective study conducted at a tertiary healthcare centre over a period of two years. Methods and Material: All biopsy materials which underwent squash cytology and histopathological examination were collected, evaluated, classified, and graded according to WHO classification of CNS Tumors, 2016. The squash cytosmear diagnosis was compared with histopathological features and radiological diagnosis. Discordances were evaluated. Statistical Analysis Used: The cases were categorized into true positives, false positives, true negatives, and false negatives. Diagnostic accuracy, sensitivity, and specificity were calculated from 2*2 table. Results: A total of 190 cases were included in the study. A total of 182 cases (95.70%) were neoplastic of which 87.36% were primary CNS neoplasms. Diagnostic accuracy in non-neoplastic lesions was 88.8%. Most common neoplastic lesions were glial tumors (35.7%), meningioma (17.3%), tumors of cranial and spinal nerves (12%), and metastatic lesions (12%). Diagnostic accuracy of squash cytology was higher in glial tumors (93.8%), meningioma (96.7%), and metastatic lesions (95.45%). Diagnostic accuracy of radiological modalities was 85.78%. Conclusions: A good familiarity with cytomorphological features of CNS lesions, clinical details, radiological findings, and intraoperative impression of neurosurgeon enables the pathologist to improve diagnostic accuracy and reduce errors.

Background: High blood sugar is a typical reaction to stress. In the diabetic population, hyperglycemia can be a serious issue and has been linked to higher mortality rates. Recent studies have shown that anesthetics reduced glucose tolerance; however, it is still unclear how propofol, ketamine, and thiopental of Na affect glucose metabolism. The present study compared the blood glucose levels of thiopental of Na, ketamine, and propofol among patients with cataract surgery. Materials and Methods: The study included 135 ASA II and III adult patients of both genders who were older than 65, known to have type II diabetes, receiving intravenous (IV) sedation, and scheduled for cataract surgery. The three groups were comparable with regard to patients, age, gender, weight, duration of the operation time, duration of recovery time, duration of diabetes, and anesthesiologist’s physical status (based on the American Society of Anesthesiology). Patients were randomly assigned to one of three groups, including receiving IV thiopental of Na 5 mg/kg/h (group T), ketamine 2 mg/kg/h (group K), or propofol 2 mg/kg/h (group P) after the induction of IV sedation with 1-2 mic/kg fentanyl and 0.03 mg/kg midazolam. Changes in blood glucose levels were examined as dependent variables in patients with cataract surgeries while under the influence of these medications up to 6 hours after. Results: The results showed that blood glucose concentrations increased significantly over time in all groups. Moreover, blood glucose concentrations did not differ significantly between the groups receiving the thiopental of Na ketamine or propofol at any measurement time. During the first post-administrative hour, the thiopental of Na, ketamine, and propofol groups demonstrated blood glucose levels of 114.2±16.24 mg/dL, 136.2±12.28 mg/dL, and 122.2±13.84 mg/dL, which were not statistically significant (P=0.72). Regarding the frequency and severity of blood glucose level changes during or after surgery, the groups did not significantly differ at any point in time. Conclusion: The findings of the present study suggest that the thiopental of Na, ketamine, and propofol have equal effects on glucose metabolism.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC:Recommendations for anesthetic care are often difficult to implement in the intraoperative setting because of the requirement for continuous attention WHAT THIS ARTICLE TELLS US THAT IS NEW: Closed-loop, automated management of anesthetic, analgesic, fluid, and ventilation parameters was superior to manual control and might influence postoperative outcomes BACKGROUND:: Cognitive changes after anesthesia and surgery represent a significant public health concern. We tested the hypothesis that, in patients 60 yr or older scheduled for noncardiac surgery, automated management of anesthetic depth, cardiac blood flow, and protective lung ventilation using three independent controllers would outperform manual control of these variables. Additionally, as a result of the improved management, patients in the automated group would experience less postoperative neurocognitive impairment compared to patients having standard, manually adjusted anesthesia. METHODS:In this single-center, patient-and-evaluator-blinded, two-arm, parallel, randomized controlled, superiority study, 90 patients having noncardiac surgery under general anesthesia were randomly assigned to one of two groups. In the control group, anesthesia management was performed manually while in the closed-loop group, the titration of anesthesia, analgesia, fluids, and ventilation was performed by three independent controllers. The primary outcome was a change in a cognition score (the 30-item Montreal Cognitive Assessment) from preoperative values to those measures 1 week postsurgery. Secondary outcomes included a battery of neurocognitive tests completed at both 1 week and 3 months postsurgery as well as 30-day postsurgical outcomes. RESULTS:Forty-three controls and 44 closed-loop patients were assessed for the primary outcome. There was a difference in the cognition score compared to baseline in the control group versus the closed-loop group 1 week postsurgery (-1 [-2 to 0] vs. 0 [-1 to 1]; difference 1 [95% CI, 0 to 3], P = 0.033). Patients in the closed-loop group spent less time during surgery with a Bispectral Index less than 40, had less end-tidal hypocapnia, and had a lower fluid balance compared to the control group. CONCLUSIONS:Automated anesthetic management using the combination of three controllers outperforms manual control and may have an impact on delayed neurocognitive recovery. However, given the study design, it is not possible to determine the relative contribution of each controller on the cognition score.

Introduction: When performing a nerve-sparing (NS) robotic radical prostatectomy (RARP), cancer location based on multiparametric MRI (mpMRI) is essential, as well as the location of positive biopsy cores outside mpMRI targets. The aim of this pilot study was to assess the feasibility of intraoperative 3D-TRUS-mpMRI elastic fusion imaging to guide RARP and to evaluate its impact on the surgical strategy. Methods: We prospectively enrolled 11 patients with organ-confined mpMRI-visible prostate cancer (PCa), histologically confirmed at transperineal fusion biopsy using Koelis Trinity. Before surgery, the 3D model of the prostate generated at biopsy was updated, showing both mpMRI lesions and positive biopsy cores, and was displayed on the Da Vinci robotic console using TilePro™ function. Results: Intraoperative 3D modeling was feasible in all patients (median of 6 min). The use of 3D models led to a major change in surgical strategy in six cases (54%), allowing bilateral instead of monolateral NS, or monolateral NS instead of non-NS, to be performed. At pathologic examination, no positive surgical margins (PSMs) were reported. Bilateral PCa presence was detected in one (9%), four (36%), and nine (81%) patients after mpMRI, biopsy, and RARP, respectively. Extracapsular extension was found in two patients (18%) even if it was not suspected at MRI. Conclusions: Intraoperative 3D-TRUS-mpMRI modeling with Koelis Trinity is feasible and reliable, helping the surgeon to maximize functional outcomes without increasing the risk of positive surgical margins. The location of positive biopsy cores must be registered in 3D models, given the rates of bilateral involvement not seen at mpMRI.

Abstract Objective The purpose of this study was to introduce a new feasible and effective intraoperative localization technique for small peripheral pulmonary nodules in hybrid operating room. Methods Between June 2020 and June 2021, the intraoperative localization was performed in 27 patients for 35 small pulmonary nodules at our institution. The procedure was undergone under thoracoscopic observation. After making the VATS ports, a titanium clip was clipped at the visceral pleura as near the pulmonary nodule as possible to be a marker for the nodule. VATS resection was performed next. Results A total of 27 patients were included in this study, including 6 males and 21 females. The median age was 58 years (range 34–78 years). All surgeries were performed by two-port VATS. A total of 35 pulmonary nodules underwent intraoperative localization. The mean diameter of nodules was 10.6 ± 3.7 mm. The distance of nodules to visceral pleura was 8.3 ± 8.7 mm. The mean localization time was 23.3 ± 3.3 min. The median time of C-arm scanning was 3 (range 2–4) times. The median times for clipping were 2 (range 1–3) times. All the nodules were localized successfully and resected precisely. No VATS were converted to thoracotomy. There were no complications related to localization procedures. Conclusions This new intraoperative localization technique was feasible, safe and effective. And also the intraoperative procedure could avoid extra suffering for patients.

Background: The emergence of the new WHO classification standard in 2021 incorporated molecular characteristics into the diagnosis system for meningiomas, making the diagnosis and treatment of meningiomas enter the molecular era. Recent findings: At present, there are still some problems in the clinical molecular detection of meningioma, such as low attention, excessive detection, and a long cycle. In order to solve these clinical problems, we realized the intraoperative molecular diagnosis of meningioma by combining real-time fluorescence PCR and AIGS, which is also the first known product applied to the intraoperative molecular diagnosis of meningioma. Implications for practice: We applied AIGS to detect and track a patient with TERTp mutant meningioma, summarized the process of intraoperative molecular diagnosis, and expounded the significance of intraoperative molecular diagnosis under the new classification standard, hoping to optimize the clinical decisionmaking of meningioma through the diagnosis and treatment plan of this case. [ABSTRACT FROM AUTHOR]

Background & Method: The aim of present study is to evaluate intraoperative technical difficulties during PHILOS Plating for treatment of displaced proximal humerus fractures. Proximal humerus fracture were attended in casualty and OPD and were admitted. After the patient with proximal humerus was admitted to the hospital, all history and clinical details were recorded in history sheet according to planned proforma. Radiographic evaluation was done and fractures were classified according to Neer's classification. Result: 57% patients had two part fracture of proximal humerus which was the most common type in our study. Right side was involved in more patients. 34 patients had right side involved. In our patients, treated by PHILOS plating most common complication was varus malunion and least common complication was implant failure. Conclusion: Functional Outcome is better and earlier in Younger Patients. Although outcome is also good in elderly. Age and fracture configuration play a significant role in the clinical outcome of these fractures after internal fixation. Complications may be related to inappropriate surgical technique or fracture geometry. Those related to surgical technique are preventable and include improper fracture reduction, screw placement, improper plate placement leading to impingement, excessive soft tissue stripping of the fracture fragments predisposing to avascular necrosis and occasional neurovascular injury. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the diagnostic accuracy of preoperative computed tomography (CT) and intraoperative endoscopic tumor staging with regard to histopathologic staging in patients with early laryngeal cancer. Study Design: A retrospective nonrandomized single‐institution comparative cohort study including 109 patients. Setting: A tertiary surgical center. Methods: Patients were treated for T1a, T1b, and T2a laryngeal squamous cell carcinoma by endoscopic laser surgery. The outcome measures were the presence of under‐ or overstaging in endoscopic and CT findings and positive postoperative margins. Results: Endoscopic overstaging as compared with histopathologic T category correlated with rising tumor category (P =.001; odds ratio [OR], 69.1) and CT findings showing anterior commissure involvement (P =.002; OR, 9.54), while endoscopic understaging correlated with rising tumor histologic grade (P =.039; OR, 4.28) and smaller tumor size (P =.011; OR, 6.39). CT overstaging vs histopathologic T category correlated with CT findings showing anterior commissure involvement (P =.001; OR, 21.76), supraglottic involvement (P =.001; OR, 59.98), subglottic involvement (P =.001; OR, 39.94), rising clinical T category (P =.01; OR, 9.11), and rising tumor histologic grade (P =.004; OR, 10.95). CT understaging as compared with histopathologic T category correlated with smaller clinical T categories (P =.002; OR, 12.72) and smaller tumor histologic grade (P =.030; OR, 7.02). Rising age, rising tumor size, anterior commissure involvement on CT, and tumor extension into the supraglottis were risk factors for positive margins. Conclusion: Our results indicate that CT adds little valuable information in differentiating small superficial lesions in the glottis, while systematically overstaging cases of early laryngeal cancer. In T1a and T1b glottic tumors, endoscopy should be the preferred diagnostic method. [ABSTRACT FROM AUTHOR]

Background: Despite acute appendicitis is one of the most common surgical emergencies, its aetiology remains incompletely understood. Aim: This study aimed to assess the rate at which faecoliths were present in acute appendicitis treated with appendicectomy and whether their presence was associated with complicated appendicitis. Methods: All adult patients who underwent appendicectomy for acute appendicitis in a 2 years period (January 2018 and December 2019) at a single institution were retrospectively reviewed. The presence of a faecolith was identified by at least one of three methods: pre-operative CT scan, intraoperative identification, or histopathology report. Patients were grouped according to the presence or absence of a faecolith and demographics, type of appendicitis and surgical outcomes analysed. Complicated appendicitis was defined as appendicitis with perforation, gangrene and/or periappendicular abscess formation. Results: A total of 1035 appendicectomies were performed with acute appendicitis confirmed in 860 (83%), of which 314 (37%) were classified as complicated appendicitis. Three hundred thirty-nine (35%) of the appendicitis cases had faecoliths (complicated 165/314 cases; 53%; uncomplicated 128/546; 23%, p < 0.001). The presence of a faecolith was associated with higher complications and a subsequent longer post-operative stay. Conclusion: The rigorous methodology of this study has demonstrated a higher rate of faecolith presence in acute appendicitis than previously documented. It reinforces the association of faecoliths with a complicated disease course and the importance in prioritising emergency surgery and postoperative monitoring for complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Real-time diagnosis tools and methods are desired to aid in the intraoperative grading of glioma and tumor boundary identification to achieve safe maximal tumor removal. Raman spectroscopy is an optical method for real-time glioma detection, but few studies use fresh glioma tissue for biochemical analysis. This study is the first investigation of human glioma using a portable VRR-LRRTM Raman analyzer under quasi-clinical conditions, and reveals significant spectral differences between normal (control) and different grades of glioma. A principal component analysis–support vector machine (PCA-SVM) machine learning method was used to distinguish glioma tissues from normal tissues and different glioma grades. The accuracy in identifying glioma from normal tissue was over 80%, compared with histopathology as the gold standard. This result validates the possibility of glioma diagnosis using fresh tissue and provides instant feedback for neurosurgeons in guiding maximal safe resection, and it may support the translation of this portable tool for in vivo and real-time use in tissue biochemical analysis. There is still a lack of reliable intraoperative tools for glioma diagnosis and to guide the maximal safe resection of glioma. We report continuing work on the optical biopsy method to detect glioma grades and assess glioma boundaries intraoperatively using the VRR-LRRTM Raman analyzer, which is based on the visible resonance Raman spectroscopy (VRR) technique. A total of 2220 VRR spectra were collected during surgeries from 63 unprocessed fresh glioma tissues using the VRR-LRRTM Raman analyzer. After the VRR spectral analysis, we found differences in the native molecules in the fingerprint region and in the high-wavenumber region, and differences between normal (control) and different grades of glioma tissues. A principal component analysis–support vector machine (PCA-SVM) machine learning method was used to distinguish glioma tissues from normal tissues and different glioma grades. The accuracy in identifying glioma from normal tissue was over 80%, compared with the gold standard of histopathology reports of glioma. The VRR-LRRTM Raman analyzer may be a new label-free, real-time optical molecular pathology tool aiding in the intraoperative detection of glioma and identification of tumor boundaries, thus helping to guide maximal safe glioma removal and adjacent healthy tissue preservation. [ABSTRACT FROM AUTHOR]

Introduction: Intraoperative ultrasound (IOUS) may aid the resection of space-occupying brain lesions, though technical limits may hinder its reliability. Methods: IOUS (MyLabTwice®, Esaote, Italy) with a microconvex probe was utilized in 45 consecutive cases of children with supratentorial space-occupying lesions aiming to localize the lesion (pre-IOUS) and evaluate the extent of resection (EOR, post-IOUS). Technical limits were carefully assessed, and strategies to enhance the reliability of real-time imaging were accordingly proposed. Results: Pre-IOUS allowed us to localize the lesion accurately in all of the cases (16 low-grade gliomas, 12 high-grade gliomas, eight gangliogliomas, seven dysembryoplastic neuroepithelial tumors, five cavernomas, and five other lesions, namely two focal cortical dysplasias, one meningioma, one subependymal giant cell astrocytoma, and one histiocytosis). In 10 deeply located lesions, IOUS with hyperechoic marker, eventually coupled with neuronavigation, was useful to plan the surgical route. In seven cases, the administration of contrast ensured a better definition of the vascular pattern of the tumor. Post-IOUS allowed the evaluation of EOR reliably in small lesions (<2 cm). In large lesions (>2 cm) assessing EOR is hindered by the collapsed surgical cavity, especially when the ventricular system is opened, and by artifacts that may simulate or hide residual tumors. The main strategies to overcome the former limit are inflation of the surgical cavity through pressure irrigation while insonating, and closure of the ventricular opening with Gelfoam before insonating. The strategies to overcome the latter are avoiding the use of hemostatic agents before IOUS and insonating through normal adjacent brain instead of corticotomy. These technical nuances enhanced the reliability of post-IOUS, with a total concordance to postoperative MRI. Indeed, the surgical plan was changed in about 30% of cases, as IOUS showed a residual tumor that was left behind. Conclusion: IOUS ensures reliable real-time imaging in the surgery of space-occupying brain lesions. Limits may be overcome with technical nuances and proper training. [ABSTRACT FROM AUTHOR]

Aim: Vascular surgery is an important part of the multidisciplinary approach to surgical treatments, and vascular surgeons are often called on intraoperatively to provide immediate assistance to their colleagues. Our aim was to describe the extent of assistance provided during emergency intraoperative consultations at a single tertiary academic centre. Material and Methods: We reviewed the records of patients who were consulted intraoperatively in our hospital over a period of approximately 4 years (January 1, 2017-December 31, 2020) and organized the data collected. Results: 40 emergency intraoperative consultations were identified. 55% of the patients were female, with an average age of 48.83 years. The most frequently consulted subspecialty was obstetrics and gynecology (32%). Index cases were elective/nonurgent (90%), most involving tumor resection (77.5%). The primary reason for vascular consultation was revascularization (37.5%). The primary blood vessel and anatomic field of intervention were categorized. Most cases (50%) included preservation of blood flow, including primary arterial repair (20%) and ligation of the bleeding vessels (20%) in the first choice. Postoperative mean length of stay was 13 days, with a 30-day mortality of 5.1%. Conclusion: Using a wide variety of skills and techniques, vascular surgeons strive to respond to urgent open surgical consultations in various anatomical sites. Our study provides evidence to the wide range of knowledge and skills required for modern vascular surgeons and the place of the subspecialty in the core services offered in a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients. [ABSTRACT FROM AUTHOR]

Background: IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. Materials and Methods: From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow‐up CT were collected from a prospectively maintained data base and reviewed. Results: Eight patients underwent IPVS following LDLT (mean age‐10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7–5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post‐operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in‐hospital mortality secondary to septic complications. Conclusion: Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally. [ABSTRACT FROM AUTHOR]

Purpose : Real-time intraoperative perfusion assessment may reduce anastomotic leaks. Laser speckle contrast imaging (LSCI) provides dye-free visualization of perfusion by capturing coherent laser light scatter from red blood cells and displays perfusion as a colormap. Herein, we report a novel method to precisely quantify intestinal perfusion using LSCI. Methods : ActivSight™ is an FDA-cleared multi-modal visualization system that can detect and display perfusion via both indocyanine green imaging (ICG) and LSCI in minimally invasive surgery. An experimental prototype LSCI perfusion quantification algorithm was evaluated in porcine models. Porcine small bowel was selectively devascularized to create regions of perfused/watershed/ischemic bowel, and progressive aortic inflow/portal vein outflow clamping was performed to study arterial vs. venous ischemia. Continuous arterial pressure was monitored via femoral line. Results: LSCI perfusion colormaps and quantification distinguished between perfused, watershed, and ischemic bowel in all vascular control settings: no vascular occlusion (p < 0.001), aortic occlusion (p < 0.001), and portal venous occlusion (p < 0.001). LSCI quantification demonstrated similar levels of ischemia induced both by states of arterial inflow and venous outflow occlusion. LSCI-quantified perfusion values correlated positively with higher mean arterial pressure and with increasing distance from ischemic bowel. Conclusion: LSCI relative perfusion quantification may provide more objective real-time assessment of intestinal perfusion compared to conventional naked eye assessment by quantifying currently subjective gradients of bowel ischemia and identifying both arterial/venous etiologies of ischemia. [ABSTRACT FROM AUTHOR]

Purpose: Surgeons will likely be called to assist with or offer advice regarding an unanticipated intraoperative event or finding many times during their careers. Yet, there is no practical framework of how to respond to these consults nor is there any formal training in this area. The review of the limited literature and expert senior opinions can help explain the ethical components involved but does not address some of the practical aspects that the consulting surgeon may need to confront when responding to an unplanned intraoperative consultation. Methods: We reviewed the existing surgical literature on intraoperative consultation across surgical disciplines and interpreted it in light of our own experiences and the advice of senior surgical colleagues. Results: We present a framework for the minimum professional expectations of a surgeon responding to an intraoperative consultation. Conclusion: In this manuscript, we present a selected review of the available literature on the topic, establish some of the guiding ethical principles, and offer an actionable and detailed framework that can support trainees and practicing surgeons dealing with these increasingly common and stressful unplanned circumstances. [ABSTRACT FROM AUTHOR]

To examine the relationship between perioperative care quality and postoperative comfort level of patients undergoing hip replacement surgery. This is a descriptive study. This study was conducted with 90 patients between February and September 2021 in a training and research hospital in Turkey. Data were collected from Information Form, the Good Perioperative Nursing Care Scale (for Patients) (GPNCS), and the Post Hip Replacement Comfort Scale (PHRCS). The mean age of the patients was 65.58 ± 15.10 years. The mean total scores of the patients in GPNCS and PHRCS were 134.61 ± 16.29 and 3.58 ± 0.40, respectively. In the correlation analysis, a statistically significant and positive weak relationship was determined between GPNCS and PHRCS, and as the quality of care during the surgery increases, the postoperative comfort levels increase (r = 0.253, P <.05). Ensuring the comfort of patients during the surgery as well as in the pre-, intra- and postoperative period is necessary and important for the quality of care. In addition, since the quality of the care during surgery is effective on the postoperative comfort levels of the patients, quality nursing care is required pre-, intra-, and postoperative periods. [ABSTRACT FROM AUTHOR]

Purpose Ophthalmic surgeons are at an increased risk for musculoskeletal disorders resulting from ophthalmology-specific routines and equipment, which have become widely associated with poor posture. The purpose of this study was to observe the effect that a commercially available posture trainer, Upright Go, can have on the improvement of posture of ophthalmic surgeons.

Purpose: Traditionally, plain radiographs are used in intraoperative spinal level localization (SLL), whereas counting vertebrae is often hampered by shoulders and scapulae in lateral views, thus increasing the potential for wrong-level surgery. To improve the localization accuracy, this study evaluated the safety and feasibility of oblique radiographs with methylene blue markings for SLL and explored the optimal angle and height of oblique radiographs. Methods: The clinical data of 33 patients with upper thoracic spine lesions who were operated on in our hospital from January 2021 to April 2022 were retrospectively analyzed. Oblique radiographs with methylene blue markings were used for intraoperative SLL. Results: A total of 33 patients were included in this study. The average BMI was 24.3 ± 0.7 kg/m2. The ipsilateral lamina structures were clearly shown in all cases. The median radiographing times of all the patients was 3, and the median radiographing duration was 2 min and 25 s. The average angle of oblique radiographs was 55.1 ± 3.8°, and the average distance from the skin to the root of the spinous process was 4.9 ± 1.2 cm. Conclusions: Using oblique radiographs with methylene blue markings, not only the bone structure of an upper thoracic spine can be revealed clearly, but also the positioning deviation of traditional needle localization can be avoided. The lesion segment can be precisely located by this technology during surgery. Our angle of oblique radiographs and height determination method can be used to reduce the radiation exposure and shorten the operation time.

Key Clinical Message Three‐dimensional transesophageal ultrasound of the spinal cord is a new and promising imaging modality that could easily be used clinically for real‐time evaluation of the spinal cord anatomy or for intraoperative guidance.

Objective: To describe a single incision approach to correction of an SST deformity after penile implantation. Patient and surgical procedure: Eight months after inflatable penile implant (IPP) surgery via a penoscrotal approach at an outside institution, patient presented with a complaint of a floppy glans and penile shortening. Exam revealed SST deformity, reservoir herniation in his groin and a high riding pump. He was a diabetic with a HgA1C of 7.5%. The recommendation was to proceed with removal of all components of his IPP, proximal extracapsular tunneling, re-sizing and re-implantation of his IPP through a single infrapubic incision. A decision to add a distal biologic cap if necessary was discussed pre-operatively. Results: The patient had a successful removal and replacement of all his components of the IPP through a single incision and proximal extracapsular tunneling. The original implant was 18cm with 2.5 cm rear tip extenders (RTE). All compartments were washed out with Irrisept® irrigation only. We replaced it with a hydrophilic coated implant dipped in Irrisept® measuring 22cm with 2 cm RTE through a single infrabubic incision for an additional 3.5cm in length. The pump and reservoir were placed in their appropriate locations. The surgery lasted approximately 60 minutes. Intraoperative cultures grew out Enterococcus species, Bacillus species and Coagulase Negative Staphylococcus. Patients are routinely given sulfamethoxazole/trimethoprim for 5 days pre-operatively and 9 days post-operatively. No additional antibiotics were given after surgery. The patient resumed sexual activity 3 weeks after surgery as is the case with our virgin surgery IPP patients. The patient has a functional implant without any signs of infection or SST 6 months after surgery. Conclusion: Correction of SST deformity can be successfully performed through a single operative incision with proximal extracapsular tunneling. This can be done with either a penoscrotal or infrapubic approach. Recovery times are no different than an original surgical implant surgery at our institution. Irrisept® washout and dipping provides effective intraoperative infection control.

Background Eye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation. Methods We conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used” ("eye tracking" OR "gaze tracking") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)”. Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted. Results A total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (n = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon’s eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found. Conclusion Pupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.

Introduction:In recent, a new classification system for intraoperative adverse events (iAEs) was proposed, called “the Classification of Intraoperative Complications (CLASSIC).” Our aim was to evaluate the relationship between CLASSIC and the grade of postoperative complications (PostC) in gastrointestinal oncological surgery.Methods:Demographics, preoperative laboratory parameters, grades of iAEs, grades of PostC, and intraoperative pH and lactate levels were evaluated in patients who underwent gastric and colorectal surgery.Results:A total of 95 patients were included in this study. Mean age was 60±14, 57 male vs 38 females. There was no significant relationship between the grade of iAEs and PostC in terms of demographics and the presence of intraoperative acidosis. Preoperative albumin level was inversely proportional to the grade of iAEs. There was no relationship between the grade of iAEs and the grade of PostC (p=0.563). The actual rates of high-grade PostC in patients with low-grade iAEs and high-grade iAEs were 10% and 18%, respectively. Additionally, the length of stay was higher in patients with high-grade iAEs (p=0.018).Conclusion:CLASSIC may be a predictive of the grade of PostC in patients who undergo gastrointestinal surgery. High-grade iAEs is a valuable predictor of increased hospital stay.

Problem: Post-operative complications cause suffering and death among patients who have undergone surgery, increase the length of hospital stay, and thus increase costs, moreover, they reduce the quality of life and life expectancy among patients who have left the hospital. The aim of this study was to explore the trend of hospital admission due to intraoperative and post-procedural complications and disorders of the musculoskeletal system in England and Wales during the past 21 years. Methods: A secular trends study was conducted using hospital admission data extracted from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW) for the period between April 1999 and April 2020. Hospital admissions were identified using the diagnostic code (M96). Results: Between 1999 and 2020, a total of 95,783 hospital admission episodes were recorded in England and Wales. Hospital admission rates increased by 6.42-fold [from 3.36 (95% CI 3.20–3.52) in 1999 to 24.92 (95% CI 24.52–25.32) in 2020 per 100,000 persons, p

Surgery plays a critical role in the treatment of malignant glioma. However, due to the infiltrative growth and brain shift, it is difficult for neurosurgeons to distinguish malignant glioma margins with the naked eye and with preoperative examinations. Therefore, several technologies were developed to determine precise tumor margins intraoperatively. Here, we introduced four intraoperative technologies to delineate malignant glioma margin, namely, magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry. By tracing their detecting principles and developments, we reviewed their advantages and disadvantages respectively and imagined future trends. [ABSTRACT FROM AUTHOR]

The infiltrative growth and malignant biological behavior of glioma make it one of the most challenging malignant tumors in the brain, and how to maximize the extent of resection (EOR) while minimizing the impact on normal brain tissue is the pursuit of neurosurgeons. The current intraoperative visualization assistance techniques applied in clinical practice suffer from low specificity, slow detection speed and low accuracy, while Raman spectroscopy (RS) is a novel spectroscopy technique gradually developed and applied to clinical practice in recent years, which has the advantages of being non-destructive, rapid and accurate at the same time, allowing excellent intraoperative identification of gliomas. In the present work, the latest research on Raman spectroscopy in glioma is summarized to explore the prospect of Raman spectroscopy in glioma surgery. [ABSTRACT FROM AUTHOR]