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BACKGROUND: In the last decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been gaining in popularity for intraoperative support during lung transplant (LT), being advocated for routinely use also in uncomplicated cases. Compared to off-pump strategy and, secondarily, to traditional cardiopulmonary bypass (CPB), V-A ECMO seems to offer a better hemodynamic stability and oxygenation, while data regarding blood product transfusions, postoperative recovery, and mortality remain unclear. This systematic review and network meta-analysis aims to evaluate the comparative efficacy and safety of V-A ECMO and CPB as compared to OffPump strategy during LT. METHODS: A comprehensive literature search was conducted across multiple databases (PubMed Embase, Cochrane, Scopus) and was updated in February 2024. A Bayesian network meta-analysis (NMA), with a fixed-effect approach, was performed to compare outcomes, such as intraoperative needing of blood products, invasive mechanical ventilation (IMV) duration, intensive care unit (ICU) length of stay (LOS), surgical duration, needing of postoperative ECMO, and mortality, across different supports (i.e., intraoperative V-A (default (d) or rescue (r)) ECMO, CPB, or OffPump). FINDINGS: Twenty-seven observational studies (6113 patients) were included. As compared to OffPump surgery, V-A ECMOd, V-A ECMOr, and CPB recorded a higher consumption of all blood products, longer IMV durations, prolonged ICU LOS, surgical duration, and higher mortalities. Comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. The lowest rate of postoperative ECMO was recorded after OffPump surgery, while no differences were found comparing different extracorporeal supports. Finally, older age, male gender, and body mass index ≥ 25 kg/m2 negatively impacted on RBC transfusions, ICU LOS, surgical duration, need of postoperative ECMO, and mortality, regardless of the intraoperative extracorporeal support investigated. INTERPRETATION: This comparative network meta-analysis highlights that OffPump overperformed ECMO and CPB in all outcomes of interest, while, comparing different extracorporeal supports, V-A ECMOd and, secondarily, V-A ECMOr overperformed CPB in nearly all above mentioned outcomes, except for RBC transfusions. Older age, male gender, and higher BMI negatively affect several outcomes across different intraoperative strategies, regardless of the intraoperative extracorporeal support investigated. Future prospective studies are necessary to optimize and standardize the intraoperative management of LT.

Despite increasing female representation in medical fields, women remain underrepresented in high-impact authorship positions. This study examines gender disparities in authorship of randomized controlled trials in general surgery journals over the past 20 y. Utilizing PubMed and the Journal Citation Reports (Clarivate, 2023), we identified 8810 randomized controlled trials from 117 surgery journals, filtering down to 5694 studies for final analysis. Gender identification was performed using Genderize.io. Results indicate that women accounted for 26.4% of first authorships and 18.7% of last authorships. Logistic regression revealed that a male last author significantly increases the likelihood of a male first author (odds ratio 2.68; 95% confidence interval 2.18-3.32). Over time, there is a positive trend in female authorship, with high correlation coefficients for both first (Spearman's correlation coefficient 0.916, P < 0.005) and last (Spearman's correlation coefficient 0.878, P < 0.005) authors. Interestingly, journal quartiles did not significantly influence the gender of first authors. These findings suggest persistent gender inequity in surgical research authorship, influenced by mentorship dynamics. The study underscores the need for strategies to enhance female representation in academic leadership to foster a more equitable scholarly environment. Limitations include reliance on Genderize.io for gender determination and the focus on general surgery journals, which may omit relevant studies from other domains. Overall, this research highlights incremental progress toward gender equality in surgical academia, advocating for continued efforts to close the gender gap. [ABSTRACT FROM AUTHOR]

Aim: To compare the effectiveness of preventive interventions in reducing reccurrent diabetic foot ulcers. Meta-analysis (MA) was conducted to address clinical questions on this topic of the Italian guidelines on diabetic foot. Methods: This MA includes randomized controlled trials evaluating the effectiveness of various preventive interventions, namely: treatment of pre-ulcerative foot lesions, structured educational programs, psychological interventions and the use of therapeutic footwear to relieve plantar pressure in people with diabetes mellitus and a history of previous ulcers. Results: A total of 731 studies were identified and 14 were considered eligible for the analysis. We found that treatments of pre-ulcerative foot lesions did not provide any statistically significant effects (MH-OR: 0.84 [0.31, 2.33], p = 0.74, I2 = 38%). Conversely, structured educational programs were associated with a trend toward reduction of ulcer recurrence risk (MH-OR: 0.13 [0.01, 1.64], p = 0.10, I2 = 88%). No randomized controlled studies assessing the efficacy of psychological interventions have been retrieved. The use of therapeutic footwears can effectively reduce the risk of reulceration in diabetic patients with an history of previous DFU, in particular prefabricated rigid-soled therapeutic footwears showed a significant reduction of the risk of ulcer recurrence in comparison with semirigid soles (MH-OR: 0.17 [0.05, 0.57], p = 0.004). Conclusions: The study provides low-certainty evidence that, among preventive strategies in patients with previous DFU, rigid-sole therapeutic footwear and structured education programs are capable of reducing the risk of foot re-ulceration. [ABSTRACT FROM AUTHOR]

Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents—such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine—depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period. [ABSTRACT FROM AUTHOR]

Introduction: The need for a standardized core curriculum in regional anesthesia has become essential, particularly with the integration of ultrasound revolutionizing and exponentially increasing clinical practice and possibilities. In fact, numerous novel techniques, often overlapping, can confuse practitioners. This study aims to establish a core curriculum for upper limb, lower limb, paraspinal and fascial plane blocks for residency training, addressing potential educational gaps caused by the multitude of techniques, through a Delphi consensus process involving recognized Italian regional anesthesia experts. Methods: A steering committee was formed in order to select a panel of experts in regional anesthesia. A three-round Delphi consensus was planned: two rounds of electronic voting and a final round of mixed electronic voting and round table discussion. The consensus was defined as ≥ 75% agreement for inclusion and lower than ≤ 25% agreement for exclusion from the core curriculum list. Techniques reaching the 50% threshold were included with low consensus. Results: Twenty-nine techniques were selected to be included in the ultrasound-guided regional anesthesia core curriculum. Twenty-two were included with strong consensus: Upper limb: interscalene brachial plexus block, supraclavicular brachial plexus block, infraclavicular brachial plexus block, axillary brachial plexus block, intermediate cervical plexus block Lower limb: femoral nerve block, pericapsular nerve group block, adductor canal block, sciatic nerve block (transgluteal approach, infragluteal approach, and at the popliteal fossa), ankle block Paraspinal/fascial plane blocks: erector spinae plane block, deep serratus anterior plane block, superficial pectointercostal plane block, interpectoral plane block, pectoserratus plane block, rectus sheath block, ilioinguinal iliohypogastric nerves block, transversus abdominis plane block (with subcostal and midaxillary approaches) The remaining seven techniques were included with low consensus: superficial cervical plexus block, lumbar plexus block, fascia iliaca block (suprainguinal approach), anterior quadratus lumborum block, lateral quadratus lumborum block, paravertebral block, and serratus anterior plane block. Conclusions: This curriculum aims to standardize training and ensure that residents acquire the essential skills required for effective and safe practice regardless of the residents' subsequent specialization. By incorporating these techniques, educational programs can provide a structured and consistent approach to regional anesthesia, enhancing the quality of patient care and improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Bleeding incidents during percutaneous dilatational tracheostomy are concerning, and most cases occur in patients with unrecognized and unanticipated anatomical variations in the vascular anatomy. However, the extent of this variation remains unclear. To address this knowledge gap, our study aimed to comprehensively map laryngeal vascular anatomy in a cohort of adult patients. Methods: Ultrasound assessments of the soft tissue in the neck were performed, spanning from the thyroid cartilage to the third tracheal ring and extending 2 cm laterally on both sidesperformed. We subdivided this area into 12 zones comprising four medial and eight lateral sections. A pre-planned form was used to document the presence of arteries or veins in each zone. The results are reported as odds ratios, 95% CIs, and corresponding P values. Results: Five-hundred patients were enrolled from August 14, 2023, to November 13, 2023, at the University Hospital of Padua. Arteries and veins were identified in all investigated zones (varying from a minimum of 1.0%-46.4%). The presence of invessels progressively increased from the cricothyroid membrane to the third tracheal ring and from the midline to the paramedian laryngeal area. Conclusions: Given the prevalence of arteries and veins, particularly in areas where tracheostomies are commonly performed, we strongly advocate for routine ultrasound assessments before such procedures are performed. [ABSTRACT FROM AUTHOR]

This article is a meta-analysis of randomized clinical trials on the use of prostanoids in patients with diabetes and chronic limb-threatening ischemia (CLTI) for the treatment of diabetic foot syndrome (DFS). The study found that prostanoids, such as iloprost and alprostadil, did not have a significant beneficial effect on major amputation, minor amputation, all-cause mortality, ulcer healing, pain, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), quality of life, or peri-procedural complications. The authors concluded that the current evidence is not sufficient to support the extensive use of prostanoids in diabetic patients with CLTI, and further research is needed to determine their risk/benefit and cost/efficacy ratios. [Extracted from the article]

Purpose Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block. Methods The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50 mm needle), using diluted black tissue marking dye (20 mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed. Results Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10 cm laterally, and on the ventral side of the chest from T2/3-T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2-3 and 5-6 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen. Conclusions The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block., Author(s): Daniele Bonvicini [sup.1], Rafael Boscolo-Berto [sup.2] [sup.3], Alessandro De Cassai [sup.4], Michele Negrello [sup.4], Veronica Macchi [sup.2] [sup.3], Ivo Tiberio [sup.1], Annalisa Boscolo [sup.4], Raffaele De Caro [sup.2] [sup.3], [...]