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The introduction of a new collagen substitute, which will potentially reduce the invasiveness of techniques by avoiding the need for a second surgical site (ie, the donor site), needs to be evaluated in relation to the surgical procedure that could benefit the most by utilizing such a matrix. This study compared the clinical outcomes following treatment of RT1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel (MCAT) technique or the multiple coronally advanced flap (MCAF) in conjunction with a new volume-stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference between the two surgical techniques in terms of discomfort. A total of 20 patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups: MCAF+VCMX (Group A) or MCAT+VCMX (Group B). The following measurements were recorded at baseline (before surgery) and at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PD), keratinized tissue width (KTW), and gingival thickness (GT). Postoperative pain and discomfort were recorded using a visual analog scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), and secondary outcomes were complete root coverage (CRC), changes in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements in REC and GT compared to baseline (P < .05). The mRC was 79.95% ± 29.92% in the MCAF group and 64.74% ± 40.5% in the MCAT group (P = .124). CRC was seen in 65.6% of MCAF-treated sites and 52% of MCAT-treated sites (P = .181). Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX. [ABSTRACT FROM AUTHOR]

Purpose: To complete a reanalysis study of two similarly designed prospective controlled studies exploring prognostic factors associated with the surgical outcomes of reconstructive treatment of peri-implantitis. Materials and Methods: Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant suprastructure removal and complete coverage of grafted sites. The second study employed a nonsubmerged healing protocol in which healing abutments were kept in place and the implants were not fully submerged. Both studies measured all prognostic factors at similar time points throughout 1 year and included clinical defect fill (DF) and radiographic defect fill (RDF), reduction of pocket depth (PDR), and bleeding on probing (BoP). Multilevel regression was used for statistical assessment of outcomes relative to the impact of site, local, surgical, and patient-related variables. Results: Overall, 59 implants (30 submerged and 29 nonsubmerged) were treated. Statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm), and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BoP reduction was similar. After controlling for treatment (submerged/nonsubmerged), there were no other significant associations with patient-related (age, sex, smoking, prior periodontitis etc), or implant-related (previous prosthesis type, arch, keratinized tissue width [KTW], etc) factors. Conclusions: Within the study's limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a nonsubmerged approach. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of using a customized xenograft shell with a 1:1 mixture of particulate xenograft and autogenous bone for the reconstruction of horizontally deficient anterior maxillary alveolar ridges. Materials and Methods: CBCT images of the atrophic maxilla of eight patients were acquired and generated into 3D models. The data were transferred to a 3D printer for fabrication. During the surgery, xenograft blocks were manually sliced and customized on the 3D-printed models into bone shells. Then they were fixed to the atrophic site, and the gap was augmented with a 1:1 mixture of particulate xenograft and autogenous bone. Results: Clinical assessment showed no adverse effects; however, one patient exhibited wound dehiscence. The mean difference between the preoperative and 6-month postoperative CBCTs showed a net average bone gain of 4.06 mm at 2 mm from the crest and 4.34 mm at 5 mm from the crest, which was statistically significant. On the other hand, a statistically significant graft resorption of 1.41 mm at 2 mm from the crest and 2.19 mm at 5 mm from the crest was found when the mean difference between the immediate and 6-month postoperative CBCTs was calculated. Conclusions: Within the limitations of the study, the use of xenograft shells as a barrier for maxillary alveolar ridge reconstruction is a predictable technique; however, further investigations regarding the required time for graft consolidation are required. [ABSTRACT FROM AUTHOR]

In both plastic surgery and burn treatment departments, the management of postoperative wounds is a crucial element of surgical care, profoundly influencing patient recovery and the broader spectrum of healthcare outcomes. The monitoring of wound flatness after surgery, although a pivotal component of this process, is frequently underemphasized. In most cases, this parameter can only be judged based on doctors' personal experience. Here, we propose a compact, fully integrated wireless sensing system encapsulated by soft biocompatible materials for quantitative assessment of wound flatness and long-term temperature. The absence of physical tethers and the ion-gel-based construction of the micro-structured sensor represent key defining features, resulting in high measurement resolution of 2 mm radius and 0.096 Ω / ° C and reliable capabilities. In addition, these sensors can be connected to the server network or mobile clients to evaluate the state of postoperative suture wounds and monitor the patient's recovery status. With our devices, detailed data on smoothness and temperature of sutured wounds can be collected, analyzed, and stored for medical assistance as well as being used to improve the quality of surgery. [ABSTRACT FROM AUTHOR]

Context: Decreased trunk neuromuscular control is a risk factor for both upper- and lower-extremity injuries, yet there are few reliable and valid clinical tests to identify deficits. Objective: The purpose of this study was to determine the reliability and known-groups validity of a novel clinical test, the seated trunk control test (STCT). Design: Cross-sectional reliability and known-groups validity study. Setting: Laboratory. Participants: 89 unique participants: 34 were 3 months postoperative anterior cruciate ligament reconstruction (ACLR) and 55 healthy controls. Methods: For the STCT, participants sat on a balance board with their eyes closed for three 30-second trials while investigators counted balance errors. Intraclass correlations (ICCs) were used to assess interrater reliability (N = 20) and test–retest reliability (N = 40). To assess known-groups validity, independent t tests were used to compare STCT errors at 3 months post-ACLR with healthy matched controls (N = 34/group). Area under a receiver operating characteristic curve identified an optimal cutoff for distinguishing between groups. Results: The STCT had perfect interrater reliability (ICC2,3 = 1.00) and good test–retest reliability (ICC3,3 =.79; 95% confidence interval =.61–.89). The ACLR group made significantly more errors on the STCT (mean [SD] = 15.5 [5.4]) than controls (mean [SD] = 8.2 [4.1]; P <.001, Cohen d = 1.52). The STCT's ability to distinguish between groups was excellent (area under a ROC curve = 0.86). A cutoff of 12 errors maximized sensitivity (76%) and specificity (85%). Conclusions: The STCT is reliable between raters and across days. It also has excellent ability to distinguish between individuals with a recent ACLR and healthy matched controls, which provides initial evidence to suggest that the STCT may be clinically useful for identifying deficits in trunk neuromuscular control. [ABSTRACT FROM AUTHOR]

BACKGROUND: Surgical revascularization decreases the long-term risk of stroke in children with moyamoya arteriopathy but can be associated with an increased risk of stroke during the perioperative period. Evidence-based approaches to optimize perioperative management are limited and practice varies widely. Using a modified Delphi process, we sought to establish expert consensus on key components of the perioperative care of children with moyamoya undergoing indirect revascularization surgery and identify areas of equipoise to define future research priorities. METHODS: Thirty neurologists, neurosurgeons, and intensivists practicing in North America with expertise in the management of pediatric moyamoya were invited to participate in a three-round, modified Delphi process consisting of a 138-item practice patterns survey, anonymous electronic evaluation of 88 consensus statements on a 5-point Likert scale, and a virtual group meeting during which statements were discussed, revised, and reassessed. Consensus was defined as ≥ 80% agreement or disagreement. RESULTS: Thirty-nine statements regarding perioperative pediatric moyamoya care for indirect revascularization surgery reached consensus. Salient areas of consensus included the following: (1) children at a high risk for stroke and those with sickle cell disease should be preadmitted prior to indirect revascularization; (2) intravenous isotonic fluids should be administered in all patients for at least 4 h before and 24 h after surgery; (3) aspirin should not be discontinued in the immediate preoperative and postoperative periods; (4) arterial lines for blood pressure monitoring should be continued for at least 24 h after surgery and until active interventions to achieve blood pressure goals are not needed; (5) postoperative care should include hourly vital signs for at least 24 h, hourly neurologic assessments for at least 12 h, adequate pain control, maintaining normoxia and normothermia, and avoiding hypotension; and (6) intravenous fluid bolus administration should be considered the first-line intervention for new focal neurologic deficits following indirect revascularization surgery. CONCLUSIONS: In the absence of data supporting specific care practices before and after indirect revascularization surgery in children with moyamoya, this Delphi process defined areas of consensus among neurosurgeons, neurologists, and intensivists with moyamoya expertise. Research priorities identified include determining the role of continuous electroencephalography in postoperative moyamoya care, optimal perioperative blood pressure and hemoglobin targets, and the role of supplemental oxygen for treatment of suspected postoperative ischemia.

The field of postoperative care has seen a remarkable shift toward the utilization of electronic implantable devices, including sensors, biosensors, stimulators, and drug delivery systems, all designed with a biodegradable form factor and wireless data/power transmission capability. These technologies hold immense potential for postsurgery out‐of‐hospital monitoring during the postdischarged period, where continuous monitoring of physiological signals is lacking. Furthermore, these devices eliminate the need for secondary surgeries required for device retrieval as they can safely degraded in the body, thus enhancing patient recovery. This review delves into the latest advancements in biodegradable implantable devices, examining their application in monitoring vital signs, the innovative wireless communication and powering technologies they employ, and the biodegradable materials that enable their function. The analysis extends to evaluating the efficacy and limitations of these devices across various medical applications. Moreover, it explores future research directions, emphasizing material advancements, device miniaturization, customization, and the integration of artificial intelligence to create closed‐loop therapeutic systems. This comprehensive review underscores the transformative potential of these technologies in enhancing postoperative care and outlines the pathway for future innovations in this dynamic field. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This study aimed to investigate the effectiveness of the joint application of the compassionate care framework (CCF) and a quality control (QC) team in improving the quality of postoperative nursing management for patients in anorectal surgery.Patients who underwent anorectal surgery at the China–Japan Friendship Hospital between May 2022 and December 2022 were selected by convenience sampling. A digital random generator was used for random grouping. The odd numbers entered the control group (n = 53) and the even numbers entered the study group (n = 53). The control group received postoperative traditional nursing, and the study group received postoperative nursing and QC team management. A questionnaire survey was used to analyse patients' satisfaction with nursing. The two groups were compared for nursing quality scores, patient satisfaction with nursing care and incidence of complications.After management, compared with the control group, the study group scored significantly higher for the nursing process, environmental management, emergency response and safety protection (p < 0.05 for all). The study group also exhibited higher satisfaction scores with the nursing process, nurse‐patient relationship and service attitude compared with the control group (p < 0.05 for all). The complication incidence rate in the study group was significantly lower than in the control group (p < 0.05).The combined use of the CCF and a QC team can effectively improve the quality of postoperative nursing management for patients in anorectal surgery, reduce the incidence of complications and enhance patient satisfaction with nursing care, thus holding significant potential for wider application. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative urinary dysfunction poses a significant challenge for rectal cancer patients. While pelvic floor muscle training (PFMT) has shown promise in other contexts, its efficacy following rectal cancer surgery remains uncertain. Results: A clinical trial involving 79 rectal cancer patients found that initiating Kegel exercises post-surgery led to significant improvements in urinary symptoms compared to standard care. Adherence to exercises correlated with symptom reduction, with no reported adverse events. We have defined the main outcome of our study as the improvement in urinary function scores post-surgery. Effectiveness is considered as any statistically significant improvement in these scores. Conclusion: Early initiation of Kegel exercises shows promise in alleviating postoperative urinary dysfunction in rectal cancer patients. Further research is needed to optimize postoperative care protocols and enhance patient outcomes. [ABSTRACT FROM AUTHOR]

Aromatic l‐amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, including motor and autonomic dysfunction, hypotonia, and developmental delay, often before the age of one. Until recently, treatment options were limited to symptom control, but the recent approval of the first gene therapy for AADC deficiency in Europe and the UK has provided an alternative to treating symptoms for this disease. Eladocagene exuparvovec is a one‐time gene therapy, administered bilaterally to the putamen by magnetic resonance imaging‐guided stereotactic neurosurgery. While administration of the gene therapy itself is minimally invasive, the anesthetic management of patients with AADC deficiency is challenging due to the absence of sympathetic regulation secondary to the lack of adrenergic neurotransmitters. Optimal anesthetic management requires an understanding of the complex and heterogeneous nature of the disease. Hemodynamic instability, temperature dysregulation, and hypoglycemia are of primary concern, but there are also challenges regarding intravenous access and airway management. A thorough preoperative assessment is essential and should be guided by the patient's history. Advanced planning is necessary regarding the timing of the procedure schedule and operative plan; meticulous preparation, simulation for the operating room, as well as communication with all perioperative staff members, are crucial. Intraoperatively, utmost care must be taken to protect the skin, maintain body temperature, and to prepare for inotropic and/or glycemic support as needed. Postoperative intensive care management is necessary for consideration of postoperative extubation and provision of supportive care. With careful planning, preparation, and vigilance, patients with AADC deficiency can safely undergo anesthesia. [ABSTRACT FROM AUTHOR]

Purpose: Patients with hypoalbuminemia, (serum albumin (SA) < 3.5 g/dL) are at greater risk for complications after surgery, including increased postoperative infection rates after total knee arthroplasty (TKA). This study aimed to analyze both preoperative and postoperative SA in patients who experienced acute periprosthetic infection within the first 4 weeks after surgery. Methods: We retrospectively analyzed data from 490 consecutive TKAs (314 patients). Five patients developed early acute infection requiring surgical treatment. SA data were collected preoperatively (SA0) and 1 week postoperatively (SA1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed. Results: No statistical differences were found in parameters expected to influence SA values between the surgically treated (STG) and non-treated groups (non-STG). None of the patients in STG had SA0 and SA1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery were significantly greater in STG than in non-STG. Conclusion: SA dynamics revealed a greater reduction in both the amount and rate in STG before and after surgery than in non-STG. No correlation was found between early acute periprosthetic infection after TKA and each SA0 and SA1W time point. Further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level. Methods: Twenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery. Results: All 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery. Conclusion: Quadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations. Chinese clinical trial registry: June 2, 2018; ChiCTR1800016457. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the postoperative infection and graft success rates, and the hearing improvement, after endoscopic cartilage underlay myringoplasty with versus without antibiotic ointment coating. Materials and methods: This was a retrospective case-control study. The clinical records of patients who underwent endoscopic cartilage underlay myringoplasty and who met the selection criteria were retrieved and divided based on middle ear packing status into groups with antibiotic ointment packing (AOP group) and with no antibiotic ointment packing (no-AOP group). The operation time, postoperative infection, graft success status, and hearing improvement were compared between the 2 groups. Results: Patients with 166 perforations constituted the AOP group, and patients with 141 perforations comprised the no-AOP group. At 3 months postoperatively, middle ear infections had occurred in 24 (14.5%) ears in the AOP group and 4 (2.8%) ears in the no-AOP group (P <.01). At 12 months postoperatively, the graft success rate was 81.3% in the AOP group and 97.9% in the no-AOP group (P <.01). No significant group differences were observed, preoperatively (P =.657) or postoperatively (P =.578), in the air-bone gap (ABG) values or mean ABG gains (P =.758). Conclusion: Middle ear packing without antibiotic ointment coating does not increase the postoperative infection rate or reduce the graft success rate after endoscopic cartilage underlay myringoplasty compared to antibiotic ointment coating. On the contrary, coating with antibiotic ointment increases the risk of postoperative infection given the complexity of middle ear manipulation. [ABSTRACT FROM AUTHOR]

Objective: The surgical strategy of cholesteatomas is still controversial. This study aimed to compare the hearing improvement and determine the prognostic factors between endoscopic and microscopic ear surgery for attic cholesteatoma via a multicenter retrospective study. Methods: This retrospective study included 169 patients with attic cholesteatoma who received endoscopic ear surgery (EES) or microscopic ear surgery (MES) from 12 otorhinolaryngology centers. Hearing improvement between EES and MES was evaluated, including the postoperative pure tone average (PTA) and air-bone gap (A-B Gap), as well as the hearing threshold across the low-, mid-, and high-frequency. The success rate of grafts was collected. Linear regression was performed to access the prognostic value of preoperative PTA and A-B Gap. Patients were followed up for at least 3 years. Results: The graft success rate of EES was 89.66% (78/87) versus 80.49% (66/82) for MES. The postoperative PTA and A-B Gap demonstrated significant improvement in EES compared to MES (Post-PTA: t = 3.281, P =.001; Post-A-B Gap: t = 2.197, P =.029). In the EES group, there were 59 ears (67.82%) with a postoperative A-B Gap ≤20 dB HL, which revealed a higher rate of successful hearing outcomes in EES as opposed to MES (χ2 = 9.904, P =.019). There were significantly better hearing improvement, shorter surgical times, and lower hospital stays in EES for epitympanic cholesteatoma without stapes superstructure involvement. The preoperative AC ≤79 dB and/or preoperative A-B Gap ≤52 dB was associated with a better prognosis in EES for epitympanic cholesteatoma with stapes superstructure involvement. Conclusions: EES showed higher graft success rate, better hearing improvement, shorter surgical times and hospital stays for attic cholesteatoma, particularly without stapes superstructure involvement. The range of preoperative PTA and A-B Gap have shown the prognostic value, which maybe a favorable surgical indication for EES or MES. [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: 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]

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]

Introduction: Although stimulation-induced sensations are typically considered undesirable side effects in clinical DBS therapy, there are emerging scenarios, such as computer-brain interface applications, where these sensations may be intentionally created. The selection of stimulation parameters, whether to avoid or induce sensations, is a challenging task due to the vast parameter space involved. This study aims to streamline DBS parameter selection by employing a machine learning model to predict the occurrence and somatic location of paresthesias in response to thalamic DBS. Methods: We used a dataset comprising 3,359 paresthetic sensations collected from 18 thalamic DBS leads from 10 individuals in two clinical centers. For each stimulation, we modeled the Volume of Tissue Activation (VTA). We then used the stimulation parameters and the VTA information to train a machine learning model to predict the occurrence of sensations and their corresponding somatic areas. Results: Our results show fair to substantial agreement with ground truth in predicting the presence and somatic location of DBS-evoked paresthesias, with Kappa values ranging from 0.31 to 0.72. We observed comparable performance in predicting the presence of paresthesias for both seen and unseen cases (Kappa 0.72 vs. 0.60). However, Kappa agreement for predicting specific somatic locations was significantly lower for unseen cases (0.53 vs. 0.31). Conclusion: The results suggest that machine learning can potentially be used to optimize DBS parameter selection, leading to faster and more efficient postoperative management. Outcome predictions may be used to guide clinical DBS programming or tuning of DBS based computer-brain interfaces. [ABSTRACT FROM AUTHOR]

Background: Interatrial right-to-left shunt flow through a patent foramen ovale (PFO) can be caused by changes in heart position for anastomosis during off-pump coronary artery bypass (OPCAB). We herein present a case in which the direction of PFO shunt flow changed with heart position during OPCAB and the ventilation settings after sternal closure. Case presentation: A 66-year-old man with interstitial pneumonia underwent OPCAB. Preoperative transesophageal echocardiography revealed right-to-left shunt flow through a PFO induced by the Valsalva maneuver. During OPCAB, heart displacement resulted in right-to-left shunting and acute hypoxemia, which quickly improved with increase of inspired oxygen fraction. After chest closure, bidirectional shunt flow developed under increased airway pressure. Conclusions: Vigilant intraoperative monitoring with TEE and postoperative airway pressure management are important to address shunt flow and hypoxemia due to PFO. [ABSTRACT FROM AUTHOR]

Background: Finding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay. Methods: 1006 consecutive patients undergoing elective TKA across two large tertiary centres were included over six years. They were divided into one of four groups according to the type of analgesia received: Group N patients received no neuraxial morphine or regional block. Group B patients received adductor canal block (ACB) only. Group M patients received intrathecal morphine (ITM) but no regional block. Group BM patients received both ACB and ITM. Results: Patients who received an ACB had faster postoperative mobilization compared to those without (p < 0.001). Patients in Group BM had the lowest pain scores at rest (Visual Analogue Scale (VAS) 2.9) and with movement (VAS 5.3), while Group B patients experienced the highest pain scores at rest (VAS 3.7) and on movement (VAS 6.5) (p = 0.005). Patients who received ITM had the lowest opioid requirements (p < 0.001). There was no significant differences between groups in requirement for rescue pain management strategies (p = 0.06). Conclusions: The combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. Methods: This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. Results: The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Conclusions: Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. Trial Registration Number: ClinicalTrials.gov NCT04803422. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing high-risk surgeries with acid-based disorders are associated with poor outcomes. The screening of mixed acid-based metabolic disorders by calculating delta anion gap (AG)/delta bicarbonate (Bic) has a clinically relevant role in patients with high AG metabolic acidosis (MA), however its utility in individuals facing high-risk surgical procedures remains unclear. Objective: Characterize metabolic acidosis using delta-AG/delta-Bic and its associations in patients undergoing high-risk surgeries with possible outcome-related complications. Design: Prospective observational multicentric study. Setting: Three tertiary hospitals in Brazil. Patients: Patients undergoing high-risk surgeries, aged 18 years or older, requiring postoperative critical care. Main outcome measures: Patients undergoing high-risk surgeries monitored during the postoperative phase across three distinct intensive care units (ICUs), with assessment encompassing laboratory analyses upon admission and 24 h thereafter. Patients with MA and with elevated AG within 24 h were separated into 3 subgroups: [G1 – delta-AG/delta-Bic < 1.0] MA associated with hyperchloremia; [G2 – delta-AG/delta-Bic between 1.0 and 1.6] MA and no mixed disorders; and [G3 – delta-AG/delta-Bic > 1.6] MA associated with alkalosis. Primary endpoint was 30-day mortality. The secondary endpoints were cardiovascular, respiratory, renal, neurological, coagulation and infective complications. Results: From the 621 surgical patients admitted to ICU, 421 (51.7%) had any type of acidosis. After 24 h, 140 patients remained with MA with elevated AG (G1: 101, G2: 18, and G3: 21). When compared to patients from subgroups 1 and 3, the subgroup with no mixed disorders 2 showed higher 30-day mortality (adjusted HR = 3.72; 95% CI 1.11–12.89, p = 0.001), cardiovascular complications (p = 0.001), ICU mortality (p = 0.03) and sum of all complications during the ICU period (p = 0.021). Conclusion: In the postoperative time, patients with metabolic acidosis and no mixed disorders present higher ICU-Mortality and higher cardiovascular postoperative complications when compared with patients with combined hyperchloremia or alkalosis. Delta-AG/delta-Bic can be a useful tool to evaluate major clinical outcomes in this population. Key points: In the context of high-risk surgeries, patients experiencing metabolic acidosis accompanied by an elevated anion gap exhibit a reduced likelihood of survival in the intensive care unit (ICU). The application of the delta-AG/delta-Bic ratio for assessing mixed disorders in patients with elevated anion gap acidosis during the early postoperative phase proves to be a valuable and clinically relevant tool. A subgroup of patients presenting metabolic acidosis accompanied by an elevated anion gap although without associated disorders, demonstrate a poorer clinical prognosis within the ICU setting. [ABSTRACT FROM AUTHOR]

Background: The effects of unilateral submandibular gland excision on the size of the contralateral gland are not well understood, with no human studies reported to date. This study aims to investigate the impact of unilateral submandibular gland excision on the contralateral gland's size, providing insights into compensatory mechanisms and their clinical implications. Method: This retrospective study involved patients with oral cancer who underwent unilateral submandibular gland excision and ipsilateral neck dissection at Gangneung-Wonju National University Dental Hospital between 2008 and 2023. Patients were included if they had preoperative and follow-up 3D radiological images. The contralateral submandibular gland volume was measured using 3D Slicer software on preoperative, post-operative, and follow-up radiographic data. Results: The mean volume change of the contralateral submandibular gland was 1.35 ± 2.06 cm3, with a mean change ratio of 1.18 ± 0.24. These changes were statistically significant (p = 0.006). Other factors such as age, gender, and radiotherapy did not significantly affect the volume change ratio (p > 0.05). Conclusion: The contralateral submandibular gland exhibits a statistically significant increase in volume following unilateral gland excision, indicating compensatory hypertrophy. This morphological adaptation should be considered in post-operative care and surgical planning for oral cancer patients to optimize outcomes. [ABSTRACT FROM AUTHOR]

Background: The impact of the etiology of rotator cuff injury (RCI) on outcomes after rotator cuff repair remains unclear. This study aimed to evaluate the postoperative outcomes of patients with RCIs of different etiologies and identify the risk factors affecting prognosis. Methods: This study included 73 patients with RCI who underwent arthroscopic rotator cuff repair. The patients were categorized into either a traumatic group or a non-traumatic group based on their history of trauma. Preoperative and postoperative assessments included shoulder range of motion, muscle strength, and physical examination findings specific to the shoulder for both groups. Clinical differences between arthroscopic repair of traumatic and non-traumatic RCIs were evaluated using univariate analysis. Logistic regression analysis determined independent risk factors for rotator cuff repair prognosis. Results: Among the 73 patients, 31 were in the traumatic group and 42 in the non-traumatic group, with a minimum postoperative follow-up of 12 months and a mean follow-up of 13.8 months. The duration of the disease was significantly longer in the non-traumatic group compared with the traumatic group (P < 0.001). The mean tear area was more significant in the traumatic group than in the non-traumatic group (P = 0.003), and the preoperative pain level and functional scores were better in the non-traumatic group compared with the traumatic group. Postoperatively, there were no differences between the two groups regarding scores, joint mobility, strength, and complications. At 12 months postoperatively, multivariate regression analysis indicated that full-layer tear (OR = 5.106, 95% CI: 1.137–22.927, P = 0.033), fat infiltration (OR = 6.020, 95% CI: 1.113–32.554, P = 0.037), and tear area (OR = 6.038, 95% CI: 2.122–17.177, P < 0.001) significantly affected the University of California at Los Angeles (UCLA) score. Conclusion: Compared with non-traumatic RCI, traumatic RCI presents with more pronounced pain and impaired joint function preoperatively yet demonstrates comparable postoperative clinical outcomes. Full-layer tears, fat infiltration, and large tear areas are unfavorable factors affecting rotator cuff repair, and postoperative rehabilitation management of these patients should be emphasized. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Single‐port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single‐port laparoscopic Hartmann's reversal(SPL‐HR) through the colostomy site.Prospective data from consecutive patients who underwent SPL‐HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single‐port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated.SPL‐HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50–172) min and a median blood loss of 100 (10–360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien‐Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2–9) days.The SPL‐HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay. [ABSTRACT FROM AUTHOR]

In this report, we present the case of a 71‐year‐old African‐American woman experiencing 2 months of intermittent headaches and episodes of blurred vision. Despite a comprehensive medical history that revealed chronic conditions and previous unrelated surgeries, the initial evaluation appeared to be unremarkable. Following the discovery of a mass on an imaging and a subsequent biopsy, the diagnosis of craniopharyngioma (WHO grade I) was confirmed. However, a brain mass was identified after additional ophthalmologic examination and MRI. This case explores the significance of recognizing atypical presentations of a brain injury that required a specific approach for diagnosis, surgical intervention and treatment, and postoperative care. This case contributes to the constantly evolving understanding of atypical manifestations of tumor characteristics and their complexities, along with the need to develop appropriate patient management strategies and provide optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities. Methods: A retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code "Bone Excision" were identified within the surgery booking system and screened for eligibility. Results: Patients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea. Conclusion: Patients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses. [ABSTRACT FROM AUTHOR]

Background: Skin cancer in African countries results primarily from exposure to high ambient ultraviolet radiation. It is an emerging public health issue with limited improvement in management services. Mohs surgery, a renowned surgical procedure in the treatment of skin cancer, involves exact tumor excision along with horizontal frozen tissue examination. It is known to minimize the defect size and improve patient outcomes. Therefore, Mohs surgery is highly effective for almost all nonmelanoma skin cancers. Despite its proven potential, the implementation of Mohs surgery in Africa faces various limitations. This commentary seeks to provide insights into the current threats and opportunities surrounding the execution of Mohs surgery in African healthcare systems. The role of governments, healthcare professionals, and international organizations is also highlighted in this paper. Methods: A literature search was conducted by retrieving articles from PubMed and Google Scholar. Previous articles that discuss skin cancer, Mohs surgery, and cancer in Africa were analysed to understand the implementation aspects of Mohs surgery in Africa. Results: The implementation of Mohs surgery in Africa is very limited due to challenges such as inadequately trained healthcare professionals, costs associated with the surgery, and cultural beliefs and misconceptions. Nevertheless, telemedicine has been used in surgical consultations regarding the postoperative management of patients who undergo Mohs surgery. Conclusion: Despite advances in medicine, African dermatological health care remains underdeveloped. Therefore, increased investment in healthcare training, infrastructure development, and more African-based skin cancer studies are necessary and paramount factors for the expansion and accessibility of Mohs surgery in Africa. [ABSTRACT FROM AUTHOR]

Background: Postoperative respiratory complications significantly contribute to patient morbidity and healthcare costs. Non-invasive ventilation (NIV) methods, such as Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP), are increasingly used to manage these complications, yet comparative efficacy data between these modalities remains limited. Objective: To compare the effectiveness of CPAP and BiPAP in reducing postoperative respiratory complications in a cohort of 200 surgical patients. Methods: This retrospective study analyzed medical records from 200 patients who underwent major abdominal, thoracic, or cardiovascular surgery and received either CPAP or BiPAP postoperatively. The primary outcomes were the incidence of postoperative respiratory complications, including minor and major complications. Secondary outcomes included the duration of hospital stay and the need for escalation to invasive ventilation. Results: Of the 200 patients, 100 received CPAP and 100 received BiPAP. The incidence of no postoperative complications was higher in the CPAP group (82%) compared to the BiPAP group (75%), but the difference was not statistically significant (OR 1.52, 95% CI 0.82-2.82, p=0.18). Minor and major complications were slightly more common in the BiPAP group, with odds ratios of 1.58 (p=0.27) and 1.28 (p=0.62), respectively. Both groups had similar durations of hospital stays and rates of escalation to invasive ventilation, with no significant differences observed. Conclusion: CPAP and BiPAP are effective in managing postoperative respiratory complications, with no significant differences in the overall efficacy observed between the two modalities. However, CPAP showed a non-significant trend towards fewer respiratory complications. Future prospective studies are warranted to further explore these findings and help refine guidelines for the use of NIV in the postoperative setting. [ABSTRACT FROM AUTHOR]

Introduction: The hemodynamic effects of mitral valve repair (MVr) with respect to transmitral pressure gradients (TMPGs) have not been described well in patients undergoing leaflet preservation techniques. In a population of patients undergoing robotic MVr with leaflet preservation, we investigate the expected change of the postrepair intraoperative TMPG in the postoperative follow‐up period. Methods: We retrospectively studied 144 adult patients who underwent robotic MVr. Demographic, clinical, procedural, and echocardiographic data were collected and analyzed. Results: We found a slight increase in the mean TMPG from the intraoperative postrepair to the immediate postoperative period (intraoperative 3.3 ± 1.4 mmHg vs. first postoperative transthoracic echocardiography [TTE] follow‐up 3.6 ± 1.9 mmHg, p = 0.016) with a gradual decline in the long‐term follow‐up (mean TMPG at last follow‐up TTE 2.4+2.1 mmHg). When dichotomizing the patient population using a cutoff of 3 mmHg for the intraoperative mean TMPG, patients with an intraoperative mean TMPG > 3 mmHg had higher mean TMPG gradients at first TTE (4.5 ± 2.4 vs. 3.1 ± 1.3 mmHg, p < 0.001) as well as at last TTE (3.0± 2.2 vs. 2.1 ± 2.0 mmHg, p = 0.01) when compared with patients with an intraoperative mean TMPG ≤ 3 mmHg. There was no difference in clinical outcomes. Conclusions: Although the hemodynamic effect of MVr seems to be small, patients with an intraoperative TMPG > 3 mmHg have a higher mean TMPG at follow‐up. The hemodynamic effect does not seem to have an impact on clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance is a significant symptom associated with both rotator cuff tears and arthroscopic rotator cuff repair. Melatonin has been shown to be safe and effective in managing multiple sleep disorders, including secondary sleep disorders, with relatively minor adverse effects and lack of addictive potential. Purpose: To investigate the effects of oral melatonin on postoperative sleep quality after arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a prospective randomized clinical trial evaluating patients undergoing arthroscopic rotator cuff repair. Exclusion criteria included history of alcohol abuse, current antidepressant or sedative use, revision rotator cuff repair, severe glenohumeral arthritis, and concurrent adhesive capsulitis. Patients were randomly assigned in a 1:1 ratio to 1 of 2 groups: 5-mg dose of melatonin 1 hour before bedtime or standard sleep hygiene (≥6 hours per night, avoiding caffeine and naps in the evening). Patients in the melatonin group took their assigned melatonin dose for 6 weeks beginning the day of surgery. Patient-reported outcome assessments, including the Pittsburgh Sleep Quality Index (PSQI), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Single Assessment Numeric Evaluation (SANE), and pain medication charts were collected preoperatively as well as at 2 weeks, 6 weeks, 3 months, 4 months, and 6 months postoperatively. Numeric variables were analyzed using paired and unpaired t tests, with significance set at P <.05. Results: Eighty patients were included for final analysis (40 in the control group, 40 in the melatonin group). Patient characteristics such as age, sex, race, body mass index, and laterality did not differ significantly (P ≥.05). Preoperative ASES, SANE, and PSQI scores did not differ between groups (P ≥.055). PSQI scores were significantly lower (better quality sleep) in the melatonin group at the 6-week postoperative period (P =.036). There was a positive correlation between how patients rated the intensity of their pain and the PSQI at the 6-week postoperative period (0.566). The PSQI question regarding sleep quality was found to be significantly lower in the melatonin group at the 3-month, 4-month, and 6-month postoperative periods (P =.015, P =.041, and P ≤.05, respectively). SANE scores were significantly lower in the melatonin group (P =.011) at 6 weeks and then higher in the melatonin group (P =.017) at 6 months. ASES scores were significantly higher in the melatonin group at 4 and 6 months (P =.022 and P =.020, respectively). Lastly, patients who were randomized into the melatonin group were found to use significantly less narcotic medication at the 4-month postoperative period (P =.046). Conclusion: Melatonin use after arthroscopic rotator cuff repair led to improved sleep quality (PSQI) in the early postoperative period as well as improved functional outcomes (ASES and SANE scores) and decreased narcotic use in the later postoperative period. Patients with significant sleep disturbances associated with rotator cuff repairs may benefit from the use of melatonin. Registration: NCT04278677 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

These concepts aim to accelerate postoperative recovery, reduce hospital stay duration, and increase patient satisfaction. But how do we achieve good results with these approaches? A central aspect of fast-track concepts is preoperative preparation. This includes comprehensive patient education about the entire treatment process, including realistic expectations for the postoperative phase. Good prehabilitation care, which includes physiotherapy exercises and nutritional counseling, can improve patients' physical condition before surgery and thus speed up postoperative recovery. Intraoperatively, minimally invasive techniques and the use of modern anesthesia methods play a crucial role. These techniques reduce tissue trauma and minimize postoperative pain, leading to faster patient mobilization. The use of tranexamic acid to reduce blood loss and the application of local anesthetics also contribute to improved postoperative outcomes. Postoperatively, multimodal pain management is essential. By combining different analgesics and early mobilization, pain can be effectively controlled, and knee joint functionality can be quickly restored. Close collaboration between surgeons, anesthetists, physiotherapists, and nursing staff is crucial in this regard. Another important factor is structured follow-up care. Regular physiotherapy sessions and continuous monitoring of the healing process help to detect and treat complications early. Involving patients in the rehabilitation process and promoting self-responsibility are also key to long-term success. In conclusion, modern fast-track concepts in knee arthroplasty lead to good results through interdisciplinary collaboration, comprehensive preoperative preparation, minimally invasive surgical techniques, and effective pain management. The continuous development of these concepts and their adaptation to individual patient needs are the keys to successful treatment. [ABSTRACT FROM AUTHOR]

Objective: Postoperative patients with temporomandibular joint internal derangement (ID) often have problems such as limited mouth opening and pain. Exercise therapy can be advantageous for improving the recovery of patients following surgery. However, there is continuing discussion on the precise aspects of the exercise program, including the optimal timing, length, intensity, and use of assistive equipment. Hence, this study aimed to incorporate pre‐existing exercise treatment regimens and investigate their impact. Methods: Publications that detailed the clinical treatment of patients with temporomandibular joint ID who received postoperative exercise therapy interventions were included. Nine databases were searched until October 1st, 2023. The JBI critical appraisal tools were used to assess the methodological quality of the included studies. Results: Five studies were finally included for subsequent analysis; two were randomised controlled studies, and three were quasi‐experimental. Exercises suitable for such patients encompass vertical, transverse, and horizontal stretching, among which vertical stretch can be divided into active and passive movements. The start time ranged from the first to the fifth week after surgery, with a duration of 1–6 months. Although the data in the studies could not be integrated and further analysed, preliminary results showed that maximum mouth opening and pain in patients improved significantly. The therapeutic effect of combining three exercise methods was best and was related to patient compliance. Conclusion: Exercise therapy positively affects postoperative rehabilitation in patients with temporomandibular joint ID. It is proposed that targeted, comprehensive studies be conducted to provide a basis for designing more sophisticated exercise therapy regimens and further confirm its curative effect. [ABSTRACT FROM AUTHOR]

Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation. This article reviews the literature to provide guidance for postoperative protocols following upper extremity replantation. [ABSTRACT FROM AUTHOR]

Achieving an anatomical reduction in acetabular fracture is essential but may also be challenging. Most of complex fractures are treated with anterior approaches without direct visualization of the acetabular surface. In this paper, we present the surgical technique for arthroscopic assistance during open reduction and fixation for complex acetabular fractures. To our knowledge, this technique has not been described in the literature yet. [ABSTRACT FROM AUTHOR]

As advances are made in quantitative magnetic resonance imaging, specifically diffusion tensor imaging, researchers have investigated its potential to serve as a biomarker of disease or prognosticator for postoperative recovery in the management of cervical spondylotic myelopathy. Here, we narratively review the current state of the emerging literature, describing areas of consensus and disagreement. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we queried 2 large databases for original manuscripts published in English and systematically produced a narrative review of the use of diffusion tensor imaging in the management of cervical spondylotic myelopathy. Of the 437 manuscripts initially returned in our query, 29 met the final inclusion criteria, and data were extracted regarding diffusion tensor imaging indices and their relationships with clinical outcomes following surgery. Preoperative fractional anisotropy was most commonly found to correlate closely with postsurgical clinical outcomes, though results were mixed. Preoperative fractional anisotropy most frequently and best correlates with functional outcomes following surgery for cervical spondylotic myelopathy, according to a review of the current literature. The findings were not universal and at times contradictory, highlighting the need for high-quality future investigations to better define the utility of diffusion tensor imaging in spinal disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. Methods: A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. Results: Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. Conclusion: Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility. [ABSTRACT FROM AUTHOR]

Purpose: To identify the risk factors for distal junctional failure (DJF) in women treated for adult spine deformity with fusion to L5 and to highlight the significance of preoperative assessment, surgical decision-making, and postoperative care. Methods: This is a retrospective study of data collected prospectively on the local institutional spine surgery registry (2016–2021). All patients, women older than 18 years, with a diagnosis of adult spine deformity who underwent long posterior instrumentation to L5 and had a minimum of 2-years follow-up were included in the study (two groups: with or without DJF). Demographic and radiographic data, corrective strategy, preoperative level of degeneration at L5/S1 and GAP score were compared between the two groups. Results: Forty-eight patients (n = 48) satisfied eligibility criteria. At two-years follow-up, nine patients (18,7%) developed a DJF that required surgical revision. Thirty-nine patients did not present distal junctional complications. Patients with or without DJF showed significant differences in terms of preoperative spinopelvic parameters (PT: 28°± 6° vs. 23°± 9°, p-value 0.05; DJF group vs. not DJF) and degeneration of L5-S1 (Pfirmann grade L5-S1 disc 3.7 ± 1.0 vs. 2.6 ± 0.8, p-value 0.001; DJF group vs. not DJF) (L5-S1 Facet joint Osteoarthritis 3.1 ± 0.8 vs.2.4 ± 0.8, p-value 0.023; DJF group vs. not DJF). Conclusion: DJF following spinal deformity correction surgery is influenced by a combination of patient-related, surgical and implant-related factors. Fusion construct length, preoperative and postoperative sagittal alignment and the grade of degeneration of the distal disc have been identified as significant risk factors. Surgeons should carefully evaluate these factors and employ appropriate strategies. [ABSTRACT FROM AUTHOR]

Purpose: Pulmonary sequestration is a rare pulmonary malformation that often necessitates surgical intervention due to potential complications such as recurrent infections or hemoptysis. This case series presents the clinical trajectory of four patients diagnosed with pulmonary sequestration, from initial diagnosis through postoperative care, with a specific focus on the limited arterial supply in two of the cases. Materials and Methods: We conducted a retrospective descriptive analysis of four patients diagnosed with pulmonary sequestration who underwent surgical treatment at our institution between January 2013 and November 2022. The affected lung segments were excised via either thoracoscopy or thoracotomy. We evaluated perioperative and postoperative complications, hospital stay duration, histological findings, and the vascular supply of the affected areas. Results: Thoracoscopic surgery was initially preferred for all patients, though one required conversion to an open procedure due to technical challenges. Perioperative complications included increased pain and atelectasis. Two patients developed pleural empyema postoperatively, necessitating additional surgical intervention. The overall outcomes were favorable, with appropriate management addressing the complications effectively. Conclusions: Pulmonary sequestration, despite its rarity, often requires surgical treatment. Both thoracoscopic and open surgical methods are effective, though thoracoscopic surgery is generally preferred when feasible. The findings underscore the importance of meticulous preoperative planning and vigilant postoperative care to manage and mitigate potential complications. [ABSTRACT FROM AUTHOR]

Simple Summary: In a retrospective study of 86 patients, we identified independent predictors of recurrence-free survival (RFS) and overall survival (OS) after the resection of liver metastases of uveal melanoma using a multivariable Cox model. A disease-free interval of ≤24 months and a chromosome 8q surgain were associated with worse survival. With these two parameters, we built a novel clinico-genetic score that defined three risk groups with distinct prognoses. This novel score identified patients with a high risk of relapse after surgery. These patients may benefit from neoadjuvant or adjuvant systemic therapy following complete surgical resection with the hope of improving survival outcomes. Surgical treatment of liver metastases of uveal melanoma (LMUM) could be proposed for selected patients. This retrospective study examined the prognostic significance of the genetic profiles of liver metastases after LMUM resection. A total of 86 patients treated with resection for LMUM, who underwent genetic analysis of liver metastasis, were included. A multivariable Cox model identified the independent predictors of recurrence-free survival (RFS) and overall survival (OS). The disease-free interval (DFI) and a chromosome 8q surgain (>3 copies) were independent predictors and categorized patients into three risk groups with distinct postoperative prognoses. For the low-, intermediate-, and high-risk scores of recurrence, the median RFS values were 15 months (95% CI: 10–22), 6 months (95% CI: 4–11), and 4 months (95% CI: 2–7), and the median OS values were 86 months (95% CI: 55-NR), 25 months (95% CI: 17–48), and 19 months (95% CI: 12–22), respectively. The predictive accuracy of this scoring system was demonstrated by a mean area under the curve (AUC(t)) of 0.77 (95% CI: 0.65–0.90) for RFS and 0.81 (95% CI: 0.70–0.92) for OS. This novel score, based on a DFI of ≤24 months combined with a chromosome 8q surgain, identifies patients at a high risk of early recurrence and could help clinicians to propose perioperative treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: In the radio-oncological treatment of patients with prostate cancer, there are significant differences in therapy tolerance due to risk factors, previous illnesses, and pre-treatment of the prostate. Patients with previous prostate surgery (TURP or ThuLEP) are a significant risk group in prostate cancer treatment and differ from non-operated patients in terms of quality of life. Patients who underwent transurethral prostate resection (TURP) exhibited greater overall quality of life impairment immediately after radiotherapy compared to those who had transurethral laser enucleation (ThuLEP) or no surgery. Operation time and radiation technique are important factors regarding therapy tolerance. In our study, the post-radiotherapy quality of life of prostate cancer patients who previously underwent transurethral resection of the prostate (TURP) is compared to those who had thulium laser enucleation of the prostate (ThuLEP) and those who had no prior surgery. It also aims to identify and assess risk factors affecting therapy tolerance in this patient group. We analyzed 132 patients with localized prostate cancer treated with definitive radiotherapy (RT), including 23 who had prior TURP and 19 who previously underwent ThuLEP. A total of 62% of patients underwent irradiation within 12 months after surgery. We included only patients treated with radiotherapy using the IMRT technique. Changes in patient-reported urinary toxicity were evaluated using the International Prostate Syndrome Score (IPSS) and the quality of life index of the World Health Organization (QoL/WHO-PSS) over a three-year post-radiotherapy period. Patients with prior TURP experienced significant deterioration in QoL and IPSS immediately after irradiation (p < 0.001), whereas those without previous surgery showed both less significant differences in IPSS and QoL scores. In conclusion, patients with previous TURP/ThuLEP differ from those without previous surgery in urinary quality of life and acute and chronic urinary symptom profiles after RT. The surgical technique (ThuLEP vs. TURP) and the time interval to irradiation are crucial factors affecting RT tolerance in acute and late settings. The previously operated patient group reported a significantly longer period of increased symptom burden. [ABSTRACT FROM AUTHOR]

Simple Summary: Adjuvant chemotherapy (AC) using S-1 has demonstrated favorable outcomes for patients with pancreatic cancer (PC). However, the current S-1 completion rate is insufficient to achieve its benefits. Moreover, an absence of dependable markers to forecast S-1 completion warrants C-reactive protein-to-albumin ratio (CAR) investigation as a potential predictive factor related to nutritional status. Previously, we revealed that a postoperative CAR value of ≥0.05 serves as a marker predicting S-1 AC treatment non-completion due to adverse events (AEs) in the Ehime study. Thus, this study aims to substantiate the correlation between postoperative CAR and S-1 therapy non-completion due to AEs using an alternative cohort from another institution (the Dokkyo study). Background: S-1 in adjuvant chemotherapy (AC) administration after pancreatic cancer (PC) surgery has been standardized in Japan. The Ehime study confirmed that a postoperative higher C-reactive protein-to-albumin ratio (CAR) value predicted the risk of adverse event (AE)-related S-1 non-completion as an AC in patients with PC after curative surgery. This study aimed to investigate the index to predict S-1 tolerance among patients who underwent curative surgery for PC (the Dokkyo study). Methods: This retrospective validation cohort study included 172 patients at the Department of Hepato-Biliary Pancreatic Surgery, Dokkyo Medical University, Japan, from January 2010 to December 2022. All patients underwent nutritional screening using the postoperative CAR. S-1 completion status and its effect on prognosis were systematically followed up and investigated. We conducted a statistical analysis of predictive markers to investigate their association with S-1 completion. Results: Patients were categorized into the S-1 completion (N = 91) and non-completion (N = 81) groups. The S-1 completion group demonstrated a significantly lower CAR than the S1 non-completion group. Moreover, the current study revealed a significant difference in the S-1 completion rate, applying the CAR cutoff value of 0.05 established in the Ehime study. Additionally, univariate and multivariate analyses confirmed that a CAR of <0.05 was significantly associated with S-1 completion. Conclusions: The Dokkyo study confirmed the results observed in the Ehime study. Consequently, an increased postoperative CAR value appeared as a universal applicable marker for the risk factor of AE-related S-1 non-completion after curative surgery for patients with PC. [ABSTRACT FROM AUTHOR]

Background Mesenteric ischemia (Me-Is) after cardiac surgery is underreported in present literature but has still earned the bad reputation of a dismal prognosis. This study adds clinical outcomes in a large patient cohort. Methods Between 2009 and 2019 of the 22,590 patients undergoing cardiac surgery at our facility 106 (0.47%) developed Me-Is postoperatively. Retrospective patient data was analyzed. Additionally, patients were stratified by outcome—survivors and nonsurvivors. Results Patients were predominantly male (n = 68, 64.2%), mean age was 71.2 ± 9.3 years. Most procedures were elective (n = 85, 80.2%) and comprised of more complex combined procedures (50.9%) and redos (17.9%). Mean EuroSCORE II averaged 10.9 ± 12.2%. Survival at 30 days was 49.1% (n = 52). Clinical baseline and procedural characteristics did not differ significantly between survivors and nonsurvivors. The median postoperative interval until symptom onset was 5 days in both groups. Survivors were more frequently diagnosed by computed tomography and nonsurvivors based on clinical symptoms. Me-Is was predominantly nonocclusive (n = 84, 79.2%). Laparotomy was the main treatment in both groups (n = 45, 78.8% vs. n = 48, 88.9%, p = 0.94). Predictors of mortality were maximum norepinephrine doses (hazard ratio [HR] 8.29, confidence interval [CI] 3.39–20.26, p < 0.0001), lactate levels (HR 1.06, CI 1.03–1.09), and usage of inotropes (HR 2.46, CI 1.41–4.30). Conclusion The prognosis of Me-Is following cardiac surgery is poor—independently from diagnostic or treatment patterns. There exists a significant asymptomatic time period postoperatively, in which pathophysiologic processes seem to cross the Rubicon. After clinical demarcation, the further course can almost no longer be influenced. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation is endorsed after abdominal surgery. Healthcare professionals are key figures in mobilisation. However, their experiences of barriers and enablers of mobilisation shortly after abdominal surgery is yet not fully explored. Therefore, the aim was to describe the healthcare professionals' experiences of postoperative mobilisation shortly after abdominal surgery. Methods: This study has a qualitative descriptive design. In November 2017, individual interviews were conducted with a convenience sampling of ten nurses, three nurse assistants and four physiotherapists who participated in an interventional trial mobilising adult patient within two hours after abdominal surgery. Data were analysed with inductive content analysis. Reporting of the study followed the COREQ checklist. Findings: The study findings are presented in two categories: 'a responsibility for the patient' and 'prerequisites and challenges' with five subcategories. The healthcare professionals had initial concerns that mobilisation shortly after surgery would not be safe for the patient and would add extra burden on their workload. However, with time, their perceptions changed to believing that it enhanced the recovery and was feasible to conduct at the postoperative recovery unit. Conclusion: Mobilisation shortly after abdominal surgery at the postoperative recovery unit, was found to be beneficial for the patients without reducing patient safety. However, it is important to assure that sufficient resources and adequate competence are available if such intervention should be implemented in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Many previous studies reported that mobility did not recover to the preoperative level even several months after total knee arthroplasty (TKA). However, recent studies indicate that the time required for recovery may have been shortened. The correct information regarding the mobility improvement is very helpful in assessing a patients' progress in rehabilitation. Therefore, we evaluated the mobility early after TKA. Materials and Methods: One hundred seventy patients participated. We measured gait speed and the Timed Up and Go test (TUG) as mobility at pre-operatively and post-operatively at one, two, and three weeks. Results: Gait speed at 1 and 2 weeks after TKA was significantly lower than the preoperative value, but no significant difference was observed at 3 weeks. TUG at 1 week after surgery was significantly slower than the preoperative value, but no difference at 2 weeks, and faster than the preoperative value at 3 weeks. Approximately half of the patients (gait speed, 50%; TUG, 55%) demonstrated improvements exceeding their preoperative values. Conclusions: Our findings suggest that achieving preoperative mobility within 3 weeks after TKA may serve as a target for assessing early postoperative recovery progress. [ABSTRACT FROM AUTHOR]

Background: Robotic retro-muscular mesh repair of parastomal hernia (PH) is possible with transversus abdominis release. The aim of this study is to report mid-term results with this method. Methods: Patients who underwent surgery for PH were enrolled in a prospective study. Patients with concomitant midline hernia also underwent Rives repair. Polypropylene meshes with an absorbable buffer mesh were used in the retro-muscular pocket—except PTFE was chosen for inflammatory bowel disease patients. Follow-up was by telephone and physical examination and CT if suspicion of complication. Results: Of the 56 included ostomy patients, 44 had colostomies, 10 had ileostomies, and two had urostomies. Thirty-nine percent had a concomitant hernia, and 25% had recurrent PH. The mean operating time without accessory repair was 156 min (SD 37), and with accessory repairs 220 min (SD 62). One bowel lesion and one vascular injury to the stoma occurred, prompting intraoperative stoma revision without postoperative morbidity. Postoperative complications ensued in 12 patients (23%). One patient had stoma necrosis after 3 weeks and the stoma was relocated. One patient had a mesh infection, 3 patients temporary ileus, one patient hypovolemic renal failure, and two patients experienced a flare-up of their Crohn's Disease. One parastomal abscess was drained percutaneously. The median postoperative stay was 3 days (1–21; mean 3.7 days), and the readmission rate was 8.9%. The recurrence rate at mean and median 24 months follow-up is 5.4%, two in ileostomy patients and one colostomy patient with unaltered bulging where CT shows a relatively large prolapse and recorded as a failure. Conclusion: Robotic Pauli repair has shown promising results. However, repair fails of PH at small bowel ostomies with short mesentery. ePauli/TAR is now the preliminary choice for eligible patients at our site. Comparative studies with the intraperitoneal mesh standard are needed. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery offers effective treatment for morbid obesity and associated medical comorbidities, with excellent short- and long-term outcomes. Although it has been well documented that racial minority bariatric patients have worse outcomes than White patients, it remains unclear whether this recognition has led to improvement. Herein, we assess recent trends in bariatric surgery among Black and White patients and compare early postoperative outcomes by race. Methods: Primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients from 2015 to 2021 reported to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program were studied. Bariatric patients were stratified by race (Black and White) and perioperative outcomes were compared between matched Black and White patients. Primary outcome was 30-day mortality. Secondary outcomes included hospital readmissions, hospital length of stay (LOS), reoperation, and postoperative complications. Results: Overall, there were 193,071 Black and 645,224 White primary bariatric patients, with a higher volume of SG and RGYB performed among White patients. A total of 219,566 Black and White bariatric patients were matched and included in the case–control. Black patients were found to have higher rates of 30-day mortality (0.02% vs. 0.01%; p = 0.03) and readmissions (3.68% vs. 2.65%; p < 0.001). There were no significant differences in LOS, reoperations, or overall postoperative complications. However, there was a higher postoperative pulmonary thromboembolism rate (0.16% vs 0.08%; p < 0.001).). The differences in perioperative outcomes stratified by race persisted over the study period (Fig. 1). Conclusion: Black bariatric surgery patients continue to have worse perioperative outcomes compared with their White counterparts. Further work must be done to determine contributing factors in order to effect improvement in outcomes in bariatric surgical care for racial minority patients. [ABSTRACT FROM AUTHOR]

Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Introduction: Patients undergoing thoracic surgery commonly receive perioperative physio-therapy, typically consisting of education, mobilization, breathing exercises, and mobility exercises. To date, no study has described physiotherapy practice for patients undergoing thoracic surgery in Sweden. Purpose: To investigate physiotherapy interventions for patients undergoing thoracic surgery in Sweden. Methods: All physiotherapists currently working in thoracic surgery units in Sweden (n = 8) were eligible to participate. A survey was e-mailed to the physiotherapists, to determine physiotherapy interventions offered to patients undergoing thoracoscopy or open thoracic surgery. Of 21 physiotherapists, 13 (62%) responded, representing seven hospitals. Results: Physiotherapists reported routinely providing preoperative education and postoperative treatment for all patients undergoing thoracic surgery. Breathing exercises and mobilization were usually initiated on the day of surgery or the first postoperative day. Common treatments were deep breathing exercises, with or without positive expiratory pressure, and airway clearance techniques. Upper limb and shoulder exercises were typically initiated on the first or second day after surgery. The most important factor reported to influence treatment choice was personal experience of the attending physiotherapist. No routine post-discharge rehabilitation was provided. Conclusion: Physiotherapists in Sweden reported routinely treating patients scheduled for thoracic surgery, both pre and postoperatively. Prehabilitation or post-discharge rehabilitation was not routinely provided. [ABSTRACT FROM AUTHOR]

Background: Postoperative rectovaginal fistula leads to a loss of patients' quality of life and presents significant challenges to the surgeon. The literature focusing specifically on postoperative rectovaginal fistulas is limited. The objective of the present study is to identify factors that can enhance the success of the management of this postoperative rectovaginal fistula. Methods: This retrospective multicentric study included all patients undergoing surgery for rectovaginal fistulas, excluding those for whom the etiology of rectovaginal fistula was not postoperative. The major outcome measure was the success of the procedure. Results: A total of 82 patients with postsurgical fistulas were identified, of whom 70 were successfully treated, giving a success rate of 85.4%. On average, these patients required 3.04 ± 2.72 interventions. The creation of a diversion stoma did not increase the success rate of management [odds ratio (OR) = 0.488; 95% confidence interval (CI) 0.107–2.220]. Among the 217 procedures performed, 69 were successful, accounting for a 31.8% success rate. The number of interventions and the creation of a diversion stoma did not correlate with the success of management. However, direct coloanal anastomosis was significantly associated with success (OR = 35.06; 95% CI 1.271–997.603; p = 0.036) as compared with endorectal advancement flap (ERAF). Other procedures such as Martius flap did not show a significantly higher success rate. Conclusion: The creation of a diversion stoma is not necessary in closing a fistula. ERAF should be considered as a first-line treatment prior to proposing more invasive approach such as direct coloanal anastomosis. [ABSTRACT FROM AUTHOR]