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Abstract Background Glycated albumin (GA) is an indicator of glycemic variability over the past 2–4 weeks and has suitable characteristics for predicting the prognosis of ischemic stroke during the acute phase. This study evaluated the association between early neurological deterioration (END) and GA values in patients with acute ischemic stroke (AIS). Methods We assessed consecutive patients with AIS between 2022 and 2023 at two large medical centers in Korea. END was defined as an increase of ≥ 2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. We evaluated various glycemic parameters including fasting glucose (mg/dL), hemoglobin A1c (%), and GA (%). Results In total, 531 patients with AIS were evaluated (median age: 69 years, male sex: 66.3%). In the multivariable logistic regression analysis, GA value was positively associated with END (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI]: 1.10–9.50). Initial NIHSS score (aOR = 1.04, 95% CI: 1.01–1.08) and thrombolytic therapy (aOR = 2.06, 95% CI: 1.14–3.73) were also associated with END. In a comparison of the predictive power of glycemic parameters for END, GA showed a higher area under the curve value on the receiver operating characteristic curve than fasting glucose and hemoglobin A1c. Conclusions High GA values were associated with END in patients with AIS. Furthermore, GA was a better predictor of END than fasting glucose or hemoglobin A1c.

Background: Glycated albumin (GA) is an indicator of glycemic variability over the past 2–4 weeks and has suitable characteristics for predicting the prognosis of ischemic stroke during the acute phase. This study evaluated the association between early neurological deterioration (END) and GA values in patients with acute ischemic stroke (AIS). Methods: We assessed consecutive patients with AIS between 2022 and 2023 at two large medical centers in Korea. END was defined as an increase of ≥ 2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. We evaluated various glycemic parameters including fasting glucose (mg/dL), hemoglobin A1c (%), and GA (%). Results: In total, 531 patients with AIS were evaluated (median age: 69 years, male sex: 66.3%). In the multivariable logistic regression analysis, GA value was positively associated with END (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI]: 1.10–9.50). Initial NIHSS score (aOR = 1.04, 95% CI: 1.01–1.08) and thrombolytic therapy (aOR = 2.06, 95% CI: 1.14–3.73) were also associated with END. In a comparison of the predictive power of glycemic parameters for END, GA showed a higher area under the curve value on the receiver operating characteristic curve than fasting glucose and hemoglobin A1c. Conclusions: High GA values were associated with END in patients with AIS. Furthermore, GA was a better predictor of END than fasting glucose or hemoglobin A1c. [ABSTRACT FROM AUTHOR]

Background: In the early postoperative stage after heart transplantation, there is a lack of predictive tools to guide postoperative management. Whether the vasoactive-inotropic score (VIS) can aid this prediction is not well illustrated. Methods: In total, 325 adult patients who underwent heart transplantation at our center between January 2015 and December 2018 were included. The maximum VIS (VISmax) within 24 h postoperatively was calculated. The Kaplan-Meier method was used for survival analysis. A logistic regression model was established to determine independent risk factors and to develop a nomogram for a composite severe adverse outcome combining early mortality and morbidity. Results: VISmax was significantly associated with extensive early outcomes such as early death, renal injury, cardiac reoperation and mechanical circulatory support in a gradedependent manner, and also predicted 90-day and 1-year survival (p < 0.05). A VIS-based nomogram for the severe adverse outcome was developed that included VISmax, preoperative advanced heart failure treatment, hemoglobin and serum creatinine. The nomogram was well calibrated (Hosmer-Lemeshow p = 0.424) with moderate to strong discrimination (C-index = 0.745) and good clinical utility. Conclusion: VISmax is a valuable prognostic index in heart transplantation. In the early post-transplant stage, this VIS-based nomogram can easily aid intensive care clinicians in inferring recipient status and guiding postoperative management. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is a frequent occurrence following major surgery and is independently associated with high morbidity and mortality. Data regarding AKI following abdominal surgery is limited in sub-Saharan Africa and Tanzania in particular. This study aimed to determine the incidence, predictors and early outcome of AKI among patients undergoing abdominal surgery at Bugando Medical Centre (BMC). Methods: This was a longitudinal study to determine the incidence, predictors and early outcome of acute kidney injury among patients undergoing abdominal surgery at BMC between March 2022 and July 2022. Results: 172 patients were studied (M: F= 1.1: 1). The overall median age of patients at presentation was 34 years. Forty-six (26.7%) patients developed AKI postoperatively. Among the patients who had AKI, 30(65.2%) were classified as KDIGO stage 1, 12 (20.1%) as stage 2 and 4 (8.7%) as stage 3. On multivariate analysis, the age ≥45 years (p=0.036), pre-existing medical illness (p=0.015), preexisting renal dysfunction (p= 0.007), duration of surgery (p=0.007) and emergency surgery (p= 0.001) were the main predictors of postoperative AKI. The overall median length of the hospital was 8.7 days, and the overall mortality rate was 5.8%. The mortality rate among patients with AKI was significantly high compared to patients without AKI (15.2% v/s 2.4%; p= 0.020). Postoperative AKI was independently considerably associated with prolonged length of hospital stay (p= 0.001) and mortality (p=0.020). Recovery was observed in 63% of patients who developed postoperative AKI. Conclusion: AKI incidence is high among patients undergoing abdominal surgery at BMC and is associated with high mortality and increased LOS. Prompt identification and aggressive treatment of postoperative AKI risk factors offer the potential to reduce the burden of AKI in this group of patients. [ABSTRACT FROM AUTHOR]

Abstract Background A wide variety of factors have been reported to influence stroke prognosis. Quality indicators serve as standards of care. The aim of this study is to assess the clinical and demographic characteristics of patients with stroke and to measure quality indicators in relation to stroke early outcome. We analyzed a prospective hospital-based data. All patients with acute stroke admitted to Kasr-al-ainy stroke unit over a 1-year period were included. Clinical variables and quality indicators were studied in relation to early outcome which was measured by both disability at discharge assessed by modified Rankin score (mRS) and in-hospital death. Results We studied 242 patients with acute stroke, 145 patients (59.9%) had poor outcome at discharge [mRS 3–6]. There were 36 (14.9%) in-hospital deaths. High mRS and National institute of health stroke scale (NIHSS) at stroke onset, low Gugging swallowing scale (GUSS) score and hypertension (HTN) were independent predictors for more disability on discharge. Chest infection, bed sores, high mRS at stroke onset and hemorrhagic transformation were independent predictors for in-hospital mortality. Receiving recombinant tissue plasminogen activator (rtPA) showed significant association with good outcome. Mean door to needle time (DNT) was 50.6 min. Low GUSS score was associated with increased risk of chest infection. Conclusions Stroke severity, potentially modifiable risk factors and complications are associated with an increased risk of poor early outcome. Dysphagia screening using GUSS scale can predict patients with higher risk of aspiration pneumonia after stroke. DNT needs to be improved.

Background: A wide variety of factors have been reported to influence stroke prognosis. Quality indicators serve as standards of care. The aim of this study is to assess the clinical and demographic characteristics of patients with stroke and to measure quality indicators in relation to stroke early outcome. We analyzed a prospective hospital-based data. All patients with acute stroke admitted to Kasr-al-ainy stroke unit over a 1-year period were included. Clinical variables and quality indicators were studied in relation to early outcome which was measured by both disability at discharge assessed by modified Rankin score (mRS) and in-hospital death. Results: We studied 242 patients with acute stroke, 145 patients (59.9%) had poor outcome at discharge [mRS 3–6]. There were 36 (14.9%) in-hospital deaths. High mRS and National institute of health stroke scale (NIHSS) at stroke onset, low Gugging swallowing scale (GUSS) score and hypertension (HTN) were independent predictors for more disability on discharge. Chest infection, bed sores, high mRS at stroke onset and hemorrhagic transformation were independent predictors for in-hospital mortality. Receiving recombinant tissue plasminogen activator (rtPA) showed significant association with good outcome. Mean door to needle time (DNT) was 50.6 min. Low GUSS score was associated with increased risk of chest infection. Conclusions: Stroke severity, potentially modifiable risk factors and complications are associated with an increased risk of poor early outcome. Dysphagia screening using GUSS scale can predict patients with higher risk of aspiration pneumonia after stroke. DNT needs to be improved. [ABSTRACT FROM AUTHOR]

Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between‐hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between‐hospital variation in outcomes was assessed using the variance of random hospital effects (tau2). In addition, we estimated the correlation between hospitals' EVT‐patient volume and (case‐mix–adjusted) outcomes. Both early outcomes and case‐mix characteristics varied significantly across hospitals. Between‐hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case‐mix adjustment (tau 2=0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case‐mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT‐patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores (r=0.48) and weakly with lower NIHSS score at 24 to 48 hours (r=0.15). Conclusions Between‐hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case‐mix but not by patient volume. In contrast, between‐hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT‐patient volume but not by case‐mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case‐mix is applied for NIHSS score.

Background: Targeted therapies combined with anthracycline chemotherapy have improved the survival of patients with acute promyelocytic leukaemia (APL). High short-term mortality has been demonstrated in low- and upper-middle-income countries, with limited local data. Aim: This study aimed to describe the demographic variables, clinical characteristics and laboratory features associated with the short-term mortality of patients with APL. Setting: The Division of Clinical Haematology, Universitas Academic Hospital (UAH), Bloemfontein, South Africa. Methods: Demographic and clinical data were obtained from the patients' files and the MEDITECH electronic filing system. Laboratory data were retrieved from TrakCare, the National Health Laboratory Service (NHLS) electronic database. Data were analysed to report the demographic variables, clinical characteristics and laboratory features, and the short-term mortality of all newly diagnosed patients treated for APL during the 5-year period, 2015–2019. Results: Twenty-seven patients were included in this study. The 7-day mortality rate was 18.5%, and the 30-day mortality rate was 33.3%. Sanz and modified Sanz scores were significantly associated with 7-day mortality but not 30-day mortality. Creatinine ≥ 105 µmol/L was significantly associated with both 7- and 30-day mortalities. Patients who died within the first 30 days of admission had significantly higher median white cell counts and partial thromboplastin times. Hypogranular APL was identified in 55.6% of patients. Conclusion: The short-term mortality of APL at UAH is in keeping with findings at other treatment centres in middle-income countries. Despite being considered rare, hypogranular APL was the predominant type in this cohort. Contribution: This study highlights the need for practices pertaining to peripheral smear utility and interpretation to be reviewed outside of tertiary centres. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to compare the serum inflammatory indicators and radiographic results of conventional manual total knee arthroplasty (CM-TKA) with those of MAKO-robotic assisted total knee arthroplasty (MA-TKA). Methods We retrospectively analysed 65 patients with knee osteoarthritis who underwent unilateral TKA from December 2020 to November 2021 in our department, which included 34 patients who underwent MA-TKA and 31 patients who underwent CM-TKA. The tourniquet time and estimated blood loss (EBL) were compared between the two groups. Knee function was evaluated using range of motion (ROM), functional score and pain score. Leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), creatine kinase (CK), and neutrophil-to-lymphocyte ratio (NLR) were recorded at 3 time points (preoperative, and on the first and third postoperative days). The hip-knee-ankle angle (HKA) and the femoral and tibial component angles in the coronal and sagittal planes were used for postoperative radiographic evaluation. Results The postoperative MA-TKA group had less EBL (496.9 ± 257.8 vs. 773.0 ± 301.3 ml, p 0.05). IL-6 levels were significantly lower in the MA-TKA group on the 1st postoperative day (11.4 (5.2, 21.0) vs. 24.6 (86.3, 170.8), p = 0.031). This difference in inflammatory indices became more pronounced at 72 hours after the operation because CRP, ESR, IL-6, and CK values were significantly lower in the MA-TKA group on the 3rd postoperative day (72 h) (p 0.05). Conclusions In Chinese patients with OA, there was a milder systemic inflammatory response in the early postoperative period after MA-TKA compared to that of CM-TKA, as well as better radiographic outcomes. However, the tourniquet time was prolonged, and no advantages were observed in terms of functional score or pain score in the short-term follow-up.

Background: The intraaortic balloon pump (IABP) is the most common mechanical assist device used as an adjunctive therapy for patients with low cardiac output among cardiac surgery. However, controversy still exists about the optimal time for IABP insertion. The study evaluated the association between timing of IABP insertion and outcome in cardiac surgical patients. Patients and Methods: Patients who underwent cardiac surgery between August 2007 and June 2014 were included. 273 of 3480 patients (7.84%) required perioperative IABP support. Of whom 21 (7.7%) received a preoperative IABP, 180 (65.9%) received an intraoperative IABP and 72 (26.4%) received a postoperative IABP. Predictors of early mortality were measured in stepwise multivariate logistic regression analyses. Results: The overall mortality rate for all patients requiring IABP was 29.3%. The incidence of mortality in patients who underwent pre-, intra- and postoperative IABP insertion was 19.0%, 22.8%, and 48.6%, respectively. The independent predictors of early mortality were age, cross clamp time, and postoperative IABP. However, either pre or intraoperative IABP insertion was not associated with increase in early mortality. Conclusions: IABP treatment in patients undergoing cardiac surgery was relatively safe accompanied by few complications. Timing of IABP insertion appears to be associated with survival as early insertion results are much more desirable compared to postoperative insertion.

Context: Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction with a reported incidence of 1% to 3% in the pre thrombolytic era and

Background: Targeted therapies combined with anthracycline chemotherapy have improved the survival of patients with acute promyelocytic leukaemia (APL). High short-term mortality has been demonstrated in low- and upper-middle-income countries, with limited local data. Aim: This study aimed to describe the demographic variables, clinical characteristics and laboratory features associated with the short-term mortality of patients with APL. Setting: The Division of Clinical Haematology, Universitas Academic Hospital (UAH), Bloemfontein, South Africa. Methods: Demographic and clinical data were obtained from the patients’ files and the MEDITECH electronic filing system. Laboratory data were retrieved from TrakCare, the National Health Laboratory Service (NHLS) electronic database. Data were analysed to report the demographic variables, clinical characteristics and laboratory features, and the short-term mortality of all newly diagnosed patients treated for APL during the 5-year period, 2015–2019. Results: Twenty-seven patients were included in this study. The 7-day mortality rate was 18.5%, and the 30-day mortality rate was 33.3%. Sanz and modified Sanz scores were significantly associated with 7-day mortality but not 30-day mortality. Creatinine ≥ 105 µmol/L was significantly associated with both 7- and 30-day mortalities. Patients who died within the first 30 days of admission had significantly higher median white cell counts and partial thromboplastin times. Hypogranular APL was identified in 55.6% of patients. Conclusion: The short-term mortality of APL at UAH is in keeping with findings at other treatment centres in middle-income countries. Despite being considered rare, hypogranular APL was the predominant type in this cohort. Contribution: This study highlights the need for practices pertaining to peripheral smear utility and interpretation to be reviewed outside of tertiary centres.

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Background: Acetabular fractures are among the most challenging orthopaedic fractures, and a high total hip arthroplasty (THA) conversion rate has been reported in older patients with acetabular fractures. Bone quality is a poor prognostic factor after acetabular fracture fixation and has been assessed using computed tomography (CT). However, the relationship between Hounsfield unit (HU) values measured using CT and early acetabular fracture outcomes remains unknown. This study aimed to elucidate the effect of HUs on early acetabular fracture outcomes., Methods: 50 consecutive patients who underwent open reduction and internal fixation for acetabular fractures were included. The mean follow-up duration was 24 months. 27 hips had elementary fractures and 23 had associated fractures. The reduction quality assessed using CT was as follows: anatomical, 13 hips; imperfect, 10 hips; and poor, 27 hips. Secondary hip osteoarthritis was observed in 5 patients (10%), and the surgery was converted to THA in 1 patient (2%). The HU values of the fifth vertebral body and the unaffected side of the femoral head were measured. The fracture type, radiological secondary hip osteoarthritis, conversion to THA, and postoperative displacement gap were recorded., Results: The unaffected femoral head HU values in elementary fractures (250.5 ± 50.5) were significantly higher than those in associated fractures (221.5 ± 48) ( p   <  0.047). The HU values of the fifth vertebral body and the unaffected femoral head were significantly correlated with the postoperative residual displacement gap and were significantly lower in those with secondary osteoarthritis than in those without it. The cut-off value for predicting early osteoarthritic change after an acetabular fracture was approximately 180., Conclusions: The HU values were correlated with the fracture type, postoperative displacement gap, and early osteoarthritic change after acetabular fractures and are clinically useful prognostic factors for early acetabular fracture outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

Background: The purpose of this study was to compare the serum inflammatory indicators and radiographic results of conventional manual total knee arthroplasty (CM-TKA) with those of MAKO-robotic assisted total knee arthroplasty (MA-TKA).Methods: We retrospectively analysed 65 patients with knee osteoarthritis who underwent unilateral TKA from December 2020 to November 2021 in our department, which included 34 patients who underwent MA-TKA and 31 patients who underwent CM-TKA. The tourniquet time and estimated blood loss (EBL) were compared between the two groups. Knee function was evaluated using range of motion (ROM), functional score and pain score. Leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), creatine kinase (CK), and neutrophil-to-lymphocyte ratio (NLR) were recorded at 3 time points (preoperative, and on the first and third postoperative days). The hip-knee-ankle angle (HKA) and the femoral and tibial component angles in the coronal and sagittal planes were used for postoperative radiographic evaluation.Results: The postoperative MA-TKA group had less EBL (496.9 ± 257.8 vs. 773.0 ± 301.3 ml, p < 0.001). There was no significant difference in knee function scores at 6 weeks postoperatively (p > 0.05). IL-6 levels were significantly lower in the MA-TKA group on the 1st postoperative day (11.4 (5.2, 21.0) vs. 24.6 (86.3, 170.8), p = 0.031). This difference in inflammatory indices became more pronounced at 72 hours after the operation because CRP, ESR, IL-6, and CK values were significantly lower in the MA-TKA group on the 3rd postoperative day (72 h) (p < 0.05). Postoperative radiographic examinations performed 2 days after the MA-TKA group suggested that only 2 cases of HKA had outlier values, which was remarkably better than the 12 cases found in the CM-TKA group (5.9% vs. 38.7%, p < 0.001). The frontal femoral component was significantly closer to the expected value of 90° in the MA-TKA group (90.9 (90.5, 92.3) vs. 92.4 (91.3, 93.7), p = 0.031). The remaining imaging evaluation parameters were not significantly different between the two groups (p > 0.05).Conclusions: In Chinese patients with OA, there was a milder systemic inflammatory response in the early postoperative period after MA-TKA compared to that of CM-TKA, as well as better radiographic outcomes. However, the tourniquet time was prolonged, and no advantages were observed in terms of functional score or pain score in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Elderly population is growing because of increasing life expectancy. Decision-making for major surgery like pancreaticoduodenectomy in this group is challenging. Therefore, we evaluated the feasibility of this procedure by comparing perioperative outcomes in Septuagenarians and Octogenarians patients. From August 2017 to December 2019, 18 consecutive patients who underwent pancreaticoduodenectomy were enrolled. These patients were divided into two groups (group1 – septuagenarians and group 2 – octogenarians). A comparative study between two groups was done regarding perioperative outcome and early complications. 18 patients were enrolled, 10 patients (55.6%) were septuagenarians (70-80 years) and 8 (44.4%) patients were Octogenarians (>80 years). There was no significant difference in the rate of surgical and medical complications between the two groups. Furthermore, there were no significant differences in risk factors, blood loss and operating time between the groups. Overall mortality in the study is 5.5%. Pancreaticoduodenectomy is feasible treatment option in septuagenarians and octogenarians with the help of multidisciplinary approach. Age alone should not be considered as decision maker for pancreaticoduodenectomy.

Aim of the study: This was to compare the early outcome of closed femoral shaft fractures treated with locked intramedullary nailing and plating at the National Orthopaedic Hospital Enugu. Methods: The study was a prospective study over 12-month period at the National Orthopaedic Hospital Enugu. Ethical clearance was obtained from the hospital ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were randomly selected by simple balloting into either intramedullary nailing group or plating group. The patients were evaluated at presentation and postoperatively within 48 hours, then at two weeks, six weeks, 12 weeks and 18 weeks, respectively. Participants were evaluated using Thoresen criteria. Results: A total of 52 femoral shaft fractures in 50 patients were included and analysed using SPSS version 20.0. Bone union was obtained in all the patients in the intramedullary nailing group at 12 weeks and in 84.6% patients in the plating group between 12 and 18 weeks. The overall wound infection rate was 11.5% in the locked intramedullary group and 7.7% in the plating group. Similarly, the overall limb length discrepancy was 11.5% in the locked intramedullary nailing group and 19.2% in the plating group. Based on the Thoresen criteria, good to excellent outcome was achieved in 65.4% of patients in the locked intramedullary nailing group. Discussion: The patients in both groups were evaluated clinically, radiologically and functionally based on the Thoresen criteria and significantly higher number of patients in the intramedullary nailing group (17; 65.4%) than the plating group had good to excellent outcome (x2 = 9.734; p = 0.020). Conclusion: The early outcome of treatment of closed femoral shaft fractures in adults is significantly better following locked intramedullary nailing than plating. [ABSTRACT FROM AUTHOR]

Background: In the early postoperative stage after heart transplantation, there is a lack of predictive tools to guide postoperative management. Whether the vasoactive-inotropic score (VIS) can aid this prediction is not well illustrated., Methods: In total, 325 adult patients who underwent heart transplantation at our center between January 2015 and December 2018 were included. The maximum VIS (VIS max ) within 24 h postoperatively was calculated. The Kaplan-Meier method was used for survival analysis. A logistic regression model was established to determine independent risk factors and to develop a nomogram for a composite severe adverse outcome combining early mortality and morbidity., Results: VIS max was significantly associated with extensive early outcomes such as early death, renal injury, cardiac reoperation and mechanical circulatory support in a grade-dependent manner, and also predicted 90-day and 1-year survival ( p < 0.05). A VIS-based nomogram for the severe adverse outcome was developed that included VIS max , preoperative advanced heart failure treatment, hemoglobin and serum creatinine. The nomogram was well calibrated (Hosmer-Lemeshow p = 0.424) with moderate to strong discrimination (C-index = 0.745) and good clinical utility., Conclusion: VIS max is a valuable prognostic index in heart transplantation. In the early post-transplant stage, this VIS-based nomogram can easily aid intensive care clinicians in inferring recipient status and guiding postoperative management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xiong, Yim, Chi, Wang, Lan, Zhang, Sun, Shi, Chen and Dong.)

Introduction: This study aimed to examine the characteristics of Hirschsprung's Disease (HD) in patients aged<18 who underwent surgical procedure at Dr. Zainoel Abidin (RSUDZA) General Hospital, Banda Aceh, Indonesia, between January 2010 and December 2020., Methods: This retrospective study collected and analyzed data from medical records of 18-yearold or younger children (n = 180) diagnosed with HD at RSUDZA. The surgical procedures included the Duhamel procedure, Soave procedure, the Soave Transanal Endorectal Pull-through (TEPT) procedure, and the Swenson TEPT procedure. Early outcomes of the surgery were then compared between males and females. The comparrative analysis was determined based on Chisquare analysis, where p&#60; 0.05 was considered significant., Results: There were 111 (61.7%) male patients and 69 (38.3%) female patients, with a mean age of 15.2 months. The Soave TEPT is the most frequently performed procedure (91.7%). Emerging clinical manifestations include constipation (176; 97.8%) and soiling (171; 95%). Preoperative barium enema and postoperative pathological examination confirmed that almost all patients (99.4%) had an aganglionic segment confined to the rectosigmoid area. The average length of operation was 69.7 ± 65 minutes and average bleeding time was 5.4 ± 34 mL. The average discharge time was 3.3 ± 73.3 days. No significant difference was found in post-surgery complications between males and females (p&#60;0.5). The immediate complications were not associated with surgical methods (p = 0.83)., Conclusion: Our descriptive study has suggested the Soave TEPT technique as appropriate to manage HD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Improved post-operative outcomes following gastroschisis repair are attributed to advancement in perioperative and post-operative care and early enteral feeding. This study evaluates the role of standardized postoperative feeding protocols in gastroschisis. A systematic review and meta-analysis of studies published from January 2000 to April 2019 in MEDLINE, EMBASE, Cochrane Library databases and Google Scholar was conducted. Primary outcomes were duration to full enteral feeding and cessation of parenteral nutrition. Secondary outcomes included days to first enteral feeding, length of stay, compliance, complication and mortality rates. Meta-analysis was done using the RevMan Analysis Statistical Package in Review Manager (Version 5.3) using a random effects model and reported as pooled Risk Ratio and Mean Difference. p- value < 0.05 was considered statistically significant. Eight observational cohort studies were identified and their data analyzed. Significant heterogeneity was noted for some outcomes. Standardized feeding protocols resulted in fewer days to first enteral feeding by 3.19 days (95% CI: -4.73, -1.66, p < 0.0001) than non-protocolized feeding, less complication rates, reduced mortality and better compliance to care. The duration of parenteral nutrition and time to full enteral feeding were not significantly affected. Protocolized feeding post-gastroschisis repair is associated with early initiation of enteral feeding. There is a likelihood of reduced rates of sepsis; shorter duration of parenteral nutrition, length of hospital stay and time to full enteral feeding. However, the latter trends are not statistically significant and will require further studies best accomplished with a prospective randomized trial or more cohort studies. [ABSTRACT FROM AUTHOR]

Background: Eradication of infection and fracture union are the two major objectives of treatment of infected non unions. Recent studies indicate that locked intramedullary nailing of tibia fracture non unions provide a mechanical environment which enhances fracture healing even in the presence of infection. It also allows early weight-bearing without the burden of an external frame making it more acceptable to patients than external fixators. The Cases: The authors present 2 cases of infected tibia non unions. The first case had segmental fibulectomy, fracture debridement, deep tissue sampling, locked intramedullary nailing, cancellous bone grafting and antibiotic therapy. The second case had segmental fibulectomy, wound and fracture debridement, deep tissue sampling, locked intramedullary nailing, cancellous bone grafting, fasciocutaneous flap wound cover and antibiotic therapy. Results: The first case had a satisfactory (early) outcome having achieved full weight bearing at 12 weeks with no clinical evidence of infection. Similarly, the second case had a good outcome having achieved full weight bearing without clinical signs of infection at 12 weeks (although immediate post-op period was complicated by surgical site infection which was effectively managed). Based on these two cases, the importantguiding principles were identified and discussed. Conclusion: With appropriate surgical technique and strict adherence to surgical principles, the outcome of interlocking intramedullary nailing for infected tibia non unions are satisfactory.

Introduction: Coronary Artery Disease (CAD) is a significant cause of morbidity and mortality in the Indian population. We have been very few studies comparing the Indian population who develop CAD at an early age, arbitrarily defied as less than 45 years with those who develop it at a later. Very few studies compare the conventional risk factors in the patients with early onset CAD and those who present later. Aim: To study the conventional risk factors in patient who presented with early onset of coronary artery disease (age < 45 years) planned for CABG and to study the immediate outcome and perioperative morbidity (within 30 days of surgery) in these patients. Materials and methods: Between January 2016 to December 2020, data was collected for 100 patients below age of 45 years who underwent coronary artery bypass grafting in NIMS hospital. We retrospectively analyzed the perioperative data and evaluated patient outcome. Results: The mean age was 42 years, majority was males - 80 while females - 20. Smoking - 33, Hypertension - 50, Diabetes - 35, Hypercholesterolemia - 38, were the most frequent risk factors. Impaired left ventricular function (EF < 40%) in 15, indication for surgery was triple vessel disease in -79, double vessel disease in - 15, and single vessel disease in - 6, LMCA was affected in 10, the mean hospital stay was 7.97+/- 1.97 days, there were 8 deaths (within 30 days). Post-operative ICU stay was 4.13+/-1.81 days. Use of IABP in 14 patients, inotropes required for more than 48 hours in 87 patients, complications like renal dysfunction 5, and no cerebral stroke was observed. Conclusion: We are getting considerable number of young patient with coronary artery disease as there is early age onset of risk factors and most of them land up with a triple vessel disease, however, as they are young the post-operative morbidity is low and duration of IÇU hospital stay is less. [ABSTRACT FROM AUTHOR]

Introduction: Superior mesenteric artery first pancreaticoduodenectomy is being increasingly used for pancreatic head and peri-ampullary tumors. The aim of our study was to determine the frequency of various approaches of superior mesenteric artery pancreaticoduodenectomy along with its postoperative complications in a tertiary care center. Methods: This is a descriptive cross-sectional study of patients undergoing superior mesenteric artery first pancreaticoduodenectomy with different approaches conducted at Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal, from May 2018 to April 2020. Ethical approval was taken from the Institutional Review Committee (reference no: 310520193). The whole sampling method was adopted. Thirty-four patients undergoing a superior mesenteric artery first pancreaticoduodenectomy at our center with different approaches were included in the study. The data analysis was done in the Statistical Package for the Social Sciences version 20. Results: For 34 patients chosen for the study, the male: female ratio was 1.6:1, with a mean age of 53.7 years. The medial uncinate approach was done in the majority of the cases, 26 (76.4%), whereas the inferior infracolic (mesenteric) approach was done in 1 (2.9%) case. Regarding postoperative complications, Clavien Dindo grade 3 and grade 4 were present in 11 (32.3%) patients, pancreatic fistula (Grade B and C) was observed in 6 (17.6%) patients, and mortality occurred in 2 (5.8%). The mean hospital stay was 16±9 days. Conclusions: Superior mesenteric artery first pancreaticoduodenectomy with a different approach can be performed with acceptable morbidity and mortality. Early determination of resectibility is achieved in selected cases.

Background: Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery.Methods: Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile).Results: There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid.Conclusions: Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes.Clinical Trial Registration: ChiCTR1800014996. [ABSTRACT FROM AUTHOR]

To determine the status of type A acute aortic dissection using the Tokyo Acute Aortic Super Network. Data of 6283 patients with acute aortic dissection between 2015 and 2019 were collected. Data of 3303 patients with type A acute aortic dissection were extracted for analysis. Overall, 51.0% of patients were nondirect admissions. On arrival, 23.1% of patients were in shock, 10.0% in cardiopulmonary arrest, and 11.8% in deep coma or coma. Overall, 9.8% of patients were assessed as untreatable. Of 2979 treatable patients, 18.3% underwent medical treatment, whereas 80.7% underwent surgery (open [78.8%], endovascular [1.9%], and peripheral [1.1%] repair). The early mortality rate was 20.5%, including untreatable cases. Among treatable patients, in-hospital mortality rates were 8.6% for open repair, 10.7% for endovascular repair, and 25.3% for medical treatment. Advanced age, preoperative comorbidities, classical dissection, and medical treatment were risk factors for in-hospital mortality. Nondirect admission did not cause increased deaths. The mortality rates were high during the superacute phase following symptom onset. This study demonstrated current practices in the emergency care of type A acute aortic dissection via the Tokyo Acute Aortic Super Network system, specifically a high rate of untreatable or inoperable cases and favorable outcomes in patients undergoing surgical treatment. High mortality rates were observed during the super acute phase after symptom onset or hospital arrival. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: This study aimed to correlate amplitude‐integrated electroencephalography findings with early outcomes, measured by mortality and neuroimaging findings, in a prospective cohort of infants at high risk for brain injury in this center in Brazil. Methods: This blinded prospective cohort study evaluated 23 preterm infants below 31 weeks of gestational age and 17 infants diagnosed with hypoxic‐ischemic encephalopathy secondary to perinatal asphyxia, with gestational age greater than 36 weeks, monitored with amplitude‐integrated electroencephalography in a public tertiary center from February 2014 to January 2015. Background activity (classified as continuous, discontinuous high‐voltage, discontinuous low‐voltage, burst‐suppression, continuous low‐voltage, or flat trace), presence of sleep‐wake cycling, and presence of seizures were evaluated. Cranial ultrasonography in preterm infants and cranial magnetic resonance imaging in infants with hypoxic‐ischemic encephalopathy were performed. Results: In the preterm group, pathological trace or discontinuous low‐voltage pattern (p = 0.03) and absence of sleep‐wake cycling (p = 0.019) were associated with mortality and brain injury assessed by cranial ultrasonography. In patients with hypoxic‐ischemic encephalopathy, seizure patterns on amplitude‐integrated electroencephalography traces were associated with mortality or brain lesion in cranial magnetic resonance imaging (p = 0.005). Conclusion: This study supports previous results and demonstrates the utility of amplitude‐integrated electroencephalography for monitoring brain function and predicting early outcome in the studied groups of infants at high risk for brain injury.

Prediction of neonates' critical states outcome depending on lab test findings and clinical manifestations is one of the most important and difficult problems of modern critical care medicine.Aim of the study. To evaluate changes in lab test findings and clinical manifestations in order to create individual timelines for critically ill neonates.Material and methods.We examined 229 neonates with a gestational age of 25—42 weeks. Babies' health was assessed daily throughout their ICU stay using 105 parameters. Six patients enrolled in the study died, 220 enrolled patients survived. We analyzed 24 quantitative attributes affected by variable factor «Outcome» (according to the univariate variance analysis) that reflects early outcomes of a critical state.Results. The study demonstrated that the main characteristics reflecting the severity of patient's condition and determining the outcome of a critical state are such parameters of the oxygenation status as total blood oxygen concentration, oxygen delivery index, oxygenation index, oxygen consumption index, and arterial oxygen extraction tension. The study demonstrated that neonates with favorable outcomes presented a steady increase in the oxygenation status parameters with concurrent decrease in the oxygenation index. At the same time, neonates with unfavorable out comes presented a steady decrease in the oxygen status parameters along with a significant increase in the oxygenation index. We determined that the arterial oxygen extraction tension did not comply with the reference limits even in case of a favorable outcome. The study demonstrated that a decrease in the oxygen consumption index in the unfavorable outcome group reflects a decrease in the metabolic rate in patient and indicates a terminal state of the disease.Conclusion. The assessment of tissue oxygen consumption variations with time permits to estimate the effectiveness of the intensive care, create individual timelines, and predict outcome on an individual basis.

Objective: The aim of this study was to identify differential baseline profiles of interpersonal problems in patients with emotional disorders and investigate their ability to predict the extent to which alliance is important for early treatment outcome in therapy. Method: Ninety-six patients diagnosed with emotional disorders were admitted to psychotherapy at an independent practice center. After the first session, participants completed the Inventory of Interpersonal Problems and, after each of the first four sessions, the Alliance Negotiation Scale and the Outcome Questionnaire. We characterized the interpersonal problems of the sample using the circular statistics and the structural summary methods. Based on evidence of heterogeneity between patients, we conducted cluster analysis to identify differential profiles of interpersonal problems. We tested whether the identified profiles can predict the strength of the association between alliance negotiation and early treatment outcome using hierarchical linear models. Results: A two-cluster solution showed the best fit for the data. One cluster was characterized by Cold interpersonal problems (too hostile) and the other by Overly Nurturant interpersonal problems (too dependent). The identified profiles were significant predictors of the early alliance negotiation-outcome association. Overly Nurturant patients showed greater early improvements in outcome in the face of a stronger alliance negotiation. Conclusions: Results support the importance of personalized approaches using patients' interpersonal profiles to determine the importance of alliance negotiation for early treatment outcome. Findings should be replicated in randomized controlled trials using strategies to manipulate alliance negotiation. [ABSTRACT FROM AUTHOR]

Background: One of the most common adverse effects of laparoscopic sleeve gastrectomy (LSG) is postoperative nausea and vomiting (PONV). The present study aimed to assess the impact of local injection of a mixture of magnesium sulfate and lidocaine into the pylorus on gastric intraluminal pressure (ILP) and PONV after LSG. Methods: Patients with morbid obesity who underwent LSG were randomly allocated to one of two equal groups: treatment group (pyloric injection of a mixture of magnesium sulfate and lidocaine) and control group (pyloric injection of normal saline). PONV and antiemetic requirements were recorded at 6 and 24 h postoperatively. Results: Seventy patients (63 female) with a mean age of 34.6 ± 9.9 years were included. The mean preoperative and postoperative gastric ILP was comparable in the two groups. The pyloric injection of magnesium sulfate-lidocaine mixture resulted in 31% reduction in the mean gastric ILP (19.4 ± 4.7 mmHg before injection to 13.4 ± 4.1 mmHg after injection, p < 0.0001). Pyloric injection of saline did not result in significant change in ILP (19.9 ± 4.9 vs 20.3 ± 5.1 mmHg). Of the treatment group patients, 17.1% had significant PONV at 6 h compared to 91.4% of control group patients (p < 0.0001). At 24 h, none of the treatment group patients had significant PONV versus 40% of the control group patients (p < 0.0001). Conclusion: Pyloric injection of magnesium sulfate-lidocaine mixture during LSG resulted in lower incidence of PONV and less use of antiemetic medications in the first 24 h after LSG without being associated with higher complication rate. [ABSTRACT FROM AUTHOR]

Purpose: Early outcome prediction after suicidal hanging is challenging in comatose survivors. We analysed the early patterns of brain diffusion-weighted magnetic resonance imaging (DWI) abnormalities in comatose survivors after suicidal hanging.Methods: After suicidal hanging, 18 comatose survivors were prospectively evaluated from January 2013 to December 2016. DWI was performed within 3 h after hanging in comatose survivors. We evaluated Utstein style variables and analysed abnormal spatial profile of signal intensity on DWI, brain apparent diffusion coefficient (ADC) values, and qualitative DWI scores to predict neurological outcomes.Results: All hanging associated cardiac arrest (CA) patients demonstrated bad neurological outcomes; 80% of non-CA comatose patients experienced good neurological outcomes. In hanging survivors with CA, cortical grey matter structures and deep grey nuclei exhibited profound ADC reductions and high DWI scores within 3 h after hanging, which was associated with diffuse anoxic brain damage with poor cerebral performance categories scores. CA comatose survivors had significantly lower ADC values and higher DWI scores compared to non-CA comatose survivors in the cortex and deep grey nuclei.Conclusion: Although the presence of CA is the most important clinical prognosticator in hanging-associated comatose survivors, HSI abnormalities and low ADC values in the cortex and deep grey nuclei on DWI performed within 3 h after hanging are well-correlated with unfavourable outcomes regardless of therapeutic hypothermia. Therefore, early DWI may increase the sensitivity of poor outcome prediction and may be an effective combinatorial screening method when available prognostic variables are not reliable or conclusive. [ABSTRACT FROM AUTHOR]

Aim To compare early outcome after complex endovascular aortic repair in octogenarians (age ≥ 80 years) versus non-octogenarians (age < 80 years) treated with fenestrated or branched stent grafts. Methods Single centre retrospective analysis from a prospectively collected database of all patients undergoing repair with fenestrated or branched stent grafts for para/suprarenal aortic aneurysm, type Ia endoleak after previous endovascular aortic repair, and thoraco-abdominal aortic aneurysm between January 2015 and December 2017. Early all cause mortality, major adverse events, and need for re-intervention were analysed for non-octogenarians (age < 80 years) and octogenarians (age ≥ 80 years) at the time of repair. Results 207 patients (58 [28%] females) with a median age of 73 years (IQR 68–78) underwent repair with fenestrated or branched stent grafts. There were 169 (81%) non-octogenarians with a median age of 72 years (IQR 65–76) and 38 (19%) octogenarians with a median age of 82 years (IQR 81–84). The number of patients with chronic kidney disease was significantly higher in the octogenarians (63 [37%] vs. 22 [58%], p =.03]. Nineteen patients (9%) died. The early mortality rate was higher in the octogenarians (12 [7%] vs. 7 [18%], p =.06]. Mortality rate was 4% (6/148) for elective and 22% (13/59) for urgently treated patients. Similar rates of post-operative sepsis, stroke, respiratory problems, need for dialysis, and spinal cord injury were found in both groups. Two patients in each group had early stent graft related re-interventions. The octogenarian group had increased post-operative creatinine values (1.0 [0.8–1.4] vs. 1.4 [1.0–1.9], p =.01). After multiple logistic regression, ASA class ≥4 and rupture were independent factors of early all cause mortality. Conclusions Complex endovascular repair in octogenarians has higher early all cause mortality compared with non-octogenarians. Rupture and higher ASA class of ≥4 are independent predictors for early mortality. Age ≥80 years was found to be an independent predictor for higher early all cause mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVES Strict patient selection, short cardiopulmonary bypass (CPB) time and short mechanical ventilation are well-recognized aspects of optimizing the postoperative course after total cavopulmonary connection. In this study, we evaluated the influence of our early postoperative extubation strategy in our population of Fontan patients over the past 2 decades. METHODS Early postoperative course was evaluated retrospectively in 211 consecutive patients, who were selected for total cavopulmonary connection in our institution between 1995 and 2015. We analysed postoperative haemodynamic parameters and early outcome after surgery (mortality and length of hospital stay) according to preoperative patient characteristics, duration of CPB and duration of mechanical ventilation. To investigate the influence of mechanical ventilation, the cohort was subdivided into a 'fast-track' extubation group (≤6 h ventilation, n  = 59) and a prolonged ventilation group (>6 h ventilation, n  = 152). RESULTS In the entire cohort, duration of CPB did not correlate with duration of mechanical ventilation (P  =   0.1), and it did not differ between both groups (P  =   0.3). Patients in the fast-track group showed significantly better haemodynamics with higher mean arterial pressure and lower mean pulmonary artery pressure at 6, 24 and 48 h postoperatively when compared with the prolonged ventilation group (P  =   0.02–0.001). In multivariable analysis, longer mechanical ventilation, but not duration of CPB, was independently associated with length of hospital stay. CONCLUSIONS Early weaning from mechanical ventilation correlates with improved early Fontan haemodynamics, whereas early outcome is unrelated to duration of CPB. This indicates that early extubation may represent a principal strategy for improving early results after total cavopulmonary connection. [ABSTRACT FROM AUTHOR]

Aim: Alternative approaches compared to the traditional flap surgery have been suggested to enhance the postoperative morbidity and outcome of dental implants. The aim of this study is to compare the early outcomes of dental implant insertion using three different approaches; Full Flap (FF), Crestal Flap (CF), and Flapless (FL). Subjects and methods: A total of 214 patients (671 implants) took part in this study. The FF method was used in 376 implants (122 patients), the CF was used in 137 implants (49 patients), and the FL was used in 158 implants (43 patients). Cases were performed by single operator, non-randomly allocated to the three groups according to pre-operative and operative findings. The main outcomes were postoperative pain and early implant failure. Chi-square test and ANOVA test were used to examine the differences between the target groups. Results: Implant failure rate was highest when the FL method was used (7.2%) compared to the CF group (3.6%), and the FF group (3.2%) (p = 0.042, X2 test). Significant differences were also found in the degree of postoperative pain; the average pain scale was 1.4 ± 2.5 in the FL, 0.6 ± 0.98 in the CF, and 1.9 ± 2.2 in the FF group (p= 0.012, ANOVA test). Conclusions: More implant failure was encountered using the free handed FL implant surgery. FL implant surgery needs more careful case selection and advanced treatment planning in order to gain the advantages of the procedure without compromising the results. [ABSTRACT FROM AUTHOR]

Objective: Remarkable progress has been made in the surgical treatment of capral tunnel syndrome recently. Popularity of endoscopic and minimally invasive techniques has been increased in particular. The aim of this study was to present the short-term outcomes of patients undertaken median nerve decompression surgery with palmar mini-incision using carpal tunnel knife with light (Blade-X®, Mavera Medical Devices, Ankara, Turkey). Material and Method: A total of 50 patients who were operated by using carpal tunnel knife, were retrospectively evaluated. Among those, 40 were female and 10 were male. Five patients had bilateral capral tunnel syndrome. Mean age was 59.75 (33-81 y). Mean duration of follow-up was 11,2 months (6-18 m). Preoperative clinical diagnosis was confirmed via electroneuromyography in all patients. Surgery was performed under local anesthesia without tourniquet with minimal palmar incision. Simple bandage was performed postoperatively and no immobilization was performed. Results: Mean duration of operation was 13 minutes (10-17 min). No complication was observed in any of the patients. Patients were able to use their hands for self-care after a mean of 7 days (5-13 d). Mean time to get back to work was 25 days (18-35 d) for those who are employed. All patients were satisfied except two patients experiencing scar pain. Conclusion: The most remarkable outcome of this minimally invasive method was rapid usage of the hands postoperatively and the functional recovery observed in the short-term. [ABSTRACT FROM AUTHOR]

Background: There are conflicting opinions regarding the optimal waiting time to perform surgery after rupture of supratentorial arteriovenous malformations (AVMs) to achieve the best possible outcome. Objective: To analyze factors influencing outcomes for ruptured supratentorial AVMs after surgery, paying particular attention to the timing of the surgery. Methods: We retrospectively investigated 59 patients admitted to our center between 2000 and 2014 for surgical treatment of ruptured supratentorial AVMs. We evaluated the effect of timing of surgery and other variables on the outcome at 2-4 months (early outcome), at 12 months (intermediate outcome) after surgery, and at final follow-up at the end of 2016 (late outcome). Results: Age over 40 years (OR 18.4; 95% CI 1.9-172.1; p = 0.011), high Hunt and Hess grade (4 or 5) before surgery (OR 13.5; 95% CI 2.1-89.2; p = 0.007), hydrocephalus on admission (OR 12.9; 95% CI 1.8-94.4; p = 0.011), and over 400 cm bleeding during surgery (OR 11.5; 95% CI 1.5-86.6; p = 0.017) were associated with an unfavorable early outcome. Age over 40 years (OR 62.8; 95% CI 2.6-1524.9; p = 0.011), associated aneurysms (OR 34.7; 95% CI 1.4-829.9; p = 0.029), high Hunt and Hess grade before surgery (OR 29.2; 95% CI 2.6-332.6; p = 0.007), and over 400 cm bleeding during surgery (OR 35.3; 95% CI 1.7-748.7; p = 0.022) were associated with an unfavorable intermediate outcome. Associated aneurysms (OR 8.2; 95% CI 1.2-55.7; p = 0.031), high Hunt and Hess grade before surgery (OR 5.7; 95% CI 1.3-24.3; p = 0.019), and over 400 cm bleeding during surgery (OR 5.8; 95% CI 1.2-27.3; p = 0.027) were associated with an unfavorable outcome at last follow-up. Elapsed time between rupture and surgery did not affect early or final outcome. Conclusions: Early surgery in patients with ruptured supratentorial arteriovenous malformation is feasible strategy, with late results comparable to those achieved with delayed surgery. Many other factors than timing of surgery play significant roles in long-term outcomes for surgically treated ruptured supratentorial AVMs. [ABSTRACT FROM AUTHOR]

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Background and Aim: Staple line complications and axial rotation of the gastric tube after sleeve gastrectomy are well-recognized complications of the procedure. The present study aims to investigate the role of staple line inversion and distal fixation to the transverse mesocolon in reducing these complications. Patients and Methods: This is a retrospective analysis of prospectively collected data of 252 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy (LSG). Patients were subdivided into two groups: group I comprising 124 patients did not have distal sleeve fixation and group II comprising 128 patients underwent staple line inversion and distal fixation. Results: Patients were 171 females and 81 males with a mean age of 33.2 ± 8.7 years and a mean preoperative body mass index (BMI) of 50.9 ± 8.6 Kg/m. The mean operating time was 103.9 ± 26.9 min and the median hospital stay was 1 day. Major complications were detected in 15 (5.9 %) patients, who were all in group I. Group I had significantly shorter operative time and significantly higher rates of staple line bleeding (4 % in group I versus 0 in group II) and gastric axial rotation (5.6 % in group I versus 0 in group II). There were no significant differences between the two groups regarding early postoperative vomiting (21.7 % versus 26.5 %) and staple line leak (2.4 % versus 0). Conclusion: Staple line inversion and distal fixation to the transverse mesocolon can be a simple, effective strategy to prevent staple line bleeding, and gastric axial rotation, though it prolonged the operative time of LSG. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis (UC) is an idiopathic inflammatory disorder. Currently, the final treatment is colectomy. The aim of this study was to investigate the outcomes of proctocolectomy in patients that used a high dose of prednisolone. Materials and Methods: Seventy-five patients presenting for surgical management of histopathologically proven UC. All patients were offered total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). Patients were divided into two groups: low dose of steroids (Group A) and high dose of steroid (Group B) consumers. Data from these patients after 2 years were reviewed and analyzed. Results: From total patients, 34 of them were male and 34 ones were female and seven patients underwent laparatomy. Overall incontinence rate was 8.8%; dysplasia was 22%, pouchitis was 18.9% while mortality was nil. The length of hospital stay was 6.76 days in Group A and 9.21 days in Group B (P = 0.399). Leakage was observed in nine of the patients after surgery (P = 0.589). Fecal incontinence between two groups was not statistically different (P = 0.063). Conclusions: Laparoscopic TPC-IPAA is feasible in patients needing surgical management of UC. Preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.

Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between-hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between-hospital variation in outcomes was assessed using the variance of random hospital effects (tau 2 ). In addition, we estimated the correlation between hospitals' EVT-patient volume and (case-mix-adjusted) outcomes. Both early outcomes and case-mix characteristics varied significantly across hospitals. Between-hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case-mix adjustment (tau 2 =0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case-mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT-patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores ( r =0.48) and weakly with lower NIHSS score at 24 to 48 hours ( r =0.15). Conclusions Between-hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case-mix but not by patient volume. In contrast, between-hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT-patient volume but not by case-mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case-mix is applied for NIHSS score.

We performed a multicenter prospective comparative study to determine the impact of a Japanese frozen elephant trunk device on total arch replacement compared with conventional repair without it. Between 2016 and 2019, a total of 684 patients (frozen elephant trunk procedure; n = 369; conventional repair, n = 315) from 41 institutions were enrolled. The 2 procedures were selected according to each center's strategy. The frozen elephant trunk procedure was applied more for aortic dissection, whereas the conventional repairs were predominantly performed for aneurysms. In the former, only hypothermic circulatory arrest time was reduced among the intraoperative parameters. Although there were no differences in the 30-day and in-hospital mortality rates (0.8% and 1.6%, respectively, for the frozen elephant trunk procedure vs 0.3% and 0.6%, respectively, for conventional repair), the neurologic complication rates were significantly higher in stroke (5.7% vs 2.2%; P =.022) and paraplegia (1.6% vs 0%; P =.023). In the propensity score matching analyses using 11 variables, statistical significance disappeared in the differences for mortality and neurologic morbidity (stroke and paraplegia/paraparesis) rates of 194 patients of each group, although they were still higher for the frozen elephant trunk procedure. The early outcomes of total arch replacement with the frozen elephant trunk procedure were acceptable despite its higher prevalence of emergency or redo surgery, which was comparable to that of the conventional repair. This procedure had higher rates of spinal cord injury than the conventional repair, which is a disadvantage of this approach. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: The use of tranexamic acid (TXA) reduces postoperative anemia and blood transfusion requirements. We investigated if these beneficial effects improve the early outcomes of primary total knee arthroplasty (TKA).Methods: We retrospectively studied 166 consecutive patients (179 TKAs) who received topical TXA (3 g before tourniquet deflation). This "study group" was compared with a "control group" of 197 consecutive patients (209 TKAs) in whom no TXA was used. We captured outcomes during the first 4 postoperative months. Knee Society score (KSS) was determined preoperatively, 6 weeks, and 4 months postoperatively. The outcomes were compared using univariate analysis. Multiple logistic regressions were calculated to assess differences between groups in KSS at 6 weeks and 4 months, controlling for age, sex, body mass index, and preoperative KSS.Results: Postoperative hemoglobin was significantly higher in the study than that in the control group on day 1, day 2, and at discharge (P < .0001). Blood transfusions were required in 5% and 22% of patients (P < .001), respectively. Six weeks postoperatively, the functional KSS and its 5 categories (ability to walk, negotiate stairs up and down, stand up from a chair, and the use of support) were significantly higher in the study than those in the control group (P ≤ .001). Four months postoperatively, there was no difference in the KSS between the groups.Discussion: Our study suggests that the clinical benefit of topical TXA administration extends beyond the hospitalization period. Its use may improve knee function during the first 6 postoperative weeks. This beneficial clinical effect seems to be negligible afterward. [ABSTRACT FROM AUTHOR]

Elderly patients are often considered as high-risk for major abdominal surgery due to reduced functional reserve and increased comorbidities. We herein evaluated the efficacy of totally laparoscopic distal gastrectomy (TLDG) in elderly patients with gastric cancer by measuring the postoperative systemic responses and postoperative analgesic consumption. A total of 102 patients with gastric cancer [57 who underwent TLDG and 45 who underwent laparoscopy-assisted distal gastrectomy (LADG)] were enrolled in this study. The patients were classified as elderly (aged ≥75 years) and non-elderly (aged <75 years) groups. The surgical outcome and postoperative analgesic consumption were evaluated. The elderly group exhibited a higher incidence of comorbidities and a longer postoperative hospital stay compared with those of younger patients, although there was no difference in the incidence of postoperative complications. In addition, the total consumption of additional analgesics until postoperative day 5 in patients who underwent TLDG was significantly lower compared with that in patients who underwent LADG in the elderly group; there was no such difference in the non-elderly group. The results suggested that TLDG was better for the management of postoperative pain in elderly patients with gastric cancer, who exhibit the highest mortality rates in the adult surgical population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Mortality from trauma still remains a major challenge despite recent substantial improvements in acute trauma care. In trauma care patient resuscitation to correct hypotension from volume loss still majorly relies on use of physiological parameters such as blood pressure, pulse rate, respiratory rate, urine output, Glasgow coma scale and oxygen saturation in resource limited settings. In such settings, these methods may not be sufficient to detect occult tissue hypoxia, due to undetected hypotension and accompanying metabolic derangements.

Objective: To compare early and long-term outcomes in patients undergoing resection for colorectal liver metastases (CLM) by either a laparoscopic (LA) or an open (OA) approach. Background: The LA is still a matter of debate regarding the surgical management of CLM. Methods: Data of all patients from 32 French surgical centers who underwent liver resection for CLM from January 2006 to December 2013 were collected. Aiming to obtain 2 well-balanced cohorts for available variables influencing early outcome and survival, the LA group was matched 1:1 with the OA group by using a propensity score (PS)-based method. Results: The unmatched initial cohort consisted of 2620 patients (LA: 176, OA: 2444). In the matched cohort for operative risk factors (LA: 153, OA: 153), the LA group had shorter hospitalization stays [11.1 (±9) days vs 13.9 (±10) days; P=0.01] and was associated with lower rates of grade III to V complications [odds ratio (OR): 0.27, 95% confidence interval (CI) 0.14- 0.51; P=0.0002] and inhospital transfusions (OR: 0.33 95% CI 0.18-0.59; P<0.0001). On a prognostic factors well-balanced population (LA: 73, OA: 73), the LA group and the OA group experienced similar overall (OS) and disease-free (DFS) survival rates [OS rates of 88% and 78% vs 84% and 75% at 3 and 5 years, respectively (P=0.72) and DFS rates of 40% and 32% vs 52% and 36% at 3 and 5 years, respectively (P=0.60)]. Conclusions: In the patients who are suitable for LA, laparoscopy yields better operative outcomes without impairing long-term survival. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to clarify the hazard ratio for death within 30 days after stroke comparing women to men. Material and methods We reviewed all stroke patients registered in the Kyoto Stroke Registry (from January 1999 to December 2009) in Japan. Hazard ratio (HR) for death and 95% confidence interval were calculated by the Cox regression in stroke and in each stroke subtype: cerebral infarction (CI), cerebral hemorrhage, (CH) and subarachnoid hemorrhage (SAH). We also evaluated HR for death in women in each consciousness level at the onset of stroke: the Japan Coma Scale (JCS) 0 (alert), JCS 1-digit code (disoriented but awake), JCS 2-digit code (arousable with stimulation), and JCS 3-digit code (unarousable). Results A total of 13,788 patients were analyzed. HR for death comparing women to men were 1.04 (0.88-1.23, P = 0.66 in stroke as a whole), 0.91 (0.69-1.21, P = 0.51 in CI), 0.53 (0.41-0.71, P < 0.01 in CH), and 0.89 (0.60-1.30, P = 0.535 in SAH) after adjustment for age and histories of hypertension, arrhythmia, diabetes mellitus and hyperlipemia and uses of tobacco and alcohol. Stratified by JCS, HR for death in women with CH were 0.32 (0.11-0.94 in JCS0), 0.48 (0.28-0.82 in JCS1), 0.49 (0.28-0.83 in JCS2), and 0.79 (0.65-0.97 in JCS3), respectively. HR for death in women with CI in JCS3 was significantly lower than in men (0.71; 0.52-0.98). Conclusion We evaluated HR for death comparing men to women in stroke and in each stroke subtype. Women with CH had lower HR for death within 30 days after stroke than men. [ABSTRACT FROM AUTHOR]