Anterior Group Research Articles

NCOG-31. NEUROCOGNITIVE OUTCOME FOLLOWING AWAKE CRANIOTOMY FOR INSULAR GLIOMA RESECTION: IMPACT OF SURGICAL APPROACH AND TUMOR CLASSIFICATION

Abstract BACKGROUND Insular glioma resection harbors similar risk of neurocognitive function (NCF) decline as other tumor locations. However, differences in outcomes according to transsylvian versus transcortical surgical approach and tumor classification remain unknown. METHODS 53 patients with newly diagnosed insular glioma (47% high-grade; 23% GBM; 75% left hemisphere) underwent awake craniotomy for resection (transsylvian, 64%; transcortical, 36%). Patients completed neuropsychological testing preoperatively and <2 months postoperatively (M interval=23.7 days). Tumor location was described with Berger-Sinai zones collapsed into anterior (I and/or IV), posterior (II and/or III), superior (I and/or II), and inferior (III and/or IV) groups. Tumor extension was characterized with the Pitskhelauri system into insula only, insula with extension (lobar or medial), and predominantly (>50%) extra-insular groups. Result: Decline (z-score change<-1.0) on at least 1 test occurred in 85% of patients with largest effect (partial η2) in memory (.29–.44) and verbal fluency (.39). There was no interaction with approach on any NCF change score, though transcortical was associated with more frequent fluency decline (61% vs. 26%, p=.014). Left hemisphere tumor was associated with poorer outcome on 6/12 tests (all p<.01). Predominantly extra-insular tumors showed greater reductions in fluency (M=-1.21, SD=0.90) than insula only tumors (M=-0.10, SD=0.76; p=0.024). Number of Berger-Sanai quadrants involved was inversely associated with change in executive functioning (r=-0.34, p=.018). Poorer executive function outcome was also found in anterior (M=-0.61, SD=1.41) versus posterior tumors (M=0.86, SD=1.51; p=.014), and recognition memory outcome worse for inferior (M=-2.44, SD=1.81) than superior lesions (M=-0.31, SD=1.47; p=.021). CONCLUSIONS NCF decline is common in the early term following resection of insular glioma. While risk of verbal fluency decline may be greater for transcortical surgeries, outcomes were largely similar across approaches. In addition to hemisphere, tumor extension and insular zone localization may inform domain-specific risk of NCF decline following resection.

Comparative Analysis of Surgical Outcomes in Separation Surgery vs. Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.

Retrospectively matched case-control study. To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC). The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods. Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion and complications. The Mann-Whitney U test was used for continuous data, and Fisher's exact test for categorical data. Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss (median 500ml [IQR 300-1,000] vs. 925ml [IQR 500-1,425]; P=0.036) and shorter operating times (median 214 minutes [IQR 164-281] vs. 286 minutes [IQR 220-328]; P=0.028). Intraoperative blood transfusion occurred in seven patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group (P=0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative transfusions, reoperations, or survival (P<0.05). Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control. Treatment benefits, Level IV.

Comparison of anterior vs. posterior surgery for cervical myelopathy due to OPLL: a systematic review and meta-analysis.

Systematic review and meta-analysis. To compare the effectiveness and safety between the anterior and posterior approach, and identify the more effective surgical approach for treating ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. This meta-analysis searched three electronic databases (PubMed, Embase, Cochrane library), including 17 randomized and non-randomized controlled studies published since 2000-2023 that compared the effectiveness and safety of anterior and posterior surgical approaches for the treatment of ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association (JOA) scores, functional recovery rates, excellent and good outcomes of the surgical approaches, Visual Analogue Scale (VAS), C2-C7 angle cobb and complication were analyzed. RevMan 5.3 was utilized for data analysis. This study suggested that there were no statistically differences between the anterior group and posterior group in terms of preoperative JOA score [WMD=0.23, 95% CI, (-0.22, 0.67), P=0.32], preoperative VAS [WMD=0.03, 95% CI, (-0.24, 0.30)], postoperative VAS [WMD=-0.16, 95% CI, (-0.47, 0.15) P=0.97] function recovery rate of patients with canal narrowing ratio less than 50-60% [WMD=-1.54, 95% CI, (-4.46, 1.38), P=0.30]. The anterior group showed higher postoperative JOA score [WMD=0.99, 95% CI, (036,1.63) P<0.05], post C2-C7 angle cobb [WMD=2.62, 95% CI, (0.36, 4.87), P=0.02] as well as function recovery rate (regardless of canal narrowing ratio) [WMD=16.05, 95% CI, (14.08, 18.03), P<0.05], especially a significant higher function recovery rate of patients with canal narrowing ratio greater than 50-60% [WMD=19.32, 95% CI, (17.25, 21.40), P<0.05]. There was a significant difference between anterior group and posterior group in complication. [OR=0.12, 95% CI, (0.01, 0.24), P<0.05]. Based on the study's finding, The study suggested that when the conservative treatment for OPLL is unsatisfied, the surgical approach of entering through the anterior approach is a better choice. Nevertheless, it is still necessary to consider the specific situation of the patient. One of the next research directions is how to reduce the complications of anterior surgery.

Analysis of the changes in corneal optical density following small incision lenticule extraction for myopia and related influencing factors

Purpose: To examine changes in corneal optical density (COD) following small incision lenticule extraction (SMILE) for myopia and the associated factors affecting COD. Methods: One hundred and ten eyes of 110 subjects who underwent SMILE were included in this study. COD and influencing factors were evaluated before and three months after SMILE. The changes in COD were compared and analysed with those of other influencing factors. Representative positive outcomes were chosen to investigate the influence in various ways. Results: This study found significant reductions in most anterior, central, and posterior CODs following SMILE (P<0.05), but the anterior 2-6 mm COD exhibited a significant increase (P<0.001). Lenticule thickness (LT), refractive sphere, preoperative Km, and Δcorneal volume (CV) were related to some of the whole ΔCODs (P<0.05). Age, gender, intraocular pressure (IOP), refractive cylinder, corrected distance visual acuity (CDVA), preoperative central corneal thickness (CCT), and preoperative CV were not correlated with the whole ΔCODs. Further exploration revealed that an increase in LT leads to a pattern of increasing and then decreasing changes in the whole ΔCODs. Most of the ΔCODs values were significantly lower in the high central corneal stromal ablation thickness group than in the high anterior corneal stromal ablation thickness group (P<0.05). Conclusions: Changes in COD were mainly caused by LT and its associated factors. However, the relationship between LT and ΔCOD might not be linear. Deeper corneal stromal ablation may reduce the COD. Changes in COD following SMILE are a multifaceted process influenced by various circumstances.

Quantitative EEG biomarkers for STXBP1-related disorders.

EEG patterns and quantitative EEG (qEEG) features have been poorly explored in monogenic epilepsies. Herein, we investigate regional differences in EEG frequency composition in patients with STXBP1 developmental and epileptic encephalopathy (STXBP1-DEE). We conducted a retrospective study collecting electroclinical data of patients with STXBP1-DEE and two control groups of patients with DEEs of different etiologies and typically developing individuals matched for age and sex. We performed a (1) visual EEG assessment, (b) qEEG analysis, and (c) electrical source imaging (ESI). We quantified the relative power (RP) of four frequency bands (α β, θ, δ), in two electrode groups (anterior/posterior), and compared their averages and dynamics (standard deviation [SD] over time). The ESI was performed by applying the standard Distributed Source Modeling algorithm. We analyzed 42 EEG studies in 19 patients with STXBP1-DEE (10 female), with a median age at recordings of 9.6 years (range 9 months to 29 years). The δRP was higher in recordings of STXBP1-DEE (p < .001) compared to both control groups, suggesting the pathogenicity and STXBP1-specificity of these findings. In STXBP1-DEE, the δRP was significantly higher in the anterior electrode group compared to the posterior one (p = .003). There was no correlation between the anterior δRP and the epilepsy focus, age at recordings, and concomitant medications The ESI modeling of this activity showed a widespread involvement of the dorsomesial frontal cortex, suggesting a large corticosubcortical pathologic network. Finally, we identified two groups of recordings: cluster.1 with higher anterior δRP and low dynamics and cluster.2 with lower δRP and higher dynamics. Patients in cluster.1 had a more severe epilepsy and neurological phenotype compared to patients in cluster 2. The qEEG analysis showed a predominant frontal slow activity as a specific STXBP1 feature that correlates with the severity of the phenotype and may represent a biomarker for prospective longitudinal studies of STXBP1-DEE.

Right anterior thoracotomy vs. upper hemisternotomy for aortic valve replacement with Perceval S: is there a difference?

Our study aimed to evaluate the early outcomes of aortic valve replacement with Perceval S sutureless valve through the right anterior thoracotomy and upper hemisternotomy approaches, and to determine if there are any differences between these two approaches. We carried out a study using data from 174 patients who underwent minimally invasive Perceval S valve implantation for aortic valve stenosis between January 2018 and August 2023. This was a retrospective, single-center observational study. The patients were divided into two groups: the hemisternotomy group (n = 100) and the right anterior thoracotomy group (n = 74). The overall in-hospital mortality was 1,7%. The cardiopulmonary bypass and cross-clamp times were longer in the right anterior thoracotomy group (p < .001). There were no statistically significant differences in terms of stroke, paravalvular leak, mechanical ventilation time, blood transfusion requirements, pacemaker implantation, reexploration for bleeding, conversion, wound infection, or in-hospital stay. Postoperative chest drainage was lower (p < .001) and postoperative atrial fibrillation occurred less frequently (p = .044) in the right anterior thoracotomy group. The median intensive care unit stay was shorter in the right anterior thoracotomy group (p = .018). Aortic valve replacement with the Perceval S valve through either an upper hemisternotomy or a right anterior thoracotomy is a procedure associated with low perioperative complication rates. Right anterior thoracotomy for an aortic valve replacement with the Perceval S valve was associated with lower postoperative bleeding, a lower postoperative atrial fibrillation incidence and a shorter intensive care unit stay compared to upper hemistornotomy.

Gait analysis and clinical outcomes of anterior and lateral approach total hip arthroplasty: A prospective randomized study

Objectives: This study compared the lateral and direct anterior approaches (DAAs) for total hip arthroplasty (THA) regarding gait analysis and post-operative outcomes. Methods: Patients undergoing THA for osteonecrosis or primary osteoarthritis were randomized to either the lateral or DAA. Standardized surgical procedures and implants were used. Gait analysis, including temporal distance parameters, kinetics, and kinematics, was conducted at 6 weeks, 3 months, and 18 months. Results: Thirty-four patients (16 lateral, 18 anterior) participated, with comparable demographics. At 6 weeks, the anterior approach group had significantly higher Harris hip scores, improved gait speed, greater hip extension and external rotation moments, higher peak hip abduction angle, and reduced peak hip extension angle. The lateral approach (LA) group showed decreased hip abduction and internal rotation moments. By 3 and 18 months, outcomes were similar between groups. Conclusion: The anterior approach facilitates faster rehabilitation at 6 weeks, but outcomes converge with the LA by 3 and 18 months postoperatively.

Effects of Sitting Baduanjin Exercises on Cognitive Function, Attention, and Muscle Strength among Patients with Mild Cognitive Impairment

ABSTRACT Purpose Sitting Baduanjin exercises can be effective in treating mild cognitive impairment (MCI). However, evidence on effectiveness of sitting Baduanjin exercises is lacking. This study investigated the effects of sitting Baduanjin exercises on cognitive function, attention, and muscle strength in patients with MCI. Design Quasi-experimental. Methods The participants were assigned to the experimental (n = 12) or comparison group (n = 12). The experimental group performed sitting Baduanjin exercises three times weekly for 40–50 minutes per session for 12 weeks, while the comparison group maintained their usual routine and attended health-related education. The two groups’ cognitive function and attention were assessed through a questionnaire and their muscle strength was measured at weeks 0, 9, and 13. Findings The experimental group showed significant improvements in cognitive function, attention, and muscle strength in the right shoulder anterior flexor; however, the left shoulder anterior flexor group showed no obvious improvements. Conclusion Sitting Baduanjin exercises feature simple actions, are convenient, and have positive effects on improving cognitive function, attention, and muscle strength in patients with MCI. Clinical evidence Baduanjin exercises are suitable for long-term community frontline care services. Early intervention with this exercise program may prevent healthy older people or those with health issues from progressing to dementia.

Iliac Periosteal Bone Autografting vs Talus Non-Weight-Bearing Surgery in Hepple V Talus Osteochondral Injuries: Comparative Analysis of Perioperative Outcomes.

BACKGROUND Hepple stage V osteochondral injuries of the talus include subchondral cyst formation, secondary degenerative change, and secondary osteoarthritis. This retrospective study aimed to compare perioperative outcomes from iliac periosteal bone autografting and talus non-weight-bearing surgery in 162 patients with Hepple V osteochondral injuries of the talus. MATERIAL AND METHODS According to the inclusion criteria, 162 eligible patients were selected for analysis and divided into an iliac periosteal bone autograft group (n=82) and a talus non-weight-bearing group (n=80) according to the surgical methods. General data and data on perioperative conditions, complications, intraoperative fluoroscopy times, preoperative and postoperative visual analog scale (VAS) for pain, ankle-hindfoot scoring system (AOFAS Ankle-Hindfoot Scale), and plantar flexion and extension range of motion were collected to assess ankle joint function and were compared between groups. RESULTS The comparison of perioperative results between the 2 groups showed that the incision length (P=0.000), operation time (P=0.000), and length of hospital stay (P=0.000) in the iliac periosteal bone autograft group were longer than those in the talus non-weight-bearing group. The intraoperative blood loss in the anterior group was greater than that in non-weight-bearing group (P=0.000). Regarding complications, there were more cases of donor site paresthesia (P=0.014) and postoperative pain aggravation in the iliac periosteal bone autograft group than in the non-weight-bearing group. CONCLUSIONS In patients with Hepple V osteochondral injury of the talus, the incision length, operation time, and length of hospital stay in the talus non-weight-bearing group were shorter, there was less intraoperative blood loss, and there were fewer postoperative complications. In the short term, bone transplantation in the talus non-weight-bearing group was more "minimally invasive" and the postoperative recovery was better than in the iliac periosteal bone allograft group.

Match workload and international travel associated with (ACL) injuries in professional women's football.

Women's football has grown in popularity, competitiveness and professionalism, increasing the demands placed on players and their injury risk. This study aimed to identify differences in the match workload and international travel between injured and non-injured professional women's footballers. The study was conducted as an observational, retrospective, case-control study over two football seasons (2021/2022 and 2022/2023) in four top-tier European women's football leagues. Fifty-eight professional women football players (81 injuries) formed the injury group and were matched with 81 elite women football players (162 non-injuries), from the same league, to form the control group. For each injury, cumulative match workload (minutes played, appearances, days between matches, rest) and international travel (distances, time, time zones crossed) were calculated over a 28-day period preceding the injury, for both the injured players and matched controls. The injured group had a higher number of instances of less than 5days between matches compared to the controls (p=0.03, effect size=0.3, small). The anterior cruciate ligament injury group made more appearances (p=0.09, effect size=0.8, moderate), had more instances of less than 5days between matches (p=0.09, effect size=0.8, moderate) and had less rest time (p=0.12, effect size=0.8, moderate) than the control group. No meaningful differences were observed between the hamstring injury group and the control group. These findings underscore the importance of careful consideration when developing match fixture schedules in elite women's football, particularly concerning the number of matches scheduled in a short period. Strategies to increase rest and recovery are recommended to safeguard players against injuries.

Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty

AbstractPurposeThis study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre‐ and postoperative knee kinematics in total knee arthroplasty (TKA).MethodsThe intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.ResultsThe mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (p = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP &gt; 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP &lt; 0.54).ConclusionPreoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.Level of EvidenceLevel Ⅲ.

Morphofunctional evaluation of great saphenous vein's tributaries after thermoablation: A case series

ObjectiveThis study evaluates hemodynamic and anatomic changes in great saphenous vein (GSV) tributaries after endovenous laser ablation (EVLA). MethodsThis case series analyzed 112 areas in 28 lower limbs of 25 patients who underwent EVLA from April 2022 to June 2023 at the Hospital das Clínicas de Pernambuco/UFPE. All patients were evaluated by Doppler ultrasound preoperatively and 3 months after the surgical treatment. The parameters studied were GSV diameter and patency, GSV tributary diameter, patency and flow direction, and the Venous Clinical Severity Score after EVLA. The GSV characteristics were evaluated in four regions: saphenous-femoral junction, medium thigh, knee, and medium leg. The tributary veins were grouped in four areas: anterior thigh, posterior thigh, anterior leg, and posterior leg. ResultsThe results included 28 lower limbs from 23 patients; 18 patients (67.9%) were women, and the average age was 49 years; 2 patients were lost to follow-up. Ninety days after EVLA, all treated GSVs were occluded. The average diameter of GSV decreased in all four regions studied: saphenous-femoral junction, medium thigh, knee, and medium leg (P ≤ .001). We analyzed 101 GSV tributaries. In the analysis of GSV tributaries by area, we identified a mean diameter decrease in all groups of tributaries (P < .001). Considering the tributaries with reflux, we also identified a reduction in the number of tributaries with reflux in all four groups (P ≤ .001). All tributaries were patent preoperatively; at 3 months after the surgical treatment, GSV tributaries occlusion was infrequent, except for the anterior thigh group. There was a decrease from 9 to 5 points in Venous Clinical Severity Score after EVLA (P < .001). ConclusionsThis study demonstrated that, after GSV laser ablation, there was a statistically significant decrease in the diameters of all tributary groups, and the number of tributaries with decreased reflux; however, the occlusion of tributaries was not a frequent finding.

Comparison of Biomechanical, Clinical Indicators, and Quality of Life in People Undergoing Hip Replacement Surgery with Anterior and Posterior Approaches

Background: There are ongoing debates among surgeons regarding the most effective surgical method for hip replacement, with varying preferences for the anterior and posterior approaches. Both methods have demonstrated excellent long-term outcomes, with clinical differences primarily observed in the early postoperative period. Objectives: This study aimed to compare the anterior and posterior methods of hip replacement after six months of surgery in terms of biomechanical and clinical indicators, as well as quality of life. Methods: In this cross-sectional observational study, 42 patients who underwent hip replacement surgery using either the anterior (n = 22) or posterior method (n = 20) at least six months (and a maximum of 12 months) post-surgery, along with 20 healthy individuals, were evaluated. Biomechanical indices of the center of pressure (COP) were measured using a force plate during two-leg standing with eyes open and closed. Functional balance, independence, self-perception of performance, satisfaction, and quality of life were assessed using the timed up and go test (TUG), Barthel Index, Canadian Occupational Performance Measure (COPM), and the SF-36, respectively. Results: No significant differences were found between the anterior and posterior groups in terms of COP, clinical variables, and quality of life (P &gt; 0.05). However, when compared to the control group, the anterior replacement group exhibited significantly higher COP displacement in the medial-lateral direction (P = 0.03) and COP velocity in the anterior-posterior direction (P = 0.02) during two-leg standing with eyes open. No significant differences in COP variables were observed in the posterior replacement group compared to the control group (P &gt; 0.05). Conclusions: The findings indicate no significant differences between the anterior and posterior approaches to hip replacement in terms of biomechanical and clinical indicators, as well as quality of life after six months. Therefore, the choice of surgical method can be based on the patient's condition and the surgeon’s expertise in the respective approach.

Comparing One-Year Survival in Anterior Versus Inferior ST-Elevation Myocardial Infarction Patients: Results of a Cohort Study in Western Iran

Background: The site of acute myocardial infarction (MI) plays a pivotal role in determining the prognosis and risk assessment for patients experiencing their first ST-segment elevation MI (STEMI). Objectives: This study aims to compare one-year survival rates in patients with anterior versus inferior ST-elevation myocardial infarction. Methods: This registry-based cohort study was conducted from July 2018 to December 2019, examining data from STEMI patients. A total of 643 patients diagnosed with STEMI who met the inclusion criteria were enrolled. Patients were categorized based on the location of their myocardial infarction (MI) into two groups: Those with anterior MI and those with inferior MI. Their progress was meticulously followed over the course of one year. For data analysis, Cox proportional hazards models were used to calculate two sets of hazard ratio estimates: The initial unadjusted (crude) hazard ratios and the fully adjusted hazard ratios, which accounted for potential confounding factors. Along with these hazard ratio estimates, their corresponding 95% confidence intervals (HR, 95% CI) were obtained. All statistical analyses were performed using R software version 4.2.1. Results: Throughout the follow-up period, totaling 598 patients and 4,109 person-days, only 7 patients (1.09%) were lost to follow-up. The analysis revealed no significant difference in one-year mortality rates between the inferior and anterior STEMI groups, with rates of 37 (8.39%) versus 15 (7.69%), respectively, yielding a P-value of 0.767. However, it is noteworthy that the mortality risk trended higher in the inferior MI group, with a hazard ratio of 1.093 (95% CI: 0.60 - 1.99). Conclusions: In conclusion, our study highlights the heightened mortality risk associated with inferior wall MI. These results underscore the prognostic value of MI location, shedding light on its potential role in predicting the severity and extent of infarction, thereby guiding clinical decision-making and risk management strategies in STEMI patients.

Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament in patients undergoing laparoscopic radical gastrectomy: A randomised controlled study

Objective: Ultrasound-guided bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament has recently been proposed as an effective analgesia for abdominal surgery. To test the hypothesis that this novel technique was a viable alternative approach of conventional thoracic epidural analgesia for laparoscopic radical gastrectomy. Methods: Three hundred patients scheduled for laparoscopic radical gastrectomy were randomised 1:1 into the anterior quadratus lumborum block group: receiving the novel regional analgesia, and the thoracic epidural analgesia group: receiving thoracic epidural anaesthesia. The primary endpoint was intraoperative consumption of propofol and remifentanil. Intention-to-treat analysis was performed for all variables. Results: At five and ten minutes after block, anterior quadratus lumborum block group achieved more dermatomes coverage of the sensory block with both p &lt; 0.001. Intraoperative consumption of propofol and remifentanil was comparable between two groups (1116.21 ± 199.76 versus 1166.45 ± 125.31µg, p = 0.245 and remifentanil 1.83 ± 0.41 versus 1.81 ± 0.37ng, p = 0.988). However, anterior quadratus lumborum block group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal and out-of-bed activity than the thoracic epidural anaesthesia group. No significant difference in extubation time, pain scores at rest and exercising at all time points following surgery was observed between the two groups. Conclusions: Compared with conventional thoracic epidural anaesthesia, the novel technique was an equivalent effective component of multimodal analgesic protocol for laparoscopic radical gastrectomy. There were some advantages, including shorter procedure time, more reliable dermatomal coverage, shorter duration of urinary catheterisation and earlier time of out-of-bed activity to enhance recovery after surgery. Trial registration: The study was registered in the Chinese Clinical Trial Registry on 2 November 2022 (ChiCTR2200065325).

Risk factors for transient ciliochoroidal detachment after goniotomy with the Kahook Dual Blade

To investigate ciliochoroidal detachment (CCD) frequency and risk factors after performing goniotomy with the Kahook Dual Blade (KDB). The presence of CCD was examined using anterior-segment optical coherence tomography at postoperative day (POD) 1, month 1, and month 2 in 91 eyes of patients who underwent goniotomy with KDB. Intraocular pressure (IOP) was also measured at POD 1, POD 7, month 1 and month 2. A generalized linear mixed model analysis was used to compare the age, gender, axial length, central corneal thickness, surgical procedure (combined or single), operators (K.H. or H.O.), glaucoma type and preoperative IOP between the groups. Factors were selected from the variants when there was a probability value of less than 0.05. CCD was detected in 18 eyes (19.7%) at POD 1. For postoperative IOP, no significant differences were observed between the CCD and non-CCD groups. However, the IOP on POD 1 in the CCD that was associated with the anterior chamber group (7.7 ± 3.0 mmHg) was significantly lower than that in the non-CCD group (15.3 ± 0.9 mmHg) (P = 0.02). Mixed-effects model analysis demonstrated that the surgical procedure (combined) and operator (H.O.) were significantly associated with the higher incidence of CCD. Approximately one-fifth of all eyes exhibited CCD after goniotomy with KDB. Combining cataract surgery and goniotomy with KDB and the intraoperative procedure during the goniotomy with KDB were all found to be risk factors for developing CCD.

Effects of Serratus Anterior Plane Block on Early Recovery from Thoracoscopic Lung Resection: A Randomized, Blinded, Placebo-controlled Trial.

The efficacy of serratus anterior plane block for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of serratus anterior plane block on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection. Patients undergoing minimally invasive anatomic lung resection at a single center were randomized to undergo serratus anterior plane block with 40 ml injectate containing bupivacaine 0.25%, clonidine 100 μg, and dexamethasone 4 mg (serratus anterior plane block group) or sham block with 40 ml normal saline (placebo group) at the conclusion of surgery. The primary outcome was cumulative intravenous morphine equivalents during the first 24 h postoperatively. Secondary outcomes were intravenous morphine equivalents, pain scores at rest and with cough, inspiratory volume on incentive spirometry, incidence of nausea or vomiting during the first 48 h postoperatively, Quality of Recovery-15 score on postoperative day 7, and length of stay. Using the protocol-specified intention-to-treat analysis, the median (interquartile range) intravenous morphine equivalents was 10.6 (5.0 to 27.1) mg in serratus anterior plane block patients (n = 46) versus 18.8 (9.9 to 29.6) mg in placebo patients (n = 46; 32% reduction; ratio, 0.68 [95% CI, 0.44 to 1.06]; P = 0.085). Of the secondary outcomes, only the composite pain with cough scores differed significantly in the serratus anterior plane block group by a coefficient of -0.41 (95% CI, -0.81 to -0.01; P = 0.044). A sensitivity as-treated analysis reported median (interquartile range) intravenous morphine equivalents of 10.0 (5.0 to 27.2) mg in serratus anterior plane block patients (n = 44) versus 19.9 (10.4 to 29.0) mg in placebo patients (n = 48; 36% reduction; ratio, 0.64 [95% CI, 0.41 to 1.00]; P = 0.048). The protocol-specified intention-to-treat analysis demonstrated that serratus anterior plane block did not result in a significant reduction in opioid consumption when added to a multimodal analgesic regimen after thoracoscopic anatomic lung resection. The sensitivity as-treated analysis showed a significant and modest clinical reduction in the primary outcome that warrants further investigation.

Relationship of different left bundle branch pacing sites and clinical outcomes in patients with heart failure

BackgroundLeft bundle branch pacing (LBBP) is a novel physiological pacing modality. However, whether it delivers comparable efficacy with different capture sites in patients with heart failure remains unclear. ObjectiveThis study aimed to assess the association between different pacing sites and the response of LBBP. MethodsForty-three consecutive patients with heart failure, referred for successful LBBP implantation, were prospectively recruited in this study. Patients were assigned to 3 subgroups according to the paced QRS complex morphology (left bundle branch trunk pacing [LBTP], left posterior fascicular pacing, or left anterior fascicular pacing groups). Echocardiograms and electrocardiograms were recorded and analyzed at baseline and 6-month follow-up. ResultsThe response rate was 95.0%, 88.2%, and 83.3% in LBTP, left posterior fascicular pacing, and left anterior fascicular pacing groups, respectively. All subgroups were efficient in narrowing the QRS complex (QRS complex narrowing: 38.1 ± 10.8 ms, 36.4 ± 12.6 ms, and 40.8 ± 10.8 ms) and improving cardiac function (LVEF improvement： 25.7% ± 8.1%, 15.3% ± 8.1%, and 18.8% ± 4.4%). Compared with left fascicular pacing, LBTP resulted in longer peak left ventricular activation time (76.5 ± 10.2 ms vs 82.3 ± 6.5 ms; P = .037) and shorter duration from intrinsicoid deflection in V1 or V2 to QRS end (128.0 ± 6.0 ms vs 113.3 ± 5.2 ms; P＜.0001), along with better improvement in septal systolic longitudinal strain (P = .007) and lateral-septal myocardial loading inhomogeneity (P = .036). Linear regression analysis further revealed that left bundle branch capture sites were strongly associated with the improvement in peak strain dispersion (model R2 = 0.586; P = .042) and LVEF (model R2 = 0.425; P < .0001). ConclusionDifferent left bundle branch capture sites led to a subtle difference in mechanical synchrony, which may, in turn, affect LVEF improvement in patients with heart failure.

Arthroscopic Bankart repair using a single anterior working portal technique: a systematic review and meta-analysis.

To evaluate the efficacy and outcomes of arthroscopic Bankart repair using a single anterior working portal and determine whether they are comparable to the standard two-portal technique. A search following PRISMA guidelines was performed in July 2024 in the PubMed, Embase, Scopus, and Cochrane Library databases. Studies evaluating outcomes of patients undergoing arthroscopic Bankart repair using a single anterior portal technique were included. A meta-analysis comparing outcomes was performed using a random-effects model. A P-value < 0.05 was considered statistically significant. Seven studies in patients undergoing Bankart repair with a single anterior portal were included (311 patients, 84.6% male, mean age 27.8 years, mean follow-up 37.4 months). Five of seven studies compared outcomes of a single anterior portal versus the standard two-portal technique. The duration of surgery was significantly shorter in the single anterior portal group (P < 0.00001). The postoperative Oxford Instability Score (P = 0.84), Rowe score (P = 0.26), American Shoulder and Elbow Surgeons score (P = 0.73), Constant-Murley score (P = 0.92), and Visual Analog Scale Pain score (P = 0.07) were similar between both groups. The postoperative degree of shoulder abduction (P = 0.84) and external rotation (P = 0.64) were similar between both groups. The risk of redislocation (P = 0.98) was similar between both groups. Patients undergoing arthroscopic Bankart repair with a single anterior portal had significantly lower operative times and comparable PROs, ROM, and risk of redislocation relative to patients undergoing repair with a standard two-portal technique.

Proximally positioned femoral grafts decrease passive anterior tibial subluxation in anterior cruciate ligament reconstruction using a posterior trans-septal portal.

To compare the anterior and posterior trans-septal (TS) portal approaches in anterior cruciate ligament reconstruction (ACLR) by evaluating femoral tunnel positioning and passive anterior tibial subluxation (PATS). A total of 205 patients who underwent primary ACLR using the outside-in technique between March 2018 and December 2021 were retrospectively enrolled. Patients were classified into two groups based on the viewing techniques: the anterior group was treated using anteromedial or anterolateral portals (n = 155), and the TS group was treated using posterior TS portal (n = 55). The relative locations of the femoral tunnel were evaluated using the deep-shallow planes (X-axis) and superior-inferior planes (Y-axis) with the quadrant method in the lateral femoral condyle on a 3-dimensional computed tomography image. Anterior tibial subluxation for the lateral and medial compartments relative to the femoral condyles was evaluated as measured on magnetic resonance imaging. Knee laxity was assessed using the pivot-shift test and stress radiography. In the posterior TS group, the femoral tunnel was usually located deeper on the X-axis and more superior on the Y-axis, which corresponds to a more proximal position, than in the anterior group (deeper on the X-axis and superior on the Y-axis). Moreover, the femoral tunnel locations in this group were more compactly distributed than those in the anterior group. The TS group showed significantly better reduction of postoperative PATS in the lateral compartments than the anterior group (anterior group vs. TS group: lateral compartment, 3.2 ± 3.1 vs. 4.5 ± 3.2mm; p = .016). Significantly better results were found in the TS group for knee stability as assessed by the pivot-shift grade (p = .044); however, there were no significant differences between the two groups with respect to patient-reported outcome measures (p > .05) and other complications (p = .090). Our results suggest that positioning the femoral tunnel using the posterior TS portal approach may lead to better outcomes in terms of PATS and rotational stability compared to the anterior portal approach in ACLR.