Assisted Procedures Research Articles

FP4.13 - Intravenous morphine negatively affects length of stay following minimally invasive colorectal surgery

Abstract Aim Investigate the impact of intravenous (IV) morphine administered as patient controlled analgesia (PCA) following minimally invasive colorectal resections. Method Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre. Results Our cohort included 38 colorectal resections completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform and 57 consecutive laparoscopic colorectal resections. 7 patients were excluded due to incomplete data. 51/88 (57.9%) of patients underwent a left sided resection and 24/88 (27.3%) had a stoma formed. We observed a median IV morphine dose of 15.5mg (IQR 15.5-43.5mg) and we sub-divided the cohort into those who received >15 mg of IV morphine and <15mg of morphine via PCA. Patients who received <15mg IV morphine were older (median age 75 Vs 67 years; p<0.001). There was no statistical difference in the body mass index, ASA grade, total operative time, or type of minimally invasive resection. The median length of stay was 4 days for the <15mg IV Morphine cases compared to 5 in the >15mg IV Morphine group (p<0.001). As expected, there was a quicker time to first flatus in the <15mg IV Morphine group (median 2 days Vs 3 days; p<0.001) and a shorter time to opening bowels (median 3 days Vs 4 days; p=0.003). There was no statistically significant difference in post-operative complications between the two groups. Conclusions Reducing postoperative IV Morphine dosing following minimally invasive colorectal resections may lead to prompter recovery.

SP8.2 - Single centre experience in establishing a robotic colorectal surgery programme in a UK district hospital

Abstract Aim To describe our centre’s experience in establishing a robotic programme for colorectal surgery procedures. Method Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre. Results 38 colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform between April-December 2023. These were compared to a laparoscopic cohort of 57 consecutive colorectal resections. 37% (n=14) of the robotic cases were proctored and all were resections for malignancy. There were 57.9% (n=22) males in the robotic cohort and 50.9% (n=28) in the laparoscopic cohort. There was no statistical difference between the demographics of the two cohorts in terms of age, body mass index and ASA grade. 21/38 (55.3%) robotic resections were left sided compared to 35/57 (61.4%) laparoscopic resections. No robotic cases were converted to open or laparoscopy, but 8.8% (n=5) of laparoscopic cases were converted to open. Laparoscopic procedures were shorter (median operative time 277 min compared to 412 min, p<0.001). A stoma was formed in 13/38 (34.2%) robotic cases and 16/57 (28.1%) laparoscopic cases. All bowel anastomoses performed in the robotic cohort were stapled with 16/32 (50.0%) being intra-corporeal. The median length of stay was 5 days for both cohorts. 5.3% (n=2/38) Vs 12.3% (n=7/57) had a significant post-operative complication (Clavien-Dindo ³3). No mortalities were recorded within 90 days of the procedures. Conclusions Other than longer operative times, robotic colorectal resections in a district hospital setting is comparable to laparoscopic resections.

A case series on robotic total knee arthroplasty among patient with tri compartmental osteoarthritis knee with various deformities

Robotic assisted procedures with trauma products offering comprehensive approach to orthopedic care. With this advanced surgical solutions an N number of orthopedic cases are operated which shown a speedy recovery than traditional method of Surgical intervention. This case series report explains about observation for the speedy recovery rate who opted for robotic total knee arthroplasty diagnosed with Tri Compartmental osteoarthritis knee with varus deformity in Preethi Hospitals at Madurai. This case series may explain about history, physical findings, techniques used and advantages of orthopedic Robotic surgery.

An analytical method using salting-out assisted liquid-liquid extraction to quantify ceftriaxone from micro volumes of human serum.

Ceftriaxone (CTRX) is a commonly used cephalosporin antibiotic. It is suggested that monitoring plasma/serum concentrations is helpful for its safe use. This study aimed to develop and validate an analytical method for measuring CTRX concentrations in human serum according to International Conference on Harmonization guideline M10. Ten microliters of serum sample was purified using a salting-out assisted liquid-liquid extraction procedure with magnesium sulfate. The upper layer was then diluted threefold and analyzed using a liquid chromatography-tandem mass spectrometry-based method with a total run time of 12 min. The linear calibration curve was obtained over the concentration range 5-500 μg/ml. The within-run accuracy varied from 0.2 to 6.5%, and the precision was ≤8.0%. The between-run accuracy and precision ranged from 0.7% to 5.6% and ≤6.4%, respectively. Significant carryover was resolved by injecting four blanks after high-concentration CTRX samples. The recovery rates from spiked serum at low and high concentrations were 44.4 and 43.4%, respectively. Other factors, including selectivity, matrix effects, stability, dilution integrity and reinjection reproducibility also met the acceptance criteria. Serum concentrations in 14 samples obtained from two participants receiving 2 g/day of CTRX were successfully determined using this method.

Does Gonadotropin-Releasing Hormone Agonist Administration Before Assisted Reproduction Techniques Improve Pregnancy Rates in Women With Endometriosis?

Axial downregulation with a 3- to 6-month administration of gonadotropin-releasing hormone agonists (GnRH-a) prior to assisted reproduction techniques has been proposed in order to improve clinical pregnancy rates in women with endometriosis. Although reduced inflammation, improved oocyte quality, and restored endometrial receptivity have been postulated, further investigation of their actual benefit and mechanism of action is considered essential. In that direction, well-designed clinical trials regarding the role of GnRH-a in IVF are necessary. The purpose of this review is to clarify whether GnRH-a administration prior to IVF-FET procedures improves pregnancy rates in women with endometriosis. A literature review was conducted in MEDLINE (PubMed), Cochrane, and Google Scholar and concluded on September 10, 2022. Two Cochrane meta-analyses and 16 selected studies present various interesting data of assisted reproduction technique procedures on patients with endometriosis-related infertility with or without depot GnRH-a pretreatment. The regimen may have a positive clinical effect on cases of severe endometriosis (American Society for Reproductive Medicine stages III-IV), but their use is not routinely recommended in order to improve pregnancy rates. Endometriosis and infertility are closely related through various pathogenetic mechanisms. Endometriosis has been traditionally considered to negatively affect fundamental aspects of the in vitro fertilization-frozen embryo transfer procedure. Numerous interventions, both medical and surgical, have been proposed in order to improve IVF success rates, and the optimal management of these cases poses an ever pressing challenge.

Optimization of deep eutectic solvent based ultrasonic assisted microextraction for determination of zearalenone residues in foods

A sensitive and simple ultrasonic assisted microextraction procedure based on the use of green deep eutectic solvents (DESs) was designed for the extraction of zearalenone (ZEN) residues in grains, foods and milks. Optimization of key parameters and experimental modelling were achieved by Box-Behnken design (BBD) based on surface response methodology. DES-UA-ME procedure was based on the extraction of ZEN molecules into DES prepared from a mixture of phenyl acetic acid and trimethyl glycine in a 2:1 molar ratio at pH 3.8 under ultrasonication for 11 min at 33 °C. After the phase separation step, the DES-rich phase containing ZEN was placed in an UV-Vis spectrophotometer for quantitative analysis of ZEN at 260 nm. The analytical merits of the DES-UA-ME procedure were investigated using optimum conditions for both standard calibration solutions (SCS) and matrix-matched calibration solutions (MMCS). Linearity for the SCS and MMCS was 3–800 ng mL−1 (r2:0.995) and 5–450 ng mL−1 (r2:0.992), respectively. The limit of detection (LOD) and limit of quantification (LOQ) for SCS were 0.9 ng mL−1 and 3 ng mL−1, respectively, while the LOD and LOQ for MMCs were 1.6 ng mL−1 and 5 ng mL−1, respectively. Enrichment factors for SCS and MMCS was 157 and 139 for, respectively. Validation of the DES-UA-ME procedure was tested by analysis of two certified reference materials containing ZEN. There was no significant difference between the measured amounts and the reference amounts. In the final stage, the DES-UA-ME procedure was applied to selected samples separately for both SCS and MMCS.

Enhanced external counterpulsation treatment improves multi-organ hemodynamics for postoperative liver transplantation patient. A case report

IntroductionPost liver transplantation (LT) patients endure high morbidity rate of multi-organ ischemic symptoms following reperfusion. We hypothesize that enhanced external counterpulsation (EECP) as a typical non-invasive assisted circulation procedure, which can efficiently inhibit the relative ischemic symptoms via the systemic improvement of hemodynamics.Case presentationA 51-year-old male patient, 76 kg, 172 cm, received orthotopic LT surgery for viral hepatitis B induced acute-on-chronic liver failure hepatic failure. His medical records revealed ischemic symptoms in multi-organ at the time of hospital discharge, including headache, refractory insomnia, abdominal paralysis, and lower limb pain. The EECP treatment was introduced for assisted rehabilitation and to improve the postoperative quality of life. Doppler Ultrasound examination showed significant augmentation of blood flow volume in the carotid arteries, the hepatic artery, the portal vein and the femoral artery during EECP intervention. A standard 35-hour EECP treatment led to significant improvement in quality of life, e.g. sleep quality and walking ability.ConclusionWe report a case of multi-organ ischemic symptoms in a post LT patient. EECP treatment can significantly improve the quality of life via the systematic promotion of hemodynamics.

Temporal and institutional trends in robotic surgery.

Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (-47%), esophageal (-17%), small and large intestinal (-16%), and hepatic (-7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (-10%), gastric (-12%), intestinal (-11%), hepatic (-17%), biliary (-10%), pancreatic (-11%) and hernia procedures (-14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (-4% and -22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions.

Accurate placement of thoracolumbar pedicle screws using a handheld iOS-based navigation device: a prospective intra-patient agreement study

BACKGROUNDAccurate pedicle screw placement is a challenge with reported misplacement rates of 10% and higher. A handheld navigation device (HND) may provide accuracy equal to CT-based navigation (CT-Nav) but without the cost and complexity. OBJECTIVETo study the accuracy of a handheld navigation device for pedicle screw placement. STUDY DESIGNThis prospective cross-sectional study with consistently applied reference standard enrolled 20 patients undergoing 92 pedicle screw placements. PATIENTSPatients who underwent pedicle screw placement between May 2022 and September 2022. OUTCOME MEASURESPedicle screw placement accuracy per Gertzbein–Robbins. METHODSOnce the screw pilot hole was established, the proposed trajectory of the HND was compared with that proposed by CT-Nav. Postoperatively, screw accuracy was graded according to Gertzbein–Robbins by a blinded radiologist based on CT scans. Accuracy was compared between the two systems and published control for fluoroscopy assisted and CT-Nav placement using Bayesian posterior distribution. RESULTSThe trajectory proposed by the HND and CT-Nav were in agreement in 98.9% (95% Exact CI; 94.09%–99.97%). The HND accuracy was 98.9% with 91 screws rated “A” and 1 rated “C”. Noninferiority to fluoroscopic placement was achieved because the one-sided normal-approximation 95% CI Lower Bound (LB) of 95.3% is greater than the Performance Goal (PG) of 83.4%. Posthoc analysis demonstrated that the probability of superiority of the HND relative to the historical accuracy rate of 91.5% for fluoroscopy assisted procedures is >0.999 and that the HND's accuracy rate is within 4.5% of CT-Nav of 95.5% is >0.999. No adverse events or intra-operative complications associated with HND were observed. There was 1 (1.1%) intra-operative repositioning and no reoperations for any reason. CONCLUSIONSThe accuracy rate of the HND was 98.9%, and the proposed trajectory matched with CT-Nav in 98.9% of the time. This is superior to the historical published accuracy rate for fluoroscopy-assisted procedures and equivalent to the historical published accuracy rate for CT-Nav. Clinical Trial Registration NumberDutch trial register NL74268.058.20.

Mild and deep hypothermia differentially affect cerebral neuroinflammatory and cold shock response following cardiopulmonary bypass in rat

IntroductionTargeted temperature management (TTM) is considered to be a neuroprotective strategy during cardiopulmonary bypass (CPB) assisted procedures, possibly through the activation of cold shock proteins. We therefore investigated the effects of mild compared with deep hypothermia on the neuroinflammatory response and cold shock protein expression after CPB in rats. MethodsWistar rats were subjected to 1 hr of mild (33 °C) or deep (18 °C) hypothermia during CPB or sham procedure. PET scan analyses using TSPO ligand [11C]PBR28 were performed on day 1 (short-term) or day 3 and 7 post-procedure (long-term) to assess neuroinflammation. Hippocampal and cortical samples were obtained at day 1 in the short-term group and at day 7 in the long-term group. mRNA expression of M1 and M2 microglia associated cytokines was analysed with RT-PCR. Cold shock protein RNA-binding motive 3 (RBM3) and tyrosine receptor kinase B (TrkB) receptor protein expression were determined with Western Blot and quantified. ResultsIn both groups target temperature was reached within an hour. Standard uptake values (SUV) of [11C]PBR28 in CPB rats at 1 day and 3 days were similar to that of sham animals. At 7 days after CPB the SUV was significantly higher in amygdala and hippocampal regions of the CPB 18 °C group as compared to the CPB 33 °C group. No differences were observed in the expression of M1 and M2 microglia-related cytokines between TTM 18 °C and 33 °C. RBM3 protein levels in cortex and hippocampus were significantly higher in CPB 33 °C compared to CPB 18 °C and sham 33 °C, at day 1 and day 7, respectively. ConclusionsTTM at 18 °C increased the neuroinflammatory response in amygdala and hippocampus compared to TTM at 33 °C in rats undergoing a CPB procedure. Additionally, TTM at 33 °C induced increased expression of TrkB and RBM3 in cortex and hippocampus of rats on CPB compared to TTM at 18 °C. Together, these data indicate that neuroinflammation is alleviated by TTM at 33 °C, possibly by recruiting protective mechanisms through cold shock protein induction.

O147: Use of the National Consultant Information Programme to evaluate surgical practice in England for rectal prolapse repair, identifying points of variation for improvement and the impact of the Covid-19 pandemic

Abstract Introduction Using the National Consultant Information Programme (NCIP) tool to extract and analyse data surrounding rectal prolapse repair procedures, to identify key trends and variation. Analysing data across a 4-year period to evaluate how the Covid-19 pandemic impacted current surgical practice. Methods NCIP compiles hospital episode statistics data gathered by NHS analysts. Data is categorised by key metrics including length of stay (LOS), procedure approach, deprivation score and pseudonymised provider. Data is for elective procedures in patients 17+ and has been contextualised by recent available literature. Results Of the 6702 procedures, 65.8% (4413) were carried out in the first time period, 1st April 2018 to 31st March 2020. Abdominal prolapse repair increased from 37.0% of procedures in the first 2 years, to 42.4% in the second period (1st April 2020 to 31st March 2022). Perineal approach decreased from 45.6% of procedures to 41.1% in the second period. 87.7% of patients were female. Most procedures were open (77.7%). Average LOS was 2.5 days and was highest in laparoscopic assisted procedures (5.38), 2.33 in open procedures. From 141 providers, the top 15 did 100-218 procedures each across the 4 years. 24 providers performed 15 or less, while 5 performed only 1 repair. Mortality within 90 days was 0.81% in the first data period and increased to 1.1% in the second. Conclusion Data suggests an impact on procedure numbers due to Covid-19, but not on approach type. Significant observed variation between provider approach and procedure count invites further research into reasons behind this.

First Case of Medically Assisted Suicide in Italy Set New Legal Perspectives.

The first act of assisted suicide in Italy was recently carried out. This event is an absolute novelty for the country, affected by recent legislative changes aimed only at introducing the right to interrupt health treatments and, therefore, carry out exclusively omissive end-of-life acts. These normative provisions lay their foundations in a cultural context centered on the protection of the right to life and health; however, the cases that have occurred over time, including the famous story of DJ Fabo, have led the Constitutional Court to re-evaluate these dictates, introducing in 2019 the right to resort to assisted suicide procedures within well-defined areas, including incurability of the condition, the serious suffering of the individual and the retained ability to stand trial. The case addressed concerns a quadriplegic subject who was the victim of a road accident. Following consultation with a specialized institution, the subject made the decision to undergo an assisted sui-cide procedure in Italy. Having obtained the authorization from the competent authorities, he started a fundraiser to finance the devices and drugs required and, finally, he died. The opening by Italy towards the assisted suicide procedure represents a great step towards a broad context, as well as a decisive act for the purpose of protecting the right to self-determination of the individual. However, the current legislative framework presents significant criticalities and shortcomings. In first place, the dissonance between the laws in force and the judicial sentences is likely to generate problems of uneven application of the rules in a country dominated by the principle of Civil Law. Furthermore, the need for the applicant to fully self-finance the procedure clearly clashes with the constitutional principle of free access to care. Then emerges the need for a guideline document regarding the completion of the procedure itself, the times, methods and drugs implied, in order to significantly reduce the decision-making process by the ethics committees that still weighs on each individual case. Finally, conside-ring what has been observed on the subject of voluntary termination of pregnancy, it is necessary to ask what will be the general orientation of the doctors called to perform the act and whether they will be given the opportunity to express their refusal. The case analyzed could represent the beginning of a new era for Italian culture, but the large-scale application of assisted suicide procedures requires the introduction of legislative provisions that definitively eliminate the critical issues that have emerged so far.

A high-throughput, straightforward procedure for biomonitoring organomercury species in human hair

Mercury is a pervasive and concerning pollutant due to its toxicity, mobility, and tendency to biomagnify in aquatic and terrestrial ecosystems. Speciation analysis is crucial to assess exposure and risks associated with mercury, as different mercury species exhibit varying properties and toxicities. This study aimed at developing a selective detection method for organic mercury species in a non-invasive biomonitoring matrix like human hair. The method is based on frontal chromatography (FC) in combination with inductively coupled plasma mass spectrometry (ICP-MS), using a low pressure, homemade, anion exchange column inserted in a standard ICP-MS introduction system, without requiring high-performance liquid chromatography (HPLC) hyphenation. In addition to the extreme simplification and cost reduction of the chromatographic equipment, the proposed protocol involves a fast, streamlined and fully integrated sample preparation process (in contrast to existing methods): the optimized procedure features a 15-min ultrasonic assisted extraction procedure and 5 min analysis time. Consequently, up to 100 samples could be analyzed daily, making the method highly productive and suitable for large-scale screening programs in public and environmental health. Moreover, the optimized procedure enables a limit of detection (LOD) of 5.5 μg/kg for a 10 mg hair microsample. All these features undeniably demonstrate a significant advancement in routine biomonitoring practices. To provide additional evidence, the method was applied to forty-nine human hair samples from individuals with varying dietary habits successfully finding a clear correlation between methylmercury levels (ranging from 0.02 to 3.2 mg/kg) in hair and fish consumption, in line with previous literature data.

Management of Paediatric Airway in Post-intubation Subglottic Stenosis Associated with Japanese Encephalitis.

Subglottic stenosis is narrowing of the area in between the vocal cords and the cricoid cartilage. It can cause respiratory problems which can be mild to severe. Study the management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis. Case Setting and Design: Retrospective study of 18 patients presenting with encephalitis out of which 6 cases were of post-intubation subglottic stenosis associated with Japanese encephalitis between the study period of one year (September 2017-September 2018) in the, Department of Otolaryngology and Head and Neck Surgery, North Eastern Indira Gandhi Regional Institute Of Health And Medical Sciences, Shillong, Meghalaya, India. Fifteen patients were treated in the study period. Different approaches were used. Post-intubation subglottic stenosis depends on the duration of intubation and the quality of life post-tracheostomy depends on the type of tube used. Bronchoscopic assisted procedures during the tracheostomy or after an interval helps to decrease the morbidity. Management of paediatric airway in post-intubation subglottic stenosis associated with Japanese encephalitis needs proper strategy and dedicated and intensive post-operative care. Bivona® silicone tracheostomy tube is a better option.

Determination of releasing plasticizers from dental floss using ultrasound–assisted extraction–dispersive liquid–liquid microextraction followed by gas chromatography–flame ionization detector

Recently, the wide existenceof phthalate esters in healthcare products has attracted great attention from scientists due to their negative effects on human health. As a result, the current study was carried out to determine the presence of some plasticizers in dental floss such as di-n-butyl phthalate, diethyl phthalate, di-2-ethylhexyl phthalate, di-iso-butyl phthalate, and bis-2-ethylhexyl adipate. The studied analytes were extracted from dental floss by an ultrasound–assisted extraction procedure and then enriched by a dispersive liquid–liquid microextraction method. For this purpose, a piece of dental floss was immersed in acetonitrile under sonication to extract the analytes. Then, the acetonitrile phase containing the extracted analytes was mixed with a proper extraction solvent at µL–level and injected into sodium chloride solution. The extracted analytes were determined by gas chromatography–flame ionization detector and gas chromatography–mass spectrometry. Under the best extraction conditions, limits of detection and quantification were found in the ranges 0.20–0.33 and 0.67–1.1 µg/L in solution and 0.06–0.10 and 0.19–0.33 µg g−1 in dental floss, respectively. Relative standard deviations were in the ranges 4.0–6.5% and 5.1–7.9% for intra-day and inter-day precisions for five replicates at 60 µg/L of each analyte. Enrichment factors and extraction recoveries of the analytes ranged from 350 to 460 and 70–92%, respectively.

Indications, Access and Techniques for Pericardiocentesis in South-South Nigeria

Introduction: Pericardiocentesis may be an emergency procedure to relieve pericardial effusion with Tamponade. The fluid from this procedure is examined and sent for further investigation which may guide the line of management and improve patient outcome. With the advancement of expertise in echocardiography assisted procedures, echocardiography-guided diagnostic and therapeutic pericardiocentesis is now considered standard clinical practice in the treatment of pericardial effusions.

Long-term outcomes following ileocolic resection for Crohn's disease: does earlier elective resection affect disease recurrence rates?

Surgical resection in Crohn's disease is sometimes the only alternative treating disease complications or refractory disease. The implications of early resection on disease course are still debatable. We aimed to assess the influence of preoperative disease duration on long-term postoperative disease course. A retrospective analysis of all Crohn's disease patients who underwent an elective primary ileocolic resection between 2010 and 2021 in a single tertiary medical center. The cohort was divided based on disease duration, Group A (47 patients) had a disease duration shorter than 3 years (median of 1 year) and Group B (139 patients) had a disease duration longer than 3 years (median of 11 years). Surgeries were less complex among Group A as noted by higher rates of laparoscopic assisted procedures (68.1% vs. 45.3%, P = 0.006), shorter surgery duration (134 vs. 167 min, P < 0.0001) less estimated blood loss (72.5 vs. 333 mL, P = 0.016) and faster return of bowel function (3 vs. 4 days, P = 0.011). However, propensity score matching nullified all the differences. Younger age (OR = 0.86, P = 0.004), pre-op steroids (OR = 3.69, P = 0.037) and longer disease duration (OR = 1.18, P = 0.012) were found to be independently significantly associated with severe complications. After a median follow-up time of 71.38 months no significant differences were found between the groups in terms of endoscopic (P = 0.59), or surgical recurrences rates (P = 0.82). The main effect of preoperative short disease duration was noted within the surgical complexity; however, matching suggests confounders as cause of the difference. No significant long-term implication was noted on disease recurrence.

Fisetin Delays Postovulatory Oocyte Aging by Regulating Oxidative Stress and Mitochondrial Function through Sirt1 Pathway.

The quality of oocytes determines the development potential of an embryo and is dependent on their timely fertilization after ovulation. Postovulatory oocyte aging is an inevitable factor during some assisted reproduction technology procedures, which results in poor fertilization rates and impairs embryo development. We found that fisetin, a bioactive flavonol contained in fruits and vegetables, delayed postovulatory oocyte aging in mice. Fisetin improved the development of aged oocytes after fertilization and inhibited the Sirt1 reduction in aged oocytes. Fisetin increased the GSH level and Sod2 transcription level to inhibit ROS accumulation in aged oocytes. Meanwhile, fisetin attenuated aging-induced spindle abnormalities, mitochondrial dysfunction, and apoptosis. At the molecular level, fisetin decreased aging-induced aberrant expression of H3K9me3. In addition, fisetin increased the expression levels of the mitochondrial transcription factor Tfam and the mitochondrial genes Co2 and Atp8 by upregulating Sirt1 in aged oocytes. Finally, inhibition of Sirt1 reversed the anti-aging effects of fisetin. Taken together, fisetin delayed postovulatory oocyte aging by upregulating Sirt1.

Prevalence Of Robotic Surgery In Pakistan.

Dear Editor, Robot-assisted surgery is a medical procedure that utilizes specific innovation that improves the abilities of one’s surgical skills. It enables surgeons to perform complicated surgeries in difficult-to-reach areas via small incisions. The innovation comprises of 1-Surgical arms with tiny instruments with wrists at the tip, 2-Special camera that gives improved, amplified 3D perspectives on the region 3-Surgical Control Centre where the surgeon controls the instrument and the camera. (1) Experts who utilize robotic surgery find that it develops exactness, versatility, and control during the movement and permits them to see complex areas that are not visible through other techniques. Utilizing robotic surgery procedures, experts can do delicate and complex medical procedures that may be inconvenient with traditional procedures (2) Often, robotic surgery procedures make beyond belief prominent clinical therapies possible. The benefits of fewer obtrusive medical procedures include fewer bothers, less blood loss; speedier recovery; and fewer unmistakable scars. (2) Automated robotic surgery is now practice in Pakistan by the Sindh Institute of Urology and Transplantation. Around the globe, robotic surgery has caught the attention of many physicians and is also used for other organ surgeryDespite mainstream thinking, it doesn't imply that robots are doing your medical procedure. All things being equal, a specialist controls robotic arms with outrageous accuracy. During robotic surgery, a specialist utilizes a PC to control the robotic arms that go through the method. Robotic surgery gives her unparalleled adaptability and accuracy during medical procedures. (3) In conclusion, Pakistan needs to care for an enormous pool of patients connected with the prostate, kidney, gall bladder, different tissues and organs. The current ratio of 0.473 physicians per 1,000 population in Pakistan is inadequate to maintain the nation's health. (4) Healthcare system frameworks all over the world have been changed over the most recent couple of years, bringing about a more prominent need and interest for surgical schooling outside operation theatres Lastly, the general well-being area of Pakistan ought to likewise make plans to import equipment,/ machines from organizations with the goal that it is made accessible in hospital across the country. Subsequently, this will help our careful division in its progression from a medical procedure to robotic assisted priesion medical procedure.

Surgical and endovascular assisted maturation procedures improve cannulation after arteriovenous fistula creation, but not after arteriovenous graft placement.

After creation, arteriovenous fistulae (AVF) and arteriovenous grafts (AVG) can undergo surgical or endovascular assisted maturation (AM) procedures to enable use for hemodialysis. We sought to explore the association of interventions with successful two-needle cannulation (TNC) using the United States Renal Data System (USRDS). Using the 2012-2017 USRDS, we identified patients initiating hemodialysis with tunneled dialysis catheters (TDC). Successful AVF/G use was defined as two-needle cannulation (TNC). Our principal outcome was time to first TNC after AVF/G creation. Death and new access placement were competing events that precluded TNC. Competing-risks regression models were constructed to identify factors associated with cannulation. Logistic regression was used to assess the association between AM procedures and 1-year TNC and also to compare post-cannulation outcomes. Among 81,143 patients, 15,880 (19.6%) had AVG and 65,263 (80.4%) had AVF. AVG patients were more likely than AVF patients to achieve TNC at 1 year on unadjusted (77.4% vs 64.0%, p < 0.001) and on multivariate analysis (sHR = 2.56 (2.49-2.63), p < 0.001). For AVFs, one AM surgical procedure was associated with improved 1-year TNC rates, but further revisions were not helpful. Endovascular AM procedures were associated with increased AVF TNC rates. Any procedure, surgical or endovascular, was detrimental to achieving TNC for AVGs.Following initial TNC, those accesses that needed AM procedures were associated with higher rates of access failure (AVF: OR = 1.32 (1.21-1.45); AVG: OR = 1.77 (1.500-2.00); p < 0.001), catheter replacement (AVF: OR = 1.27 (1.20-1.34); AVG: OR = 1.56 (1.42-1.71), p < 0.001), and additional endovascular procedures (AVF: 0.75 ± 1.22 no AM vs 1.33 ± 1.62 any AM; AVG: 1.31 ± 1.77 no AM vs 1.96 ± 2.22 any AM; all p < 0.001). AVG achieved TNC after creation more reliably than AVF. A single surgery or endovascular procedures for AVFs is associated with greater rates of TNC. For AVGs, any AM procedure is associated with lower cannulation rates, and reinforces the need for careful operative technique.