Bleeding Volume Research Articles

Transversal approach via a bladder neck and prostate combined longitudinal incision versus standard approach of robotic-assisted radical prostatectomy for localized prostate cancer: a retrospective analysis

BackgroundTransversal approach for robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision (L-RALP) is a novel surgical method for patients with respectable prostate cancer.MethodsThere were 669 patients with prostate cancer underwent L-RALP or S-RALP which identified from April 2016 to April 2020. The perioperative outcomes, Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores, sexual function and urinary control ability were included and compared between two groups.ResultsIn the 669 patients, 277 of them were included into the final analysis. 151 patients received S-RALP and 126 received L-RALP. Baseline features were balanced. Patients in the S-RALP group had significantly shorter average surgical time (135.93 vs 150.04 min; p < 0.001) than those in L-RALP group. Intraoperative bleeding volume, early postoperative complications rates, postoperative catheter removal time and hospital stays were comparable between two groups. There was no difference in biochemical recurrence at 3, 6, 12 and 18 months of follow-up. Of note, the urinary control function recovers of patients in the L-RALP group was significantly better than those in the S-RALP group. Moreover, patients in the L-RALP group had much better results of EPIC-CP (including urinary control and total score) than those in the S-RALP group at 6 week and 3, 6, 12 and 18 months.ConclusionsBoth S-RALP and L-RALP were safe and effective with similar long-term clinical outcomes in patients with respectable prostate cancer. Patients received L-RALP had significantly better postoperative outcomes including urinary control, and recovery period.

Single-Incision Laparoscopic Cholecystectomy Using a Set of Novel Needle Instruments.

Although the technique of single-incision laparoscopic cholecystectomy (SILC) has improved remarkably, problems such as limited exposure and instrument collision persist. We describe a new SILC technique that uses a set of specially-designed needle instruments. Fifty-six patients with benign gallbladder disease underwent SILC using the newly-designed needle assembly instruments (NAIs). The NAIs comprise an needle assembly exposing hook for operative field exposure and an needle assembly electrocoagulation hook for dissection. During the operation, the NAIs were assembled and disassembled before and after gallbladder removal within the abdominal cavity. The operative efficacy and postoperative complications of this procedure were evaluated. SILC was completed successfully in 52 cases, and four cases (7.14%) required an additional trocar. There were no conversions to open surgery. The mean operative time was 48.2 ± 21.8min, and the mean operative bleeding volume was 10.5 ± 12.5mL. Minor postoperative complications occurred in 3 cases, including 2 cases of localized fluid accumulation in the abdominal cavity and 1 case of pulmonary infection, and all of them recovered after conservative treatment. There was no occurrence of bile leak, abdominal bleeding, bile duct injury and incisional hernia. The medical cost of each case was saved by approximately $200. The abdominal scars produced by the needle instruments were negligible. NAIs can make SILC safer, more convenient, and less expensive.

Long-term outcome of uniport vs. multiport video-assisted thoracoscopic lobectomy for lung cancer

This study aims to compare the perioperative outcomes and long-term survival of U-VATS lobectomy for NSCLC with multiportal VATS (M-VATS, involving two ports or more) lobectomy. A total of 339 patients who underwent intentional VATS lobectomy for lung cancer between 2012 and 2017 were included in the analysis. Perioperative outcomes and long-term survival were evaluated. Propensity score matching was utilized to minimize baseline characteristic differences between the two groups. Out of the total cases, 17 (5.01%) were converted to open thoracotomy. The conversion rates were 4.96% (7/141) in the U-VATS group and 5.05% (10/198) in the M-VATS group. A total of 322 consecutive patients underwent VATS lobectomy and mediastinal lymphadenectomy. After propensity matching, 106 pairs were obtained, consisting of 83 males and 129 females. Intraoperative bleeding volume, number of retrieved lymph nodes, explored nodal stations, drainage time and volume, and postoperative hospital stay were similar between the two groups. Both groups exhibited comparable morbidity and mortality rates. From the multivariable analysis, there was no significant difference observed in terms of overall survival (OS) and disease-free survival (DFS) between the two patient cohorts. U-VATS demonstrated comparable perioperative outcomes and long-term efficacy to M-VATS. However, further confirmation of these findings is required.

Diagnosis dan Tata Laksana Perdarahan Batang Otak Primer

Primary brainstem hemorrhage is an intracerebral hemorrhage that affects the brainstem, primarily caused by chronic hypertension. Clinical manifestations include decreased consciousness, motor weakness, respiratory problems, hyperthermia, and pupillary abnormalities. Diagnosis is with a head CT scan/MRI, bleeding was found in the mesencephalon, pontine, or medulla oblongata. Management is conservative with stabilization of vital signs, correction of hemostatic abnormalities, and intensive monitoring of neurological symptoms. Surgery is still controversial because of the lack of clinical and research evidence. The prognosis is generally grave depending on the degree of initial loss of consciousness, location, and volume of bleeding.

Comparative study of total thoracoscopic mitral valve surgery and traditional open mitral valve surgery :propensity score matching study

Background: Conventional median open mitral valve replacement surgery usually requires a 20-30cm size incision to ensure adequate visual exposure. So, while we complete the valve replacement, it also brings about a series of problems. The appearance of TV thoracoscope changes the exposure of the surgical field. Because the microscopic field is enlarged, it not only makes the surgical vision clearer, but also greatly shortens the incision, reduces bleeding, and conceals the incision, minimizing the trauma and shortening the postoperative recovery time, which is in line with the concept of modern health. Aim: All technological innovation is controversial in the early stage, and it is such debate that can promote the progress and development of technology.This study was conducted in the context of this debate to summarize the experience of Total thoracoscopic mitral valve surgery in our center.Total thoracoscopic mitral valve replacement surgery and traditional median incision mitral valve replacement surgery were compared by the propensity score matching method.Evaluate its safety and merits. Methods: From January 2018 to December 2020, a total of 139 patients in the thoracoscopic group were eligible in the cardiothoracic surgery department of our hospital, and 1066 cases of traditional median sternotomy mitral valve replacement. After propensity score matching, 125 patients were selected in the thoracoscopic group, among 1066 patients with median incision MVR, 1:1 matched to 125, as the control group in the thoracoscopic group. Results: The results showed that the mean operative time in the thoracoscopic MVR group was significantly longer than that in the control group (185.73 ± 43.04 vs. 164.58 ± 40.28, p=0.0016). Similarly, both the mean CPB time and aortic block time were significantly longer than those in the control group (108.37±30.57min vs. 79.18±17.65min, p &lt;0.0001; 66.59±29.63min vs. 45.09±19.68min, p &lt;0.0001. Moreover, the proportion of patients with CPB greater than 120min and aortic block greater than 90min was significantly higher than the control group (24.1% vs. 3.2%, p &lt;0.0001,14.4% vs. 2.4%, p=0.0237). In addition, there was no significant difference in the mean ICU observation time between the two groups (49.35±34.51h vs. 48.72±25.89h, p=0. 8792). Differently, the mean endotracheal intubation time was significantly lower in the thoracoscopic MVR group compared to the control group (18.52±6.07h vs. 25.45±14.18h, p=0.0032). Similarly, the length of stay in the thoracoscopic group was 9.13 ± 4.58 days, which was significantly lower than 11.12 ± 5.76 days in the control group (p=0.0004). There was no significant difference in the postoperative hemoglobin concentration or platelet count between the two groups of MVR patients. Mean intraoperative bleeding volume in the thoracoscopic MVR group was significantly less than that in the control group (158.37±100.91ml vs.250.74 ± 81.34, P &lt;0.0001). Similarly, the mean postoperative discharge in the thoracoscopic MVR group was significantly than in the control group (428.39±361.38ml vs. 514.07 ± 347.92ml, p=0.0383). For patients with postoperative blood products, there were 37 (29.6%) in the thoracoscopic group and 33 (26.4%) in the control group. There was no significant difference between the two groups. Similarly, there was no significant difference in the mean total hospital costs between the two groups. Conclusion: This study shows that it has feasibility and safety for total thoracoscopic mitral valve replacement for mitral valve lesions, which can reduce the time and stay of the hospital compared with conventional direct surgery, and obtain good minimally invasive and cosmetic effect, and lay a theoretical and clinical foundation for the application of thoracoscopic technology in cardiac surgery, which has important scientific significance.

The Effect of Bismuth as A Local Hemostatic Material Post Extraction of Permanent Mandibular First Molars Teeth

Background: Bleeding is a post-extraction complication that is often found in dentistry. Normally post-extraction bleeding stops 12-24 hours after surgery, but it is often found for more than 24 hours. The post-extraction bleeding usually stops by pressing the area with sterile gauze but there is an obstacle due of the large volume of blood. Objective: to evaluate the bismuth subgallate as an effective local hemostatic agent. Methods: This study conducted on patients who came to the Oral Surgery Clinic, Nala Husada Hospital Surabaya, population aged 18-60 years, with permanent mandibular first molars diagnosed with chronic apical periodontitis et causa pulp gangrene or radix gangrene without systemic disorder and planned for extraction teeth with close method. It was divided into 2 groups by simple random sampling group design; the control group and the treatment group. After tooth extraction with the close method, a local hemostatic agent will be applied at the socket. The control group used a paste containing vaseline, while the treatment group used a paste containing bismuth subgallate. This paste contains 2.25% bismuth subgallate mixed with Peruvian balsam. After the application of local hemostatic agents, both the control group and the treatment group will be calculated the bleeding time, bleeding volume, and whether or not the secondary bleeding occurs. Conclusion: of this study is that bismuth subgallate has an effect as a local hemostatic agent after extraction of the mandibular first permanent molars.

Two-step osteotomy/discectomy through cannulated screw (TOCS) technique for en bloc resection of spine tumor: surgical technique and preliminary results.

We have developed a novel technique for osteotomy/discectomy during en bloc resection of spine tumors named two-step osteotomy/discectomy through cannulated screw (TOCS). This study aims at describing the procedure of TOCS technique and assessing its efficiency and safety. We retrospectively reviewed fourteen patients who underwent en bloc resection for spine tumors using TOCS technique in our center between August 2018 and September 2022. The technique was based on a specially designed "slotted" cannulated screw which was a cannulated screw with a longitudinal slot to provide the accessibility of T-saw. During osteotomy/discectomy, the "slotted" cannulated screw was inserted obliquely along the plane between the dura and the posterior wall of spine in light of the planned osteotomy/discectomy plane under routine fluoroscopic imaging guidance. The T-saw was introduced through the screw, and the osteotomy/discectomy was performed sequentially in two steps under the guidance of the screw by turning the slot away and toward the dura. The intra-/perioperative complication, neurological function (determined by Frankel grading), surgical margin (determined by a pathologist using AJCC R system), follow-up details were documented. The mean duration of surgery was 599.3 (360-890)min with a mean volume of intra-operative hemorrhage of 2021.4 (800-5000)mL. The intra-/perioperative complications were found in four patients (28.6%). R0 and R1 resections were achieved in nine and five patients, respectively. There was no R2 resection. After a mean follow-up period of 30.6 (10-67)months, all patients were alive except one patient died ten months after surgery due to unrelated cause. No recurrence and implant failure were found. Thirteen patients (92.9%) exhibited completely normal neurological function same as their preoperative neurological status. Using TOCS technique can facilitate a precise, complete and safe osteotomy/discectomy procedure during en bloc resection for spine tumor without the aid of intra-operative navigation.

Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients.

With advancements in the development of endoscopic technologies, the endoscopic submucosal dissection (ESD) has been one of the gold-standard therapies for early gastric cancer. To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients. Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were selected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022. Among them, 39 patients treated with ESD were included in an experimental group, and 39 patients treated with endoscopic mucosal resection (EMR) were included in a control group. We compared the basic intraoperative conditions, postoperative short-term recovery, long-term recovery effects and functional status of gastric mucosa between the two groups; the basic intraoperative conditions included lesion resection, intraoperative bleeding and operation time; the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complications; and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoperatively; and we compared the preoperative and predischarge serum pepsinogen I (PG I) and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge. The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group. The intraoperative bleeding volume was higher in the experimental group than in the control group. The operation time was longer in the experimental group than that in the control group, and the rate for base residual focus was lower in the experimental group than that of the control group, and the differences were all statistically significant (all P < 0.05). The length of hospital stay was longer in the experimental group than in the control group, and the incidence of surgical complications, 1-year postoperative recurrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group, and the differences were statistically significant (all P < 0.05). However, the difference in the 1-year postoperative survival rate was not statistically significant between the two groups (P > 0.05). Before discharge, PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period, and the above indexes were higher in the experimental group than those in the control group, and the differences were statistically significant (both P < 0.05). Moreover, before discharge, PG II level was lower in both groups compared with the preoperative period, and the level was lower in the experimental group than in the control group, and the differences were all statistically significant (all P < 0.05). Compared with EMR, ESD surgery is more thorough. It reduces the rate of base residual focus, recurrence rate, surgical complications, and promotes the recovery of gastric cells and glandular function. It is safe and suitable for clinical application.

Hydrocephalus following Brain Tumor Surgery: Factors Correlating with Occurrence of Postoperative Hydrocephalus and Predictive Scoring Model.

Hydrocephalus following brain tumor surgery is found, although cause of hydrocephalus is optimally eradicated. This study aimed to investigate factors associated with development of postoperative hydrocephalus that requires shunt procedure and generate predictive scoring model of this condition. Demographic, clinical, radiographic, treatment, laboratory, complication, and postoperative data were collected. Binary logistic regression was used to investigate final model for generating predictive scoring system of postoperative hydrocephalus. A total of 179 patients undergoing brain tumor surgery were included. Forty-five (25.1%) patients had postoperative hydrocephalus that required shunt surgery. In univariate analysis, several factors were found to be associated with postoperative hydrocephalus. Strong predictors of postoperative hydrocephalus revealed in multivariate analysis included tumor recurrence before surgery (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.28-14.98; p = 0.018), preoperative hydrocephalus (OR, 6.52; 95% CI, 2.44-17.46; p < 0.001), glial tumor (OR, 3.76; 95% CI, 1.14-12.43; p = 0.030), metastasis (OR, 5.19; 95% CI, 1.72-15.69; p = 0.004), intraventricular hemorrhage (OR, 7.08; 95% CI, 1.80-27.82; p = 0.005), and residual tumor volume (OR, 1.05; 95% CI, 1.01-1.09; p = 0.007). A cutoff predictive score with the best area under curve and optimum cutoff point was utilized for discriminating patients with high risk from individuals with low risk in occurrence of postoperative hydrocephalus. This study reported predictive factors strongly associated with development of postoperative hydrocephalus. Predictive scoring system is useful for identifying patients with an increased risk of postoperative hydrocephalus. Patients classified in the high-risk group require closed surveillance of the hydrocephalus.

Safety and Feasibility of Laparoscopic Liver Resection with the Clamp-Crush Method Using the BiSect.

Various energy devices are available for resection of the liver parenchyma during laparoscopic liver resection (LLR). We have historically performed liver resections using the Cavitron Ultrasonic Surgical Aspirator (CUSA). More recently, we have used new bipolar forceps (BiSect; Erbe Elektromedizin GmbH, Tübingen, Germany) to perform clamp-crush dissection with good results. The BiSect is a reusable bipolar forceps with a laparoscopic dissecting forceps tip and both an incision mode and coagulation mode. We evaluated the perioperative clinical course of patients who underwent LLR using the clamp-crush method with the BiSect compared with the CUSA. This single-center case control study involved patients with liver metastasis from colorectal cancer who underwent LLR using either the BiSect or CUSA at our hospital from January 2019 to December 2022. We performed the LLR using CUSA from January 2019 to early October 2020. After introduction of the BiSect in late October 2020, we used BiSect for the LLR. Before surgery, the three-dimensional liver was constructed based on computed tomography images, and a preoperative simulation was performed. We evaluated the results of LLR using the BiSect versus the CUSA and assessed the short-term results of LLR. During the study period, we performed partial liver resection using the BiSect in 26 patients and the CUSA in 16 patients. In the BiSect group, the median bleeding volume was 55 mL, the median operation time was 227 minutes, and the median postoperative length of hospital stay was 9 days. In the CUSA group, the median bleeding volume was 87 mL, the median operation time was 305 minutes, and the median postoperative length of hospital stay was 10 days. There were no statistically significant differences in the clinical course including bile leakage, bile duct stenosis, and post operative hospital stay between the two groups. Compared with LLR using the CUSA, the clamp-crush method using the BiSect in LLR is a safe and useful liver transection technique. Further study should be conducted to clarify whether BiSect is safe and useful in LLR for patients with other tumor types and patients who undergo other procedures.

Orthopaedic robot assisted closed reduction and cannulated screw internal fixation for the treatment of femoral neck fractures

To investigate the preliminary clinical effect of closed reduction and cannulated nail internal fixation for femoral neck fracture assisted by robot navigation and positioning system. From July 2019 to January 2020, 16 cases of femoral neck fracture （navigation group） were treated with closed reduction and internal fixation guided by robot system, including 7 males and 9 females, aged 25 to 72 years old with an average of （53.61±5.45） years old；Garden classification of fracture：3 cases of typeⅠ, 3 cases of typeⅡ, 8 cases of type Ⅲ, 2 cases of type Ⅳ. Non navigation group （control group）：20 cases of femoral neck fracture were treated with closed reduction and hollow nail internal fixation, 8 males and 12 females, aged 46 to 70 years old with an average of （55.23±4.64） years old；Garden typeⅠin 2 cases, typeⅡin 4 cases, type Ⅲ in 11 cases, type Ⅳ in 3 cases. The operation time, fluoroscopy times, guide needle drilling times, screw adjustment times, intraoperative bleeding volume and other indicators of two groups were evaluated. Both groups were followed up for 12 to 18 months with an average of （15.6±2.8） months. The fractures of both groups were healed without delayed union and nonunion. There was no significant difference in healing time between two groups（P=0.782）. There was no significant difference in Harris scores between two groups at the last follow-up（P=0.813）. There was no significant difference in operation time between two groups（P>0.05）. There were significant differences between two groups in fluoroscopy times, guide needle drilling times, hollow screw replacement times, and intraoperative bleeding volume（P<0.05）. Closed reduction and hollow screw internal fixation assisted by robot navigation system for femoral neck fracture has the advantages of minimally invasive operation, precise screw placement, and reduction of X-ray radiation damage during operation.

Orthopaedic robot assisted femoral neck dynamic cross fixation system for the treatment of femoral neck fractures

To explore and compare the clinical efficacy of orthopedic robot assisted femoral neck system （FNS） and traditional manual FNS in the treatment of femoral neck fractures in middle-aged and young people. The clinical data of 62 consecutive patients with femoral neck fracture and age less than 65 years old admitted to the Intelligent Orthopaedic Department of Beijing Jishuitan Hospital from June 2021 to June 2022 were retrospectively analyzed. According to whether orthopedic robot-assisted surgery the patients were divided into two groups：30 patients aged 34 to 56 years old were treated with orthopedic robot assisted FNS internal fixation after closed or limited open reduction（experimental group）； 32 patients aged 33 to 54 years old underwent FNS internal fixation after closed or limited open reduction（control group）. The age, gender, time from injury to admission, average hospital stay, surgical duration, intraoperative bleeding volume, and intraoperative fluoroscopy frequency of two groups of patients were analyzed and compared. The hip joint function in both groups of patients was evaluated using the Harris hip joint scoring standard at 6 months after surgery. All 62 patients with femoral neck fractures successfully completed the surgery. There was no significant difference（P>0.05） between the experimental group and the control group in terms of baseline data such as age, gender, time from injury to admission, time from admission to surgery and the intraoperative bleeding. The surgical duration of the experimental group was significantly shorter than that of the control group [42.1（28.5, 50.7）min vs. 53.4（36.9, 62.5） min, Z=-2.338, P=0.019]. The intraoperative X-ray fluoroscopy frequency of the experimental group was significantly lower than that of the control group[8.0 （6.0, 11.0） times vs. 15.0（13.0, 17.0） times, Z=-5.960, P<0.001]. In terms of postoperative hip joint function, there was no significant difference in Harris score between the two groups of patients at 6-month follow-up（P>0.05）. Compared with manual operation of FNS, orthopedic robot assisted FNS in the treatment of femoral neck fractures can help shorten surgical time, reduce intraoperative fluoroscopy frequency, and have similar therapeutic effects on long-term hip joint function recovery.

Safety and learning curve analysis of robotic-assisted pancreaticoduodenectomy: experience of a single surgeon.

Although prior studies have discussed learning curves (LC) of robotic-assisted pancreaticoduodenectomy (RPD), a recognized definition is lacking. This study analyzed the clinical outcomes of 85 consecutive RPD cases performed by a single surgeon to evaluate the safety and learning curve of RPD using the da Vinci Xi robotic system. There were 51 male and 34 female patients, with a median age of 64 (20-87) years. The average preoperative body weight and BMI were 64.15 ± 11.43kg and 23.36 ± 3.33kg/m2, respectively. The clinical outcomes of each patient were analyzed using the textbook outcome(TO), and the learning curve of the RPD was evaluated by calculating the TO rate of patients using the cumulative sum analysis method (CUSUM).The operation time (OT) was 288.92 ± 44.41min, and the postoperative hospital stay was 10 (1-134) days. In total, 23.52% (20/85), 5.88% (5/85), 2.35% (2/85), and 5.9% (5/85) experienced grade IIIa, IIIb, IV, and V complications. A total of 46 patients achieved TO outcomes (TO group), while 39 did not (non-TO group). The smoking rate in the TO group was lower (P < 0.05) and the albumin level was higher (P < 0.05) than that in the non-TO group. The TO rate became positive after the 56th case, all patients were divided into a learning improvement group (56 cases) and a proficient group (29 cases). The total bilirubin level in the learning improvement group was lower (P < 0.05) and the bleeding volume was higher (P < 0.05).RPD is safe and effective for carefully selected patients. The learning curve was completed after 56 patients.

Comparison of transoral vestibular robotic thyroidectomy with traditional low-collar incision thyroidectomy.

Transoral vestibular robotic thyroidectomy can really make the patient's body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.

YTHDF2-regulated matrilin-3 mitigates post-reperfusion hemorrhagic transformation in ischemic stroke via the PI3K/AKT pathway.

Hemorrhagic transformation can complicate ischemic strokes after recanalization treatment within a time window that requires early intervention. To determine potential therapeutic effects of matrilin-3, rat cerebral ischemia-reperfusion was produced using transient middle cerebral artery occlusion (tMCAO); intracranial hemorrhage and infarct volumes were assayed through hemoglobin determination and 2,3,5-triphenyltetrazoliumchloride (TTC) staining, respectively. Oxygen-glucose deprivation (OGD) modeling of ischemia was performed on C8-D1A cells. Interactions between matrilin-3 and YTH N6-methyladenosine RNA binding protein F2 (YTHDF2) were determined using RNA immunoprecipitation assay and actinomycin D treatment. Reperfusion after tMCAO modeling increased hemorrhage, hemoglobin content, and infarct volumes; these were alleviated by matrilin treatment. Matrilin-3 was expressed at low levels and YTHDF2 was expressed at high levels in ischemic brains. In OGD-induced cells, matrilin-3 was negatively regulated by YTHDF2. Matrilin-3 overexpression downregulated p-PI3K/PI3K, p-AKT/AKT, ZO-1, VE-cadherin and occludin, and upregulated p-JNK/JNK in ischemic rat brains; these effects were reversed by LY294002 (a PI3K inhibitor). YTHDF2 knockdown inactivated the PI3K/AKT pathway, inhibited inflammation and decreased blood-brain barrier-related protein levels in cells; these effects were reversed by matrilin-3 deficiency. These results indicate that YTHDF2-regulated matrilin-3 protected ischemic rats against post-reperfusion hemorrhagic transformation via the PI3K/AKT pathway and that matrilin may have therapeutic potential in ischemic stroke.

Accuracy of automated segmentation and volumetry of acute intracerebral hemorrhage following minimally invasive surgery using a patch-based convolutional neural network in a small dataset

PurposeIn cases of acute intracerebral hemorrhage (ICH) volume estimation is of prognostic and therapeutic value following minimally invasive surgery (MIS). The ABC/2 method is widely used, but suffers from inaccuracies and is time consuming. Supervised machine learning using convolutional neural networks (CNN), trained on large datasets, is suitable for segmentation tasks in medical imaging. Our objective was to develop a CNN based machine learning model for the segmentation of ICH and of the drain and volumetry of ICH following MIS of acute supratentorial ICH on a relatively small dataset.MethodsNinety two scans were assigned to training (n = 29 scans), validation (n = 4 scans) and testing (n = 59 scans) datasets. The mean age (SD) was 70 (± 13.56) years. Male patients were 36. A hierarchical, patch-based CNN for segmentation of ICH and drain was trained. Volume of ICH was calculated from the segmentation mask.ResultsThe best performing model achieved a Dice similarity coefficient of 0.86 and 0.91 for the ICH and drain respectively. Automated ICH volumetry yielded high agreement with ground truth (Intraclass correlation coefficient = 0.94 [95% CI: 0.91, 0.97]). Average difference in the ICH volume was 1.33 mL.ConclusionUsing a relatively small dataset, originating from different CT-scanners and with heterogeneous voxel dimensions, we applied a patch-based CNN framework and successfully developed a machine learning model, which accurately segments the intracerebral hemorrhage (ICH) and the drains. This provides automated and accurate volumetry of the bleeding in acute ICH treated with minimally invasive surgery.

Kaolin loaded gelatin sponges for rapid and effective hemostasis and accelerated wound healing

Severe trauma with massive active blood loss, including liver and spleen rupture, arterial bleeding and pelvic fracture, will lead disability, malformation and even death. Therefore, it is very important to develop new, fast and efficient hemostatic materials. In this study, a novel Gelatin/Kaolin (GE/KA) composite sponge was developed. Meanwhile, to further investigate the effect of kaolin content on sponge properties, we prepared four types of sponges: GE/5% KA, GE/10% KA, GE/15% KA and GE/20% KA. The results of coagulation test in vitro showed that compared to the other groups, there were more activated adhered platelets and red blood cells on the surface of GE/15% KA. The results of hemostasis test in vivo showed that compared to other experimental groups, the GE/15% KA group had significantly less hemostasis time (liver hemostasis model: 69.50 ± 2.81 s; femoral artery hemostasis model: 75.17 ± 3.06 s) and bleeding volume (liver hemostasis model: 219.02 ± 10.39 mg; femoral artery hemostasis model: 948.00 ± 50.69 mg), and was similar to the commercial hemostasis material group. Additionally, the material properties of the sponge were characterized and its biocompatibility was verified as well through cell experiments and in vivo embedding experiments. All these results indicate that the optimal content of kaolin is 15%, which provides a theoretical basis for subsequent research. All in all, the novel GE/KA composite sponge prepared in this study can be used as a multifunctional hemostatic wound dressing for the treatment of complex wounds under various trauma scenes.

Electroacupuncture Therapy Effectively Protects the Rat Brain after Intracerebral Hemorrhage

Objective. Electroacupuncture (Ea) is a useful complementary and alternative therapy for intracerebral hemorrhage (ICH). However, the neurobiological basis for the Ea treatment of ICH is still unclear. The primary aim of the present study was to explore whether Ea prevents brain edema, apoptosis, excitotoxicity, and neuroinflammation in rats after hemorrhagic stroke. Methods. Rats were randomly divided into Sham, Control, and Ea groups. We used modified neurological severity score (mNSS) and gait analysis to estimate neurological function in rats, and PET/CT to assess glucose uptake and the hemorrhagic focus volume. Measurement of the brain water content and TUNEL staining were used to evaluate brain edema and cell apoptosis, respectively. The serum myelin basic protein (MBP), neuron-specific enolase (NSE), calcium-binding protein B (S100B), and tumor necrosis factor-α (TNF-α) concentrations were examined with ELISA. The expression levels of the CD68, GALC, Arg-1, iNOS, NR2A, Glu2R, AQP4, MAP2, GFAP, AQP9, Bcl-2, Bax, and Glu proteins around the hematoma were detected via immunohistochemistry staining. Western blot was used to analyze the levels of the AQP4, AQP9, Bax, Bcl-2, iNOS, and Arg-1 proteins. Results. Ea treatment improved neurological function and reduced the hemorrhagic area and brain water content in rats after ICH. The serum concentrations of MBP, NSE, S100B, and TNF-α all decreased significantly in the Ea group compared with the Control group. Expression levels of the Glu, NR2A, AQP4, AQP9, Bax, GFAP, iNOS, and CD68 proteins in brain tissue surrounding the hematoma were obviously suppressed in ICH rats following Ea treatment. Moreover, Ea stimulation increased the levels of the MAP2, GALC, Glu2R, Arg-1, and Bcl-2 proteins, but reduced the number of TUNEL-positive cells in rats after ICH. Conclusion. The results of this study suggest that Ea may exert neuroprotective effects by suppressing brain edema, apoptosis, excitotoxicity, and neuroinflammation.

Early blood pressure lowering therapy is associated with good functional outcome in patients with intracerebral hemorrhage

BackgroundThe implementation of a care bundle might improve functional outcome for patients with intracerebral hemorrhage (ICH). However, the impact of anti-hypertensive treatment on ICH outcomes remains uncertain. Our objective is to examine whether early blood pressure (BP) lowering therapy within first 12 h is associated with good outcome in ICH patients.MethodsWe included acute ICH patients who had baseline computed tomography (CT) scans within 6 h after onset of symptoms between October 2013 and December 2021. Early BP reduction was defined as use of anti-hypertensive agents within 12 h after onset of symptom. The clinical characteristics were compared between patients who received early BP lowering therapy and those without. The associations between early BP lowering and good outcome and functional independence at 3 months were assessed by using multivariable logistic regression analyses.ResultsA total of 377 patients were finally included in this study for outcome analysis. Of those, 212 patients received early BP reduction within 12 h after ICH. A total of 251 (66.6%) patients had good outcome. After adjustment for age, admission systolic BP, admission GCS score, baseline hematoma volume, hematoma expansion, and presence of intraventricular hemorrhage, early BP lowering therapy was associated with functional independence (adjusted odd ratio:1.72, 95% confidence interval:1.03–2.87; P = 0.039) and good outcome (adjusted odd ratio: 2.02, 95% confidence interval:1.08–3.76; P = 0.027).ConclusionsIn ICH patients presenting within 6 h after symptom onset, early BP reduction within first 12 h is associated with good outcome and functional independence when compared to those who do not undergo such early intervention. Implementation of quality measures to ensure early BP reduction is crucial for management of ICH.

Neoadjuvant stereotactic ablative body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumor thrombus: a prospective pilot study.

Surgical treatment for renal cell carcinoma (RCC) and inferior vena cava (IVC) tumor thrombus (TT) is difficult, and the postoperative complication rate is high. This study aimed to explore the safety and oncologic outcomes of neoadjuvant stereotactic ablative body radiotherapy (SABR) combined with surgical treatment for RCC and IVC-TT. Patients with RCC and IVC-TTs were enrolled in this study. All patients received neoadjuvant SABR focused on the IVC at a dose of 30Gy in 5 fractions, followed by 2 ~ 4 weeks of rest. Then, radical nephrectomy and IVC tumor thrombectomy were performed for each patient. Adverse effects, perioperative outcomes, and long-term prognoses were recorded. From June 2018 to January 2019, 8 patients were enrolled-4 with Mayo grade II TT and 4 with Mayo grade III TT. Four (50%) patients had complicated IVC wall invasion according to CT/MRI. All patients received neoadjuvant SABR as planned. Short-term local control was observed in all 8 patients. Only Grade 1-2 adverse events were reported. In total, 3 (37.5%) laparoscopic surgeries and 5 (62.5%) open surgeries were performed. The median operation time was 359 (IQR: 279-446) min, with a median intraoperative bleeding volume of 750 (IQR: 275-2175) ml. The median postoperative hospital stay was 7 (5-10) days. With a 26-month (range: 5-41) follow-up period, the estimated mean overall survival was 30.67 ± 5.38 months. This is the first preoperative radiotherapy study in Asia that focused on patients with TT. This study revealed the considerable safety of neoadjuvant SABR for RCC with IVC-TT. This study was registered in the Chinese Clinical Trials Registry on 2018-03-08 (ChiCTR1800015118). For more information, please see the direct link ( https://www.chictr.org.cn/showproj.html?proj=25747 ).