Amount Of Blood Loss Research Articles

Obstetric and neonatal outcomes of immune thrombocytopenic purpura in pregnancy and the role of delta hemoglobin index: A case-control study from a tertiary center.

To evaluate the effect of idiopathic thrombocytopenic purpura (ITP) on pregnancies and the role of the delta hemoglobin indices in the evaluation of treatment effectiveness. This case-control study was conducted with 23 ITP and 115 low-risk pregnancies. Obstetric outcomes (fetal growth retardation (FGR), preterm delivery) and neonatal outcomes (weights, APGAR scores, NICU admissions, thrombocytopenia) were recorded. ITP group was subgrouped based on the platelet ratio at the admission for delivery and evaluated the impact of platelet ratios on blood loss amounts at delivery by using delta hemoglobin indices. Eleven patients received treatment during pregnancy. The gestational age at birth and fetal APGAR scores were lower, and the preterm delivery and FGR rates were higher in the ITP group. Four newborns (17.4%) had thrombocytopenia. There were two postpartum hemorrhages. Newborn platelet counts did not correlate with maternal platelet counts. The study showed no difference in delta hemoglobin counts between the ITP and control groups. ITP is associated with an increased risk of maternal and fetal complications. The presented study showed by using the delta hemoglobin indices that, hemorrhagic complications could be prevented with appropriate management. Neonatal thrombocytopenia should be considered for all ITP patients.

Does Omega-3 supplementation increase profuse postpartum hemorrhage? A hospital-based register study.

Although Omega-3 is thought to have anticoagulative properties, the potential untoward effects of Omega-3 during pregnancy have not been investigated. No previous studies have been made to specifically assess its effect on postpartum hemorrhage (PPH). Our aim was to determine if an association exists between Omega-3 intake during pregnancy and profuse PPH or massive PPH. Data on all deliveries that occurred at Karolinska University Hospital during the years 2007-2011 (n = 41 139) was collected from the medical record of Obstetrix, maternal health and delivery chart system. Women with reported Omega-3 use in early pregnancy were considered exposed and all other as unexposed. Bivariate and adjusted multivariate analysis was performed on main outcomes. Omega-3 use was associated with 25% increased odds of PPH (adjusted odds ratio (aOR) 1.25, 95% confidence interval [CI] (1.06-1.47)) and a more than doubled odds of massive PPH (aOR 2.36, 95% CI 1.26-4.44). In addition, there was a minor increase in the amount of blood loss. Although few, women on low-dose discontinued terminated at 36th week showed no significant association to blood loss measurements. Our observational findings showed 25% higher odds of PPH and two times higher odds of massive PPH in women who reported using Omega-3 in early pregnancy. Our findings give some support to advocate discontinued use of Omega-3 in late pregnancy.

Clinical efficacy of dorsal venous complex pre-suture technique in the robot-assisted laparoscopic radical prostatectomy

The clinical data of 33 patients who underwent robot-assisted laparoscopic Vattikuti Institute prostatectomy (VIP) in Cancer Hospital of Chinese Academy of Medical Sciences from October 2020 to April 2022 were reviewed and analyzed. Among them, 18 patients received traditional VIP technique and 15 patients received VIP technique with pre-sutured dorsal venous complex (DVC). The ages of the traditional VIP group and the pre-sutured DVC VIP group were (66.1±7.3) and (66.6±5.7) years, respectively. The body mass index (BMI) of the traditional VIP group and the pre-sutured DVC VIP group was (24.3±2.9) and (25.3±2.6) kg/m2, respectively. The medical expenses were (91 797.0±7 029.6) and (87 106.6±7 031.4) yuan, respectively, with no statistical significance (all P>0.05). The operations of all the 33 cases were successfully completed, and no cases were transferred to open surgery. The operation time of traditional VIP group was longer than that of pre-sutured DVC VIP group [(193.0±37.2) vs (171.1±16.1) min]. The amount of intraoperative blood loss was higher than that in the pre-sutured DVC VIP group [(68.3±22.8) vs (44.0±9.1) ml)], all P<0.05. No patients had perioperative blood transfusion, and no patients had complications within 30 days after surgery. All the 33 patients had negative incisal margins. DVC presuture technique can reduce intraoperative bleeding and shorten operative time in robot-assisted laparoscopic VIP radical prostatectomy, and has good curative effect.

Analysis of adolescent idiopathic scoliosis population for Surgical Site Infection Risk Factors

ObjectiveThe incidence of surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) patients undergoing surgical correction varies but is commonly reported between 0.5 and 6.7 %. The identification of modifiable risk factors is crucial to preventing these infections in the AIS population. Some potential modifiable risk factors include the use of stainless-steel implants, a larger volume of instrumentation and an increased volume of blood products transfused. However, evidence in support of these factors and others representing true risk for the development of SSI is limited and often varies. We aimed to determine the incidence of SSI in AIS undergoing primary scoliosis fusion at our hospital, and explore demographic and clinical variables in the development of SSI in AIS. MethodsThis was a case control retrospective study. Patients aged 10-19 year-old that underwent posterior spinal fusion for initial correction of AIS at our hospital between the years 2012–2020 were eligible. Patients with any previous spine surgery or spine fracture were excluded. A descriptive analysis was then performed on the data. ResultsOf the 334 patients on which data was collected, one SSI was identified resulting in an incidence of infection of 0.3 %. The largest ethnicity represented was Caucasian with 254 patients. The average age was 14.3 years with averaged follow-up of 6.6 years. The majority of patients (252) received implants composed of titanium and cobalt chrome. The average operation duration was 5 h and 7.7 min, and the average hospital stay was 4.2 days. The average amount of blood loss was 553 ml. Chlorhexidine wipes or some other antimicrobial preparation was used on 197 patients and betadine solution was used on 321.185 patients were recorded to have received either antibiotic-loaded allograft or antibiotic powder and 326 patients were recorded to have received intraoperative antibiotics. ConclusionsThe long term clinical follow up of our study and low incidence of infection provide additional evidence for the benefit of antimicrobial techniques and risk factor mitigation previously suggested in the literature for the prevention of SSI in AIS. Level of evidenceLevel III.

A prospective study of total hip arthroplasty for failed proximal femur fracture fixation

Background: Proximal femur fractures have been widely studied and there are several well-accepted management modalities for the same such as PFN A2, IMIL nails, and DHS. Despite several management options we do encounter significant failure rates which could be due to several factors such as post-operative time rehabilitate patients related comorbidity and differences in surgical techniques. Aim of the study was to assess the outcomes of total hip arthroplasty (THA) after failed surgical management in proximal femur fractures Methods: The 50 patients who underwent surgical management for proximal femur fractures at any given point in time and presented with non-union or malunion and inability to bear weight affecting their activities of daily living assessed with Harris hip score were enrolled in a prospective cohort study during 2015 and 2022 after obtaining IRB approval. All these patients underwent surgical management for proximal femur fractures within 3 weeks of sustaining a fracture. Results: A strong statistically significant difference is seen with pain, functional gait, functional activity, range of movement and total score in post-operative group of patients in comparison to patients of pre-operative group. THA had excellent outcomes in 42 patients (85.71%) of the study group. About 6 (14.29%) patients of the study group had good outcome. 2 patients that lost to follow up were removed from the study. Conclusions: THA is an effective procedure for failed proximal femur fracture fixation patients despite the challenges such as distorted anatomy of femoral head, poor bone quality, longer operative times, larger amounts of blood loss, high rates of intra-operativities and post operative complications.

Robot-assisted minimally invasive esophagectomy for esophageal cancer in the left lateral decubitus position.

The use of robot-assisted minimally invasive esophagectomy (RAMIE) in the prone position for esophageal cancer has been currently increasing worldwide. In future, as surgical-assisted robots become more widespread, it is estimated that only two methods of transthoracic approach will remain: RAMIE and open thoracotomy for thoracic esophageal cancer. RAMIE in the left lateral decubitus position (RAMIE-LLDP) has the same field of view as open thoracotomy, is safe in emergency situations, and provides education on open thoracotomy. Between September 2020 and April 2024, RAMIE-LLDP was performed in 64 consecutive patients with esophageal cancer. RAMIE-LLDP was performed with the operating table rotated and tilted 45° to the ventral side under artificial pneumothorax. The hand-control setting of the surgical-assist robot system was reversed left to right when the Patient Cart was rolled from the same direction as the RAMIE in the prone position. The mean total surgery and console times during the thoracic procedure were 254-min overall and 225min in the last 24 cases and 195-min overall and 178-min in the last 24 cases, respectively. The mean amount of blood loss was 203.4g overall and 28.3g in the last 24 cases. Postoperative recurrent laryngeal nerve palsy with Clavien-Dindo classification (CD) was ≥ 2 in six patients (9.4%). Postoperative pneumonia with CD ≥ 2 was observed in 11 patients (17.2%). Conversion to open thoracotomy was observed in three patients (4.7%). In all three patients, an immediate conversion to thoracotomy without patients' position change was actually possible and no serious complications were noted. No mortality occurred within 30days postoperatively. RAMIE-LLDP which facilitates emergency thoracotomy has perioperative results comparable to those of conventional thoracoscopic esophagectomy and is educational for open surgery. RAMIE-LLDP is the safest and most optimal surgery for esophageal cancer.

Prevalence of Anemia among Adolescent School Girls of Bardoli Taluka, Surat, Gujarat

Introduction: Anemia is a serious public health challenge in India. It affects women, adolescents and children throughout the lifecycle. In boys and girls it limits their development, learning ability, reduce concentration in daily task, increases risk of infections, increases school dropout rates and reduces their physical activity. Anemia in girls can increase risk of pregnancy associated complications like premature births, low birth weight of baby and perinatal and maternal mortality. Aims of the study: The aim of the present study was to identify the prevalence of anemia and its associated factors among adolescent school girls of Bardoli, Surat. Material and methods: A cross sectional survey was carried out to identify the prevalence of anemia among 815 adolescent school girls from both Government and Private schools by using non probability purposive sampling technique and who fulfilled the inclusion criteria Digital hemoglobinometer was used to collect capillary blood for estimation of hemoglobin level. Result: Study results showed that, 694 (85 %) girls were having anemia and 15% of them had normal hemoglobin level. 48% had mild anemia and 37% had moderate level of anemia. 2 (0.24%) girls had severe anemia. It was highly prevalent among 417 (60.15 %) girls of government schools than the private school. Majority 551 of them were under weight (BMI &lt; 18.5). Level of anemia was significant with age, residence, dietary pattern, education and occupation of parents, family income. Menstruation related factors like regularity, amount of blood loss was significant. Conclusion: Anemia is still a major health problem in our country. Anaemia among adolescent girls still continues to be a significant public health problem.

Validity of laparoscopic surgery for lower gastrointestinal perforations.

This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p = .049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p < .001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p < .001), especially wound infection (0% vs. 26.3%, p = .002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p < .001). In the laparoscopic group, hospital mortality was 0%. The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection.

Long-term efficacy of oblique lateral interbody fusion combined with vertebral screw fixation for the treatment of lumbar specific infection

To explore medium and long term efficacy of oblique lateral interbody fusion (OLIF) in treating lumbar specific infection. From October 2017 to January 2021, 24 patients with lumbar specific infection were treated by OLIF combined with vertebral screw internal fixation, including 15 males and 9 females, aged from 27 to 61 years old with an average of (43.0±15.0) years old;the courses of disease ranged from 6 to 24 months with an average of (14.0±7.0) months;7 patients with L2-L3, 12 patients with L3-L4 and 5 patients with L4-L5;19 patients with tuberculosis infection and 5 patients with brucella infection. The amount of intraoperative blood loss, operative time and complications were recorded, and erythrocyte sedimentation rate(ESR), C-reactive protein (CRP), visual analogue scale (VAS), Japanese Orthopaedic Association(JOA) score and American Spinal Injury Association (ASIA) rating were compared before and one month after opertaion. All patients were followed up from 9 to 24 months with an average of (13.0±6.0) months. Operative time was (132.5±21.4) min, and intraoperative blood loss was (227.3±43.1) ml. ESR and CRP were decreased from (82.34±18.62) mmol·h-1 and (53.08±21.84) mg·L-1 before operation to (33.52±17.31) mmol·h-1 and (15.48±8.36) mg·L-1 at one month after operation, respectively (P<0.05). VAS was decreased from (7.52±1.36) before opertaion to (1.74±0.87) at one month after operation (P<0.05). JOA was increased from (17.86±3.95) before operation to (24.72±3.19) at one month after operation (P<0.05). Four patients had neurological symptoms before operation, and were classified to grade D according to ASIA classification, who were recovered to grade E at 1 month after operation. One patient was suffered from psoas major muscle injury after operation, and returned to normal at 3 weeks. One patient was suffered from abdominal distension and difficulty in defecation, and relieved after gastrointestinal decompression and enema. No complications such as abdominal organ injury and poor wound healing occurred in all patients. OLIF combined with vertebral screw internal fixation is a new minimally invasive surgical method for the treatment of lumbar specific infection, especially the lesion located on the middle lumbar vertebra. It has advantages of less trauma, short operation time, less blood loss, convenient operation, complete removal of the lesion, safety and effectiveness, and has good medium-and long-term efficacy for lumbar specific infection.

Blood loss during three column osteotomies: influence on outcomes and mitigation strategies.

Three column osteotomies (3CO) are a powerful tool for the correction of rigid sagittal spinal deformities. However, 3CO surgeries are technically demanding procedures that are associated with prolonged operative times, large amounts of intraoperative blood loss, and high rates of post-operative neurological and medical complications. The purpose of this retrospective cross-sectional study is to delineate the effects of blood loss, blood transfusion, and tranexamic acid use on perioperative outcomes following 3CO. Patients undergoing 3CO between 2014 and 2021 were identified using current procedural terminology (CPT) codes, and charts were reviewed for demographics, surgical characteristics, and post-operative length of stay (LOS). Statistical analysis included T-tests for continuous characteristics and χ2 testing for categorical characteristics. Regression models were used to further investigate relationships between outcomes and variables of interest. Forty-two patients met inclusion criteria. Increased intensive care unit (ICU) LOS was positively correlated with increased operative length (P=0.02), percent estimated blood volume (EBV) lost (P=0.02), and number of units of red blood cell transfusion (P<0.001). Increased hospital LOS was associated with increased number of intraoperative blood transfusions (P=0.01). Linear regression analyses controlling for age, gender, and American Society of Anesthesiologists (ASA) class showed that each 21% increase in EBV loss was associated with a one day increase in ICU LOS (P=0.01). Similarly, each additional unit of packed red blood cells transfused was associated with 0.728 day increase in hospital LOS. Increased intraoperative blood loss was associated with longer ICU stays. Red blood cell transfusions were also associated with increased hospital and ICU LOS. No variables of interest related to intraoperative blood loss or blood transfusion were associated with readmission or reoperation at any time point. These findings highlight the need for continued focus on surgical techniques and adjuncts that can minimize blood loss and transfusion requirements.

Acquired Low Factor XIII Activity Is Associated with an Increased Need for Blood Transfusions in Patients with Gastrointestinal Bleedings

BackgroundFactor XIII plays a key role within the coagulation cascade.ObjectiveWe aimed to investigate the relevance of factor XIII activity on the outcome of patients with gastrointestinal bleedings.MethodsIn this retrospective, single-center study patients with gastrointestinal bleeding and measurement of factor XIII activity were included. The primary endpoint was the number of red blood cell transfusions in patients with reduced factor XIII activity (< 70%) compared to patients with normal activity. Additionally, the influence of factor XIII substitution was assessed.ResultsNinety-seven patients (median age: 64 [IQR 55, 77] years, 31 (32%) females) were included in the analysis. Fifty-six (58%) patients suffered from an upper gastrointestinal bleeding. 66 (68%) patients had a factor XIII activity < 70% and 24 (36%) of those received factor XIII substitution. Patients with reduced FXIII activity needed significantly more red blood cell transfusions than patients with normal activity (9 [5, 12] vs. 4 [1, 8], p < 0.001). Patients receiving factor XIII substitution showed a trend toward a decreased need for transfusions after substitution (0 [0, 5] vs. 3 [1, 6], p = 0.066). Factor XIII activity correlated negatively with the INR (rs = -0.24, p = 0.018) and positively with hemoglobin levels (rs = 0.28, p = 0.006) and with thrombocyte counts (rs = 0.30, p = 0.003).ConclusionThe present study shows an association of factor XIII activity with the requirement of blood transfusions in patients with gastrointestinal bleedings and indicates a potential benefit of factor XIII substitution. Factor XIII activity seems to be dependent from the amount of blood loss and the global coagulation parameters.

Comparison of two surgical approaches in treating children with thoracolumbar junction tuberculosis: a multicenter study

ObjectivesWe conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3–10 years.MethodsHerein, 52 TLJ TB patients (age range = 3–10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant.ResultsThe average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients’ VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up.ConclusionFor pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.

Clinical effect of posterior-only approach debridement, intervertebral fusion, and internal fixation for upper thoracic tuberculosis.

This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.

In total knee arthroplasty surgeries, what is the effective dose of intra-articular tranexamic acid?

The aim of our study was to evaluate the effect of different doses of intra-articular (IA) tranexamic acid (TXA) on blood loss in total knee arthroplasty surgeries and compare it to the control group. A total of 160 patients who underwent unilateral total knee arthroplasty surgery at Edirne State Hospital between 2016 and 2020 were divided into four groups. The estimated blood loss and amount of blood loss from drainage, as well as transfusion rates, were compared between the groups based on surgical pre- and post-operative blood parameters to evaluate the dose effectiveness. In our study, all TXA groups significantly reduced the estimated blood loss and amount of blood loss from drainage compared to the control group. No statistically significant difference was found between the control group and the group receiving 1 g of TXA in terms of transfusion rates (p = 0.062), and no statistically significant difference was found between the groups receiving 2 g and 3 g of TXA. The use of 2 g of IA TXA is an effective dose for controlling blood loss in total knee arthroplasty surgeries. Lower doses do not have a significant effect on transfusion rates, whereas higher doses do not significantly increase effectiveness.

Comparison of renal function between the artery and vein clamp and artery-only clamp in robot-assisted partial nephrectomy for moderate- to high-complexity renal masses: A propensity-matched study.

Artery and vein (AV) clamps can control venous bleeding in the surgical field and prevent carbon dioxide embolism, especially when large veins are expected to open. However, whether AV clamps cause more renal damage than artery-only (AO) clamps remains unclear. This study aimed to compare renal function and blood loss in surgeries using AO and AV clamps based on high RENAL nephrometry scores (RNS) in robot-assisted partial nephrectomy (RAPN). We retrospectively analyzed the medical records of 500 patients who underwent RAPN between March 2016 and December 2021. We performed 1:1 propensity matching for these patients. A total of 340 patients with pathological malignancies who were followed up for at least 12 months were included in this analysis. A total of 291 patients with AO clamping and 49 patients with AV clamping were included. Overall, the AV clamp group had higher total RNSs and larger diameters than the AO clamp group. Propensity score-matched analysis included 37 patients in each clamp group. The median warm ischemia times of the AV and AO clamps were 25 and 22 min, respectively, with no significant difference. There were no statistically significant differences between the groups in the amount of blood loss, rate of acute kidney injury (AKI), or renal function at 1, 3, or 12 months post-RAPN. Compared with the AO clamp, the AV clamp did not have a detrimental impact on blood loss or renal dysfunction. Consequently, AV clamps may be considered for patients presenting with moderate-to-high-complexity RNSs.

622. COMPARISON OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY WITH CONVENTIONAL MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A MULTI-INSTITUTIONAL COHORT STUDY

Abstract Background The Japanese public insurance system approved robot-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer in 2018. Since then, an increasing number of RAMIE has been performed every year. However, it is unclear whether RAMIE is more beneficial than conventional minimally invasive esophagectomy (MIE) in terms of short-term and long-term outcomes. Methods A total of 396 patients (RAMIE, 145; MIE, 251) with resectable esophageal cancer who underwent esophagectomy between 2016 and 2019 at 6 institutions were included. A propensity score matching analysis was performed to compare the short-term outcome. Two-stage esophagectomy, salvage surgery, and palliative resection were excluded. Individual propensity scores were calculated based on the following 15 variables: age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS), hemodialysis, oral steroid use, obstructive pulmonary disease, histology, tumor location, clinical T, N, M classification, preoperative therapy, field of lymphadenectomy, and organ used for reconstruction. Results After matching 272 patients were analyzed. RAMIE took the significantly longer operating time (629min; 570min, p=0.0005), but the amount of blood loss (90g; 84g), number of harvested mediastinal nodes (24; 25), and in-hospital mortality (1.5%; 0.7%) were comparable. RAMIE group showed a trend of less severe post-operative morbidity (Clavien–Dindo grade III or higher) (18%; 27%) and significant reduction of recurrent laryngeal nerve palsy (23%; 35%, p=0.046). The 5-year overall and relapse-free survival in the RAMIE and MIE groups were 65%; 61% [hazard ratio (HR), 0.77; 95% CI: 0.51, 1.17], and 61%; 51% (HR, 0.73; 95% CI: 0.51, 1.06), respectively. Conclusion RAMIE was safely performed even during the early period of its application. Despite the longer operating time, RAMIE would be a promising alternative to MIE, with a better trend of short- and long-term outcomes, including a significantly lower incidence of postoperative recurrent laryngeal nerve palsy.

The outcomes of component separation technique versus no component separation technique in the repair of large ventral hernias and impact on quality of life: a multicenter retrospective cohort study.

This study aimed to compare the results of patients who underwent anterior component separation techniques (ACST) and those who did not undergo component separation techniques (non-CST) in complicated ventral hernia repairs (VHRs) and to investigate the effect of these techniques on quality of life (QoL). A total of 105 patients who were operated for large ventral hernias were retrospectively analyzed. The patients were divided into the ACST group (n = 48) and the non-CST group (n = 57). Demographic, intraoperative, and postoperative data were recorded. Postoperative follow-up was conducted at 2 and 4 weeks, and 6, 12, and 24 months. The primary and secondary outcomes and QoL were measured. The female ratio was higher in both groups (P = 0.512). There was no significant difference between age and body mass index between the groups (P = 0.705 and P = 0.803). The mean defect size and mesh size were similar between the groups (P = 0.775 and P = 0.245). The mean operation duration and amount of blood loss were similar between the groups (P = 0.801 and P = 0.142). There was no statistically significant difference in the median visual analog scale scores between the groups (P = 0.551). During follow-up, only 3 patients (6.3%) in the ACST group and 4 patients (7.0%) in the non-CST group had recurrence. There was no significant difference in the short- and long-term QoL between the groups. The ACST is a feasible surgical option for patients with complicated VHRs. In addition, by improving QoL, the recurrence rate is similar to patients undergoing standard VHR.

Tranexamic acid in prevention of postpartum hemorrhage: a case-control study from Nepal

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. WHO recommends the use of tranexamic acid in addition to oxytocin for the prevention and treatment of PPH. However, it is not yet standardized. Our study aims to assess the effectiveness of tranexamic acid in preventing PPH in low-risk patients. Method: This hospital-based case-control study included 60 patients, 30 undergoing vaginal delivery and 30 cesarean delivery. Fifteen cases undergoing vaginal delivery received 1 g tranexamic acid in addition to 10 units of oxytocin, while 15 controls received only oxytocin. 15 cases undergoing cesarean section received 1 g tranexamic acid followed by 6 units of oxytocin after delivery, while 15 controls received only oxytocin. Blood loss after placental delivery and hemoglobin were measured 12 h postpartum. Results: Mean volume of blood loss was lower in the case as compared to the control group in both vaginal delivery (134.05 ± 8.7.85 mL vs. 334.22 ± 280.57 mL, P = 0.01) and cesarean delivery (333.35 ± 139.18 mL vs. 553.74 ± 321.37 mL, P = 0.03). The incidence of PPH was lower in the case as compared to the control group in both vaginal delivery (0% vs 16.66%, P = 0.01) and cesarean delivery (3.33% vs 23.33%, P = 0.02). Mean change in hemoglobin was lower in the case as compared to the control group in both vaginal delivery (0.50 ± 0.65 g/dl vs. 1.77 ± 2.11, P = 0.03) and cesarean section (1.52 ± 1.15 g/dL vs. 2.69 ± 1.81 g/dL, P = 0.00). Blood transfusion was lower in the case as compared to the control group in both vaginal delivery (0% vs. 13.33%, P = 0.03) and cesarean delivery (0% vs. 16.66%, P = 0.01). Conclusion: Tranexamic acid, in addition to oxytocin, reduces the mean amount of blood loss during delivery and helps prevent PPH.

Proximal femoral nail antirotation combined with locking plate in the treatment of femoral intertrochanteric fractures with lateral wall fractures

To investigate the effect of locking plate internal fixation for the treatment of proximal lateral femoral wall fracture. From January 2021 to June 2022, 31 patients with intertrochanteric fractures and lateral wall fractures were treated. Among them, 15 patients were treated with proximal femoral nail antirotation (PFNA) fixation including 3 males and 12 females with an average age of (75.87±7.46) years old;the other 16 patients were treated with 3.5 mm pre-curved screw locking plate fixtion for lateral wall fracture including 4 males and 12 females with an average age of (76.15±9.47) years old. After surgery, the surgical index, tip-apical distance(TAD), postoperative standing weight-bearing time, and fracture reduction were compared between two groups. Postoperative hip function was evaluated according to Harris hip score. All patients were followed up for an average of (12±5) months ranging from 7 to 17 months. The immediate postoperative neck angle ranged from 111° to 132°(119.3±8.3)°. Fracture reduction results were excellent in 11 cases, fair in 2, worse in 1 in PFNA group;excellent in 12, fair in 3, worse in 1 in PFNA+locking plate group. One case of the PFNA group had a spiral blade cut out through the femoral head. There were significant differences in the time of operation, the amount of blood loss during the operation, the length of incision between two groups(P<0.05). There was no significant difference in TAD and postoperative standing weight-bearing time between two groups(P>0.05). There were significant differences in Harris scores at 6 months after surgery between two groups(P<0.05). The application of PFNA-assisted locking plate in the treatment of femoral intertrochanteric fractures with lateral wall fractures is effective, and can restore the integrity of lateral wall, improve the stability of PFNA internal fixation, and reduce postoperative complications.

Oncologic and Functional Outcomes of Salvage Robot-Assisted Radical Prostatectomy: Report of the First 10 Cases.

Salvage robot-assisted radical prostatectomy (sRARP) after PSA failure in patients who underwent initial radiotherapy or focal therapy has rarely been reported in Japan. We aimed to report the oncologic and functional outcomes of the first 10 cases of sRARP. Ten patients underwent sRARP after failing to respond to initial radiotherapy or focal therapy. Initial definitive treatment included volumetric modulated arc therapy, intensity-modulated radio therapy, stereotactic body radiotherapy, heavy-ion radiotherapy, low-dose-rate brachytherapy, and high-intensity focused ultrasound. We retrospectively investigated 10 cases on oncologic and functional outcomes of sRARP. The median PSA level at sRARP, amount of blood loss, and console time were 2.17 ng/mL, 100 mL, and 136 min, respectively. Positive surgical margins were found in half of the cases. Median follow-up was 1.1 years. There were no 30-day major complications. No patients had erections after sRARP. Urinary continence and biochemical recurrence (BCR) rate were 40% and 30% at 1 year after sRARP, respectively. Salvage RARP may be a feasible option after PSA failure in patients who underwent radiotherapy or focal therapy as initial treatment, showing acceptable BCR rate.