Blood Loss In Group Research Articles

Application of Polydioxanone Sutures in the Nuss Procedure.

Background/Purpose The Nuss procedure is the most common surgical repair for pectus excavatum (PE). Surgical steel wires are used in some modifications of the Nuss procedure to attach one or both ends of a support bar to the ribs. During follow-up, wire breakage was found in some cases. Patients with wire breakage may undergo prolonged bar removal surgery and may be exposed to excessive radiation. In this study, we had a series of patients who received polydioxanone suture (PDS) fixations instead of steel wires. This retrospective study was conducted to explore the differences between these two fixation materials in the incidence of related complications and efficacies. Furthermore, we attempted to observe whether the two materials lead to similar surgical efficacy in the Nuss procedure, whether they have divergent effects on the bar removal surgery, and whether PDS can reduce the risks due to steel wire breakage as expected.Methods We retrospectively studied PDS and surgical steel wires as fixation materials for the Nuss procedure in children with congenital PE and reviewed the outcomes and complications. A total of 75 children who had undergone Nuss procedure repairs and bar removals from January 2013 to December 2019 were recruited to participate in this study. They were divided into three groups: the PDS group, the unbroken wire (UBW) group, and the broken wire (BW) group, according to the fixation materials and whether the wires had broken or not. Moreover, we selected the duration of operation (DO), intraoperative blood loss (BL), bar displacement (BD), postoperative pain score (PPS), and incision infection as the risk indicators and the postrepair Haller index (HI) as the effectiveness indicator. These indicators were statistically compared to determine whether there were differences among the three groups. Results One BD occurred in the PDS and BW groups while none took place in the UBW group. No incision infection was found in any of the groups. The PDS group had the shortest DO, while the DO in the UBW group was shorter than that in the BW group ( p < 0.05). BL in the PDS group was less than that in the other two groups ( p < 0.05). Additionally, no difference was observed in BL between the BW and UBW groups ( p > 0.05). The PPS of the PDS group was less than that of the BW group ( p < 0.05), whereas no differences were found between the other two groups. No statistical difference emerged in HI among the groups ( p > 0.05). Conclusion PDS fixation results in a similar repair outcome and shows certain advantages in the DO, BL, and PPS; also, PDSs are safe and effective in the Nuss procedure. Level of evidence Level III.

Efficacy of a Temporary Hemostatic Device in a Swine Model of Closed, Lethal Liver Injury.

Solid abdominal organ hemorrhage remains one of the leading causes of death both on the battlefield of modern warfare and in the civilian setting. A novel, temporary hemostatic device combining CELOX and direct intra-abdominal physical compression was invented to control closed SAOH during transport to a medical treatment facility. A swine model of closed, lethal liver injury was established to determine hemostasis. The animals were randomly divided into group A (extra-abdominal compression), group B (gauze packing), group C (intra-abdominal compression), group D (CELOX coverage), and group E (intra-abdominal compression and CELOX coverage) with six swines per group. Survival time (ST), blood loss (BL), vital signs, pathologic examination, and CT-scan were monitored to further observe the effectiveness of the device. Group E had an average 30-minute extension in ST (74.3±15.4minutes versus 44.0±13.8minutes, p=0.026) with less BL (46.0±13.0 versus 70.8±8.2g/kg, p=0.018), and maintained mean arterial pressure≥70mmHg and cardiac output≥3.5L/minute for a longer time. No significant differences were observed in ST and BL of groups B and E, and there were no marked differences in ST and BL of groups A, C, and D. No CELOX clots were noted in the spleen, pancreas, lungs, heart, kidneys, or the adjacent large vessels in groups D and E. Compared to group A, the CT-scan showed better hepatic hemorrhage control in group E. The device, which combined 20g of CELOX particles and 20 pieces of CELOX (8g) sponge tablets with 50-mmHg intra-abdominal compression for 10minutes, prolonged the ST by an average of 30minutes with less BL. It was not markedly different from the full four quadrants gauze packing of liver in hemostatic effect, with no CELOX clot formation in other organs.

PCN32 - Comparison of Video-Assisted Thoracic Surgery Segmentectomy (VATS-S) Versus Video-Assisted Thoracic Surgery Lobectomy (VATS-L) for Stage I Non-Small Cell Lung Cancer (NSCLC-I) in Chinese Patients: A Systemic Review and Meta-Analysis

VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. However, owing to small sample sizes of relevant clinical studies, there is no conclusive evidence of the relative benefit between the outcomes of VATS-S and VATS-L in Chinese patients. This meta-analysis offers the first robust comparative assessment of the safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients with NSCLC-I. A thorough search of major electronic databases was conducted to identify surgical studies on Chinese patients with NSCLC-I till September 2017. Random-effects meta-analysis was used to estimate risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for dichotomous and continuous variables, respectively. The main outcomes and measures were operating room time (ORT), intraoperative blood loss (BL), number of lymph nodes resected (LNRN), total volume of chest tube drainage postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS), post-operative complications (POC), overall cancer recurrence rate (ORR), local cancer recurrence rate (LRR) and distal cancer recurrence rate (DRR). 7 studies, with 762 NSCLC-I patients (229 VATS-S, 533 VATS-L), were included. Patient characteristic baselines were matched between 2 groups, including age (p=0.22), gender (p=0.67) and comorbidity rate (p=0.37). The average follow-up time was 10.2 to 27 months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml (MD:-224.42, 95%CI (-345.06, -103.79), p=0.0003); a reduction of CTD by 0.73 days (-1.42, -0.03; p=0.04); and a reduction of LOS by 0.58 days (-1.04, -0.11; p=0.02). There was no significant difference between the groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. VATS-S is a less invasive surgical technique which is associated with less chest tube drainage volume, shorter chest tube duration, and shorter length of stay compared to VATS-L in the treatment of Chinese patients with stage I NSCLC.

The efficacy of B-type natriuretic peptide for early identification of blood loss in traumatic injury

Background Because B-type natriuretic peptide (BNP) secretion has a direct linear correlation with intravascular volume status, it was assessed as an initial marker for blood loss (BL) in polytrauma patients. Methods Hemodynamically unstable trauma patients between 18 and 45 years had serial BNP levels and hemoglobin (Hgb) levels obtained on admission, at 8 and 24 hours, and every morning during resuscitation. Results The 14 patients were categorized into 2 groups based on the 24-hour trend in Hgb levels: clinically significant blood loss (Hgb decrease >3 g/dL) or no clinical blood loss (Hgb decrease <3 g/dL). On admission, the 5 patients in the no blood loss group had normal BNP levels, whereas the 9 patients in the BL group had below-normal BNP levels. Because patients in the BL category were resuscitated, their BNP levels normalized. Conclusions BNP levels below normal are indicative of intravascular volume loss in traumatically injured patients.