Common Postoperative Complication Research Articles

Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center.

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.

A modern approach to multiple pulmonary resections in children with recurrent metastatic pulmonary disease.

Implications of repeated resections of pulmonary metastasis (PM) are not well documented in the modern era. Fifteen children underwent two (n=8), three (n=3), or four or more (n=3) resections (total=38 procedures), most commonly for osteosarcoma (71%). Operative approach included muscle-sparing thoracotomy (71%), non-muscle-sparing thoracotomy (18%), and video-assisted thoracoscopy (11%). Median resected nodules per procedure was four (range = 1-95). Prolonged air leaks were the most common postoperative complication (29%). Median hospital stay was 4days, and no children were discharged with or have required oxygen. Event-free survival is 67% at median follow-up time of 54months, with an overall survival rate of 64%. Repeat resection of PM appears to be well tolerated, without prolonged hospital stays or compromised pulmonary function.

Efficacy of Foldable Capsular Vitreous Body Implants Filled With Light or Heavy Silicone Oil in the Treatment of Silicone Oil-dependent Eyes.

The purpose of this study was to compare the clinical efficacy of foldable capsular vitreous body (FCVB) filled with either light or heavy silicone oil and the incidence of complications after their implantation for the treatment of severe ocular trauma and silicone oil-dependent eyes. FCVB filled with either light (n = 16) or heavy (n = 8) silicone oil was implanted in 24 patients. During the 12-month follow-up period, the intraocular pressure, final best-corrected visual acuity, retinal reattachment condition, position of the FCVB, and complications were assessed. All surgeries were performed without issue. There was no significant difference in preoperative and postoperative best-corrected visual acuity between the two groups. A significant improvement in the intraocular pressure was observed after surgery in both the light silicone oil (P = 0.029) and heavy silicone oil (P = 0.035) groups. None of the patients developed displacement or prolapse of the FCVB. The most common early and late postoperative complications were postoperative hemorrhage (33.3%) and corneal opacification (50%), respectively. FCVB filled with heavy silicone oil can be used as a supplemental therapy for patients who have lost the anterior segment of their eye, have lesions of the inferior retina, or cannot maintain the prone position for various reasons. Implantation of FCVB combined with heavy silicone oil compensates for the shortcomings of this with light silicone oil, providing patients with more personalized treatment.

ICG mapping of postoperative lymphatic leakage in the groin: a video article and literature review.

Inguinofemoral lymphoceles are a common postoperative complication after inguinofemoral lymphadenectomy (LNE) and a challenge for patients as well as physicians. We report here our preliminary experience in the surgical management of a recurrent lymphocele using indocyanine green (ICG) detection, followed by robotic-assisted closure of the lymphatic leaks. The aim of this article is to illustrate the surgical steps of ICG-assisted detection of inguinal lymphatic leaks and their surgical treatment by means of robot-assisted suturing. Furthermore, the feasibility of the approach will be evaluated. A 59-year-old woman with locally advanced squamous cell carcinoma of the vulva and previous conventional bilateral inguinofemoral LNE presented with symptomatic therapy-resistant lymphoceles in the groin. After a lengthy and frustrating course of standard therapy, she was offered the off-label option surgical treatment with ICG detection and subsequent robot-assisted ligation of the leaks, using the Da Vinci robotic system™. Perioperative data, specific aspects of the surgical approach specifics, objective and subjective outcomes of the new approach. The procedure was performed as planned, with no intraoperative complications or device-related issues. The postoperative course was uneventful, and the patient developed no further lymphoceles. Visualisation of the leakage by ICG combined with minimally invasive robotic-assisted laparoscopy is a promising therapy option. The pictures and videos demonstrate our experience in regard of the safety, feasibility, and usefulness of this procedure. Further studies will be needed, to prove the absolute efficacy of the technique and express a general recommendation in regard of this approach for the treatment of inguinofemoral lymphoceles.

252. RIGHT GASTROEPIPLOIC ARTERY LENGTH DETERMINED ANASTOMOTIC LEAKRIGHT GASTROEPIPLOIC ARTERY LENGTH DETERMINED ANASTOMOTIC LEAKAGE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER-A PROSPECTIVE COHORT STUDY

Abstract Background This prospective cohort study, conducted at a high-volume esophageal cancer center from July 2019 to July 2022, aimed to investigate the link between the right gastroepiploic artery (RGEA) length and anastomotic leakage (AL) rates following minimally invasive esophagectomy (MIE). Real-world data on stomach blood supply in the Chinese population were examined. Materials and methods A total of 516 cases were enrolled, categorized into two groups based on the Youden index-determined optimal cut-off value for the relative length of RGEA (length of RGEA/length of gastric conduit, 64.69%) through ROC analysis: Group SR (short RGEA) and Group LR (long RGEA). The primary observation parameter was the relationship between AL incidence and the ratio of direct blood supply from RGEA. Secondary parameters included the mean length of the right gastroepiploic artery, greater curvature, and the connection type between right and left gastroepiploic vessels. Patient data were prospectively recorded in electronic case report forms. Results The study revealed median lengths of 43.60 cm for greater curvature, 43.16 cm for the gastric conduit, and 26.75 cm for RGEA. AL, the most common postoperative complication, showed a significant difference between groups (16.88% vs. 8.84%, p = 0.01). Multivariable binary logistic regression identified Group SR and LR (Odds ratio: 2.651, 95% CI: 1.124–6.250, p = 0.03) and Neoadjuvant therapy (Odds ratio: 2.479, 95% CI: 1.374–4.473, p = 0.00) as independent predictors of AL. Conclusions The study emphasizes the crucial role of RGEA length in determining AL incidence in MIE for esophageal cancer. Preserving RGEA and fostering capillary arches between RGEA and LGEA are recommended strategies to mitigate AL risk.

Six-Month Outcomes of Goniotomy Performed with a Trapezoidal Dual Blade in Combination with Cataract Surgery.

To assess the efficacy and safety of goniotomy using a uniquely shaped trapezoidal, serrated dual blade (TDB), designed to accommodate variability in patient anatomy, in reducing intraocular pressure (IOP) or anti-glaucoma medications (AGM) in adult glaucoma patients when combined with cataract surgery. Retrospective consecutive case series of patients with glaucoma who underwent phacoemulsification with TDB-goniotomy were included. Preoperative, intraoperative, and postoperative data were collected over 6 months. The primary outcome measure was surgical success, defined as IOP reduction ≥20% from baseline at 6 months, and/or reduction of at least 1 AGM. Postoperative adverse events were collected as a secondary outcome measure. Sixty-five eyes of 46 patients were included with data available on 53 eyes at 6 months. Primary open-angle (38%), primary angle-closure (37%), and mixed-mechanism glaucoma (11%) were the most common diagnoses. Most cases were severe (48%) or moderate (32%) stage. At the 6-month mark, surgical success was achieved in 92% of eyes by either or both criteria. Mean preoperative IOP decreased from 18.4mmHg (SE 0.83) to 13.0mmHg (SE 0.37) (p<0.001) at postoperative month 6. Mean AGM decreased from 2.46 (SE 0.19) preoperatively to 1.45 (SE 0.17) (p<0.001). The most common postoperative complication was an IOP spike at postoperative week 1 (11%). No serious adverse events occurred related to the goniotomy. TDB-goniotomy in combination with cataract surgery safely and effectively lowered IOP and reduced AGM burden in adults with various types and severities of glaucoma over 6-months of follow-up.

Analysis of postoperative complications of orbital fracture.

To analyze the types and causes of complications following orbital fracture reconstruction and enhance clinicians' capacity to manage or prevent such complications. We conducted a retrospective case series analysis, retrospectively collecting and analyzing clinical data of patients with orbital fractures who received surgical treatment at the Affiliated Eye Hospital of Nanchang University from May 2012 to May 2022. Descriptive statistics were employed to document common postoperative complications, and we recorded complications persisting after a minimum 6-month follow-up period. Among the 227 patients who underwent orbital fracture surgery, they were followed up for 6 to 36 months, and complications occurred in 15 cases, resulting in an incidence rate of 6.61%. These complications included implant material infections and rejections (4 cases), persistent diplopia (3 cases), intraorbital hematomas (2 cases), epiphora (2 cases), lower eyelid eversion or retraction (2 cases), and skin scars (2 cases). The primary cause of postoperative infection was chronic inflammation in the paranasal sinuses or closed cavities within the fracture area. Postoperative complications in orbital fractures were associated with various factors, including the timing of surgery, surgical approach, repair materials, surgical skills, and auxiliary techniques. Standardizing surgical techniques and implementing precise auxiliary technologies may reduce the incidence of complications and enhance the operation's success rate.

Timing of Loop Ileostomy Closure Does Not Play a Pivotal Role in Terms of Complications-Results of the Liquidation of iLEOstomy (LILEO) Study.

Loop ileostomy is commonly performed by colorectal and general surgeons to protect newly created large bowel anastomoses. The optimal timing for ileostomy closure remains debatable. Defining the timing associated with the best postoperative outcomes can significantly improve the clinical results for patients undergoing ileostomy closure. The LILEO study was a prospective multicenter cohort study conducted in Poland from October 2022 to December 2023. Full data analysis involved 159 patients from 19 surgical centers. Patients were categorized based on the timing of ileostomy reversal: early (<4 months), standard (4-6 months), and delayed (>6 months). Data on demographics, clinical characteristics, and perioperative outcomes were analyzed for each group separately and compared. No significant differences were observed in length of hospital stay (p = 0.22), overall postoperative complications (p = 0.43), or 30-day reoperation rates (p = 0.28) across the three groups. Additional analysis of Clavien-Dindo complication grades was performed and did not show significant differences in complication severity (p = 0.95), indicating that the timing of ileostomy closure does not significantly impact perioperative complications or hospital stay. Decisions on ileostomy reversal timing should be personalized and should consider individual clinical factors, including the type of adjuvant oncological treatment and the preventive measures performed for common postoperative complications.

Construction and verification of a machine learning-based prediction model of deep vein thrombosis formation after spinal surgery

BackgroundDeep vein thromboembolism (DVT) is a common postoperative complication with high morbidity and mortality rates. However, the safety and effectiveness of using prophylactic anticoagulants for preventing DVT after spinal surgery remain controversial. Hence, it is crucial to predict whether DVT occurs in advance following spinal surgery. The present study aimed to establish a machine learning (ML)-based prediction model of DVT formation following spinal surgery. MethodsWe reviewed the medical records of patients who underwent elective spinal surgery at the Third Affiliated Hospital of Zunyi Medical University (TAHZMU) from January 2020 to December 2022. We ultimately selected the clinical data of 500 patients who met the criteria for elective spinal surgery. The Boruta-SHAP algorithm was used for feature selection, and the SMOTE algorithm was used for data balance. The related risk factors for DVT after spinal surgery were screened and analyzed. Five ML algorithm models were established. The data of 150 patients treated at the Affiliated Hospital of Zunyi Medical University (AHZMU) from July 2023 to October 2023 were used for external verification of the model. The area under the curve (AUC), geometric mean (G-mean), sensitivity, accuracy, specificity, and F1 score were used to evaluate the performance of the models. ResultsThe results revealed that activated partial thromboplastin time (APTT), age, body mass index (BMI), preoperative serum creatinine (Crea), anesthesia time, rocuronium dose, and propofol dose were the seven important characteristic variables for predicting DVT after spinal surgery. Among the five ML models established in this study, the random forest classifier (RF) showed superior performance to the other models in the internal validation set. ConclusionSeven preoperative and intraoperative variables were included in our study to develop an ML-based predictive model for DVT formation following spinal surgery, and this model can be used to assist in clinical evaluation and decision-making.

Our Experience With 200 Cases of Inguinal Hernia Repair Using the Dynamic Self-Adjusting Prosthesis: A Case Series and Literature Review.

Introduction Inguinal hernioplasty (IH) is one of the most frequently performed surgical procedures globally. Today, a variety of surgical techniques and prosthesis types are available for this procedure. Methods At our center, we performed 200 inguinal hernioplasties using the dynamic self-adjusting prosthesis (protesi autoregolantesi dinamica, PAD) from May 1, 2022, to May 31, 2023. Our objective was to retrospectively analyze the outcomes and compare them with the current scientific literature on this surgical technique. Results Our results align with those reported by other authors using the same surgical technique. With the PAD technique, we assessed the type and frequency of adverse events up to 12 months following IH. All patients were male, with an average BMI of 26.6. Among the 200 hernias, 99 were right-sided, 101 were left-sided, 63 were direct, and 137 were indirect. The average length of hospitalization was one day. The most common postoperative complication was hematoma near the surgical site, but no prosthesis displacement was observed. In 71% of patients, analgesics were discontinued within 24 hours. The outcomes of our study are comparable to those reported by the inventor of this surgical technique. Conclusion The procedure has demonstrated safety and effectiveness and could serve as a viable alternative to traditional IH techniques.

Boston Type II Keratoprosthesis, 7 Years of Experience and Outcomes From a Spanish Tertiary Eye Care Hospital

To report midterm outcomes of Boston Keratoprosthesis type II at a reference center in Spain. Retrospective case series. This observational study included medical records of 9 patients who underwent Boston Keratoprosthesis type II surgery at Cruces University Hospital from May 2016 through May 2023. A total of 9 eyes received this device during the study period. One patient who had undergone a modification of the standard procedure was excluded. Preoperative and postoperative parameters were studied. The main outcomes analyzed were visual acuity, device retention, and complications and their management. The most common indication for implantation was severe Sjögren syndrome (33.3%) followed by graft-versus-host disease (22.2%). The mean follow-up was 3.89 years (±2.08). Visual acuity improved to better than or equal to 20/40 in 8 eyes (88.8%) and 20/25 in 6 eyes (66.6%), while best-corrected visual acuity of 20/20 was achieved in 4 eyes (44.4%). At the last visit, maximum visual acuity was maintained in 4 patients. The most common postoperative complication was retroprosthetic membrane formation (77.7%). New-onset glaucoma was detected in 4 patients (44.4%). Device extrusion occurred in 1 eye and 2 more patients required replacement surgery. All but 1 of the patients are on postoperative treatment with systemic immunosuppressants. The Boston type II Keratoprosthesis is a useful option for visual rehabilitation in end-stage ocular surface diseases. Multidisciplinary management of complications is of vital importance for the maintenance of vision and the device. Immunosuppressive treatment helps control the inflammation that leads to most associated complications.

Case report: Topical pilocarpine ameliorated the accommodation loss and pupillary dilation after micropulse transscleral laser treatment

BackgroundThe present study elucidates a common significant postoperative complication of micropulse transscleral laser treatment (mTLT) and explores its potential management strategies for younger patients with good central vision.Case presentationThree younger Chinese glaucoma patients with good central vision maintained high intraocular pressures (IOPs) (36, 25, and 30 mmHg) on maximally tolerated topical anti-glaucoma medications. All patients were treated with mTLT because of a higher risk of complications with filtering surgery. After the procedure, their best-corrected visual acuities were not significantly changed, IOPs were significantly decreased, and the number of topical anti-glaucoma medicines was gradually decreased. However, all patients complained about reduced near visual acuity (NVA) for 1–5 months. Slit-lamp examination revealed pupillary dilation, and binocular accommodative function examination indicated accommodation loss. After treatment with 2% topical pilocarpine, all patients reported an improvement in NVA. Among them, we could observe pupillary constriction, recovery of accommodation function, and improved NVA, even discontinuation of pilocarpine in Patient 2.ConclusionIn younger patients with good central vision, topical pilocarpine might ameliorate accommodation loss and pupillary dilation after mTLT.

The pharmacokinetics of ganciclovir during prolonged intermittent kidney replacement therapy in a cardiac transplant recipient.

Ganciclovir, a guanine analogue, is used intravenously (IV) first-line for the prophylaxis and treatment of cytomegalovirus (CMV) infection in solid organ transplant recipients. The pharmacokinetics (PK) of ganciclovir are highly variable, with myelosuppression occurring at high concentrations. Ganciclovir is primarily renally excreted as the parent compound, and clearance is significantly reduced in renal impairment. Acute kidney injury (AKI) is a common post-operative complication of cardiac transplantation, reducing the clearance of ganciclovir. In the intensive care unit (ICU), AKI is often managed by kidney replacement therapy (KRT). One form of KRT, prolonged intermittent kidney replacement therapy (PIKRT) is increasingly used for cost and flexibility advantages. Ganciclovir dosing recommendations are available for varying degrees of renal impairment and KRT, except for PIKRT. In this case of cardiac transplantation, complicated by anuric AKI, a ganciclovir dose of 2.0-2.5 mg/kg of adjusted body weight given after each PIKRT session was demonstrated to achieve PK targets.

Pathogenesis and Surgical Treatment of Dextro-Transposition of the Great Arteries (D-TGA): Part II.

Dextro-transposition of the great arteries (D-TGA) is the second most common cyanotic heart disease, accounting for 5-7% of all congenital heart defects (CHDs). It is characterized by ventriculoarterial (VA) connection discordance, atrioventricular (AV) concordance, and a parallel relationship with D-TGA. As a result, the pulmonary and systemic circulations are separated [the morphological right ventricle (RV) is connected to the aorta and the morphological left ventricle (LV) is connected to the pulmonary artery]. This anomaly is included in the group of developmental disorders of embryonic heart conotruncal irregularities, and their pathogenesis is multifactorial. The anomaly's development is influenced by genetic, epigenetic, and environmental factors. It can occur either as an isolated anomaly, or in association with other cardiac defects. The typical concomitant cardiac anomalies that may occur in patients with D-TGA include ventriculoseptal defects, patent ductus arteriosus, left ventricular outflow tract obstruction (LVOTO), mitral and tricuspid valve abnormalities, and coronary artery variations. Correction of the defect during infancy is the preferred treatment for D-TGA. Balloon atrial septostomy (BAS) is necessary prior to the operation. The recommended surgical correction methods include arterial switch operation (ASO) and atrial switch operation (AtrSR), as well as the Rastelli and Nikaidoh procedures. The most common postoperative complications include coronary artery stenosis, neoaortic root dilation, neoaortic insufficiency and neopulmonic stenosis, right ventricular (RV) outflow tract obstruction (RVOTO), left ventricular (LV) dysfunction, arrhythmias, and heart failure. Early diagnosis and treatment of D-TGA is paramount to the prognosis of the patient. Improved surgical techniques have made it possible for patients with D-TGA to survive into adulthood.

Complications After Pediatric Penetrating Keratoplasty: An IRIS Registry Study.

To describe the frequency of postoperative complications in children undergoing penetrating keratoplasty (PK). This retrospective cohort study included pediatric patients (aged 0-18 years) in the Intelligent Research in Sight (IRIS) Registry who underwent primary PK between January 2013 and December 2020. Patients were identified using Current Procedure Terminology codes. Postoperative complications were identified using International Classification of Diseases Revision 9 and 10 codes and categorized as complications affecting the anterior segment (epithelial defect, infectious keratitis, neurotrophic keratitis, and glaucoma) or posterior segment (vitreous hemorrhage, retinal detachment, choroid detachment, choroidal hemorrhage, endophthalmitis, epiretinal membrane, and proliferative vitreoretinopathy). Of the 544 pediatric patients undergoing PK, 259 (47.6%) experienced postoperative complications. Anterior segment complications (n = 222, 40.8%) were more common than posterior segment complications (n = 96, 17.6%). The most common anterior complication was infectious keratitis (n = 163, 30.0%) with a median onset time of 275 days (IQR 50-560 days) after surgery. Vitreous hemorrhage (n = 52, 9.6%) and retinal detachment (n = 48, 8.8%) were the most common posterior segment complications. Infectious keratitis was the most common postoperative complication in children undergoing PK. More complications occurred in the anterior segment (70%) of the eye as compared with the posterior segment (30%). These findings demonstrate the challenges associated with pediatric PK and may help guide postoperative monitoring and management.

Conversion chemoradiotherapy combined with nab-paclitaxel plus cisplatin in patients with locally advanced borderline-resectable or unresectable esophageal squamous cell carcinoma: a phasei/ii prospective cohort study.

To evaluate the efficacy and safety of nab-paclitaxel plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC). Patients with locally advanced ESCC (cT3‑4, Nany, M0‑1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-paclitaxel plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), event-free survival (EFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0resection rate, adverse events (AEs) and postoperative complications were calculated. 45patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1and 2years were 81.5%, 86.6%, 64.3%, 73.2 and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0resection rate were 47.6 and 84.0%. The LRC rate at 1and 2years were 95.0%, 87.1% in cCRT+Spatitents and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95%CI, 1.10-23.94; P = 0.021). The toxicities during chemoradiotherapy were tolerated, and the most common grade3-4 toxicitiy was radiation esophagitis (15.6%). The most common postoperative complication was pleural effusion (38.1%) and no grade ≥ IIIb complications were observed. nab-paclitaxel plus cisplatin are safe as the regimen of conversional chemoradiotherapy of ESCC.

The Low-Abundance Plasma Proteome Reveals Differentially Abundant Proteins Associated with Breast Implant Capsular Contracture: A Pilot Study.

Capsular contracture (CC) is one of the most common postoperative complications associated with breast implant-associated infections. The mechanisms that lead to CC remain poorly understood. Plasma is an ideal biospecimen for early proteomics biomarker discovery. However, as high-abundance proteins mask signals from low-abundance proteins, identifying novel or specific proteins as biomarkers for a particular disease has been hampered. Here, we employed depletion of high-abundance plasma proteins followed by Tandem Mass Tag (TMT)-based quantitative proteomics to compare 10 healthy control patients against 10 breast implant CC patients. A total of 450 proteins were identified from these samples. Among them, 16 proteins were significantly differentially expressed in which 5 proteins were upregulated and 11 downregulated in breast implant CC patients compared to healthy controls. Gene Ontology enrichment analysis revealed that proteins related to cell, cellular processes and catalytic activity were highest in the cellular component, biological process, and molecular function categories, respectively. Further, pathway analysis revealed that inflammatory responses, focal adhesion, platelet activation, and complement and coagulation cascades were enriched pathways. The differentially abundant proteins from TMT-based quantitative proteomics have the potential to provide important information for future mechanistic studies and in the development of breast implant CC biomarkers.

Efficacy and Safety of Phaco-Goniosynechialysis in Advanced Primary Angle Closure Glaucoma With Severe Visual Field Loss.

Phacoemulsification with goniosynechialysis (phaco-GSL) demonstrates promise in safely and efficiently managing advanced primary angle closure glaucoma (PACG) cases with tunnel vision or limited temporal visual field. However, caution is advised for patients with only one functioning eye or high visual expectations. To assess the efficacy and safety of phaco-GSL in patients with end-stage PACG exhibiting tubular vision or temporal field island. This retrospective study evaluated 68 patients (74 eyes) diagnosed with advanced PACG and exhibiting either tubular vision or temporal field island. All patients underwent phaco-GSL and were monitored for at least 1 month postoperatively. The study analyzed changes in visual acuity (VA), intraocular pressure (IOP), medication use for antiglaucoma, and postoperative complications. The mean follow-up time was 9.11 ± 10.49 months. The mean preoperative visual field deviation and VA were -28.01 ± 3.30dB and 0.36 ± 0.37 log minimum angle of resolution unit, respectively. Postoperatively, the VA for over half (54.1%) of the eyes increased, 29.7% remained unchanged, and 16.2% worsened. The final IOP decreased significantly from 24.65 ± 8.61 to 14.81 ± 3.54mm Hg. Glaucoma medication use also reduced from 1.46 ± 1.43 to 0.88 ± 1.18. The success rate was 48.6% for complete and 89.2% for qualified. IOP spikes (27.0%) and wipe-out (8.1%) were the most common postoperative complications. Vision recovered gradually in 5 of 6 wipe-out patients. One eye (1.4%) developed permanent vision loss with VA decreasing to hand motion. Phaco-GSL appears safe and effective in treating advanced PACG cases with tubular vision or temporal field island. However, caution is warranted when considering this treatment option for patients at high wipe-out risk or those with high expectations for visual outcomes.

Camera-based near-infrared autofluorescence versus visual identification in total thyroidectomy for parathyroid function preservation: Systematic review and meta-analysis of randomized clinical trials.

Hypocalcemia is the most common postoperative complication of total thyroidectomy. Near-infrared autofluorescence (NIRAF) technology is a surgical adjunct that has been increasingly utilized with the aim of preventing postoperative hypocalcemia, but its clinical benefits have not yet been firmly established. The aim of this study was to assess the clinical benefit of utilizing NIRAF technology in patients undergoing total thyroidectomy. A systematic review and meta-analysis of randomized clinical trials was performed according to PRISMA guidelines. Seven randomized clinical trials with 1437 patients (318 males, 22.13%) undergoing total thyroidectomy were included for analysis. Risk of postoperative hypocalcemia was reduced in the NIRAF arm (RR, 0.65; 95%CI, 0.50-0.84). Use of NIRAF was also associated with a reduction in the risk of permanent parathyroid dysfunction (RR, 0.46; 95%CI, 0.22-0.95) and inadvertent parathyroid gland resection (RR, 0.40; 95%CI, 0.26-0.60). We present a systematic review and meta-analysis of randomized clinical trials examining the impact of NIRAF technology on preservation of parathyroid function. Our results suggest that use of camera-based NIRAF technology reduces the risk of postoperative hypocalcemia, permanent parathyroid dysfunction, and inadvertent parathyroid gland resection.

Influence of Age and Sex on Post-Craniotomy Headache.

Post-craniotomy headache (PCH) is a common postoperative complication, and some of these patients progress to chronic PCH (CPCH). We aimed to identify clinical variables associated with PCH and its progression to CPCH, especially possible associations between age and sex differences. Therefore, we examined clinical information on PCH using the Clinical Data Warehouse over 10 years. Of the 1326 patients included, 927 patients (69.9%) experienced PCH. In multivariate analysis for PCH, age was inversely related to risk (p = 0.003), and being female showed a significant association with an increased risk of PCH (p = 0.002). There was also a significant inverse relationship between age and severity of the worst headache, with younger female patients reporting greater severity of the worst headache (p < 0.001). Of the 927 patients who experienced PCH, 319 (34.4%) progressed to CPCH. Sex was a significant factor, with females having a higher risk of developing CPCH compared to males (p < 0.001). In addition, the presence of preoperative headaches significantly increased the risk of CPCH (p = 0.001). The occurrence of PCH is associated with younger age and female sex. In particular, female sex and preoperative headaches increased the risk of developing CPCH. These clinical factors should be considered in patients undergoing neurosurgery.