Classification Of Complications Research Articles

Efficiency of Orthopaedic Audits in a Level-1 Trauma Centre Using a Modified Clavien–Dindo Complications Classification

Background: Complications are an inevitable part of orthopaedic surgery, and how one defines complications can have an impact on the ability to learn from them. There have been issues with a commonly used classification system first outlined by Clavien and Dindo. Our aim was to evaluate a modification of this classification system developed for use in our department, with our hypothesis being that this could make our audit presentations more efficient. Methods: A modified Clavien–Dindo Classification was prospectively applied to all complications recorded in the orthopaedic departmental audits at our institution for a 12-month period. The audit discussion was recorded and analysed and compared with the complication audits for the preceding 12-month period. Results: We analysed eight audit presentations before and eight audit presentations after the introduction of a modified Clavien–Dindo classification to our orthopaedic complications over a 2-year period. The number of PowerPoint™ slides (103 vs. 84, p = 0.03) and the time spent on each presentation (88 vs. 71 min, p = 0.02) decreased significantly with the introduction of the modified classification. The novel system was found to have high inter-observer reliability. Conclusions: The modified Clavien–Dindo classification system is a reproducible classification system for orthopaedic complications. It made our audit presentations more efficient.

Perioperative efficacy of laparoscopic duodenal-preserving pancreatic head resection

Objective: To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR) with laparoscopic pancreaticoduodenectomy(LPD) in the treatment of borderline and benign diseases of the pancreatic head. Methods: This is a retrospective cohort study. Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022. There were 49 male and 38 female patients with an age of 57.0(16.5) years (range: 20 to 75 years). Forty patients underwent LDPPHR and 47 patients underwent LPD. Quantitative data following a normal distribution were compared using Student's t-test, while quantitative data not following a normal distribution were compared using the Mann-Whitney U test. Comparisons of categorical or ordinal variables were made using χ2 test or Fisher's exact test. Logistic regression analysis was used to estimate the risk factors associated with the rate of complications. Results: There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate (all P>0.05). The complication rate was higher in the LDPPHR group compared to the LPD group(32 cases (80.0%) vs. 24 cases (51.1%),χ2=7.89,P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications≥Ⅲ between the two groups(4 cases (10.0%) vs. 6 cases (12.8%), χ2<0.01, P=0.947). Additionally,the rate of delayed gastric emptying (DGE) was higher in the LDPPHR group compared to the LPD group (χ2=10.79,P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups (χ2=0.48, P=0.487). There were no statistically significant differences in the rates of postoperative pancreatic fistula,bile leakage,post-pancreatectomy hemorrhage,intra-abdominal infection,and pulmonary infection between the two groups (all P>0.05). The results of the univariate logistic regression analysis showed that LDPPHR (compared to LPD, OR=3.83, 95%CI: 1.46 to 10.04, Z=2.73,P=0.006) and preoperative biliary stent placement (compared to non-use of biliary stent, OR=5.30, 95%CI: 1.13 to 25.00, Z=2.11, P=0.035) were risk factors for the complication rate,but neither was an independent risk factor for complication rate (all P>0.05). Conclusion: The preliminary results suggest that LDPPHR can achieve perioperative safety and effectiveness comparable to LPD.

#395 Gut dysbiosis in ADPKD patients: a controlled pilot study

Abstract Background and Aims Gut dysbiosis has been associated with chronic kidney disease (CKD) and nephrolithiasis and may thus be a factor explaining variability of outcome in autosomal dominant polycystic kidney disease (ADPKD). However, beside a single pilot study the gut microbiome has not been studied in ADPKD. Due to the implications of microbiota in inflammation and crystal formation, we hypothesized that gut dysbiosis could also negatively affect PKD. For this reason, we aimed to characterize the intestinal microbiome in a controlled pilot study of PKD patients and explore the potential impact of dysbiosis on PKD disease progression. Method This study was designed as an observational, cross-sectional controlled pilot study. 25 ADPKD patients were recruited from the AD(H)PKD patient cohort. 12 healthy control subjects were age- and sex matched. Patients with chronic bowel disease were excluded. Serum parameters including eGFR were analyzed around the timepoint of stool collection. The gut microbiome was analyzed by 16S rRNA gene profiling of stool samples. The sequencing data was processed using the DADA2 pipeline and QIIME version 2. Differentially abundant features were identified using linear discriminant analysis (LDA) effect size (LEfSe) analysis. Bacteria-derived serum uremic toxins (total and free Trimethylaminoxid, Indoxylsulfate, p-Cresyl-Sulfate) were measured using liquid chromatography coupled to tandem mass spectrometry (LC- MS/MS). Microbiome data was then correlated with age, kidney function, and markers of PKD disease progression like Mayo classification and early onset of arterial hypertension or urologic complications (&amp;lt;35 years of age). Results Healthy control subjects revealed a significantly higher abundance Actinobacteria (LEfSe LDA score = 3.9, p = 0.025) including probiotic Bifidobacteriaceae (LEfSe LDA score = 3.9, p = 0.021). ADPKD patients displayed a significantly increased abundance of potentially dysbiotic Enterobacteriaceae (LEfSe LDA score = 3.6, p = 0.009). Those findings were independent of kidney function. Most notably, the abundance of Streptococcaceae were significantly overrepresented in PKD patients with Mayo Classes 1D and 1E compared to 1A-1C (p = 0.011). Additionally, early onset of hypertension (&amp;lt; 35 years of age) was associated with an increased abundance of potentially dysbiotic Proteobacteria and a decreased abundance of potentially probiotic Tannerelleaceae. Furthermore, ADPKD patients revealed increased abundance of Peptococcaceae with increasing age and declining kidney function. Finally, serum uremic toxins were significantly increased in ADPKD patients and highly correlated with eGFR. Serum uremic toxins revealed a tendency of positive correlation with the abundance of Peptococcaceae which did not reach statistical significance. Conclusion This controlled pilot study confirms alterations of specific OTUs in PKD patients showing an increase of Enterobacteriaceae and decrease of probiotic Bifidobacteriaceae upon PKD. This suggests a potential shift towards gut dysbiosis. Most notably, the abundance of specific OTUs were observed to be associated with markers of rapid disease progression like Mayo classification 1D and 1E, as well as early onset of arterial hypertension. This suggests for the first time, that gut dysbiosis could affect PKD disease progression. However, it still remains unknown whether gut dysbiosis is caused by ADPKD itself or is a consequence of secondary circumstances such as antibiotic treatment which is common in ADPKD due to frequent urinary tract or cyst infections. Thus, further investigation in larger cohorts is warranted to elucidate the impact of gut microbiota on ADPKD.

Application of Clavien-Dindo Complications Classification in Cardiac Surgery Practice: A Narrative Review

Application of Clavien-Dindo Complications Classification in Cardiac Surgery Practice: A Narrative Review

A clinical case of disseminated BCG infection with a fatal outcome

Complications after the introduction of the tuberculosis vaccine develop extremely rarely. They become accidentally vaccinated infants with undiagnosed severe immunodeficiency. The article considers a clinical case of the course of disseminated BCG infection with multiple organ damage in congenital immunodeficiency in a 9-month-old boy. The disease manifested itself acutely, the child’s condition worsened within a week, and its outcome was the death of the baby. Primary immunodeficiency was confirmed by the results of a pathoanatomic examination. The discussion provides a classification of complications after the introduction of BCG vaccine, the algorithm of the doctor’s actions in case of a suspected complication after vaccination, and also describes the main signs of immunodeficiency.

Classification of postoperative complications in plastic and reconstructive surgery: a systematic review

"Introduction: Postoperative complications are an integral aspect of the surgical audit, being a surrogate marker of surgical quality. Despite demonstrated efficacy in most specialties, there is scarce validation of current systems in plastic and reconstructive surgery, let alone a system unique to the specialty. This review aims to establish the efficacy of current systems in plastic and reconstructive surgery and formulate a classification unique to our specialty. Methods: A PUBMED literature search was performed in January 2023 encompassing all available literature. Search terms included ‘classification’, ‘grading’, ‘postoperative complications’ and ‘adverse events’. Further additions through bibliographic linkage generated a total of 363 articles. Results: Twenty-four papers were related to PRS. Sixteen used current systems to describe postoperative complications, whereas eight papers used a system designed uniquely for PRS. The downfall of conventional systems is the simplicity of return to the operating theatre, constituting a single grade in the Clavien-Dindo Classification. Return to theatre has a broad scope for heterogeneity in plastic and reconstructive surgery, particularly in reconstructive patients. A modification of the Clavien-Dindo Classification is proposed. Conclusion: There is limited efficacy of current classification systems for postoperative complications in plastic and reconstructive surgery nor a well-validated system unique to the specialty. A modified system with a detailed emphasis on return to the theatre will be of value to plastic and reconstructive surgery and ideally correlate with important outcomes. This will be validated in a retrospective review of the complication audit from the developing institution."

Are adverse events during surgery for benign prostatic hyperplasia device related? A review of the MAUDE database.

The Manufacturer and User Facility Device Experience database contains anonymous, voluntary medical device reports. A review of device-related adverse events associated with Benign Prostatic Hyperplasia surgeries was completed. The objective was to evaluate the occurrence and contributing factors to clinically significant complications in a cohort of patients electing to undergo surgical intervention for Benign Prostatic Hyperplasia. The Manufacturer and User Facility Device Experience database was queried for "Aquablation, Greenlight Laser, Holmium Laser, Morcellator, Water Vapor Thermal Therapy, Loop Resection, and Prostatic Urethral Lift" from 2018 through 2021. A complication classification system (Level I-IV) based on the Clavien-Dindo system was used to categorize events. These events were then correlated with procedural technology malfunctions and classified as "device related" and "non-device related." Chi squared analysis was performed to identify associations between procedural technology and complication classification distribution. A total of 873 adverse events were identified. The adverse events were classified into level I (minimal harm) versus levels II-IV (clinically significant). Aquablation (p < 0.017) and Water Vapor Thermal Therapy (p < 0.012) were associated with a higher proportion of reports with Level II-IV complications compared with other procedure types. Level II-IV complications were not associated with a reported device related malfunction. Aquablation and water vapor thermal therapy demonstrated noteworthy clinically significant complications which were not driven by device-related malfunctions.

Acellular dermal matrix in direct-to-implant breast reconstruction: univariate and multivariate analysis on potential risk factors

BackgroundAcellular dermal matrices (ADM) are widely used in direct-to-implant breast reconstruction and were introduced as part of the implant-based breast reconstruction within the previous decade. This study presents clinical outcomes of ADM-assisted direct-to-implant breast reconstruction and evaluates the most frequent and severe postoperative complications.MethodsWe performed a retrospective analysis of patients who underwent ADM-assisted submuscular direct-to-implant breast reconstruction from March 2013 to February 2017 at the University Hospital Copenhagen, Rigshospitalet. All postoperative complications were classified using the Clavien Dindo classification of surgical complications. We used univariate and multivariate analyses with Fisher’s exact test and multiple logistic regression to determine potential risk factors.ResultsA total of 102 breast reconstructions were carried out in the inclusion period. The incidence rate of severe skin flap necrosis and surgical site infection was 6% and 4%, respectively. The total rate of skin flap necrosis was 14.7%, surgical site infection 11.8%, rotation of anatomical implants 4.90%, seroma 3.92%, dynamic breast deformity 1.96% and hematoma 1.96%. No patients suffered from red breast syndrome or capsular contracture. Total explantation rate was 4.90%. The median follow-up period was 32 months.ConclusionThis study demonstrates an acceptable rate of explantation in ADM-assisted direct-to-implant breast reconstruction. We found that skin flap necrosis and surgical site infection were the most frequently occurring complications with low rates of severe cases. However, there is a need for larger, controlled studies to further explore the impact of patient and surgery related risk factors.Level of evidenceLevel III, Risk/Prognostic.

Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine.

The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art. AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm-5), normo-dynamic, and hyperdynamic (<800 dynes·s·cm-5) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life. Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications. · Altered maternal hemodynamics is associated to fetal growth restriction.. · Altered maternal hemodynamics is associated to complicated hypertensive disorders of pregnancy.. · Maternal hemodynamics might help choosing a rational treatment during hypertensive disorders..

Safety assessment of preventive pressurized intraperitoneal aerosol chemotherapy in combined treatment of gastric cancer: preliminary results

Purpose of the study. Preventive pressurised intraperitoneal aerosol chemotherapy (PIPAC) safety assessment in the combined treatment of gastric cancer (GC).Patients and methods. The study included 48 patients with morphologically confirmed resectable GC and cardio esophageal transition, having at least one criterion that is a predictor of the development of peritoneal carcinomatosis, e. g. tumor spread to the serous layer (≥ T4a), diffuse tumor type, affected regional lymph nodes, large tumor, young age (up to 45 years), subtotally and totally affected stomach. 36 out of those patients received treatment according to the protocol. All patients received 4 cycles of neoadjuvant chemotherapy according to the FLOT scheme, radical surgical treatment in combination with a PIPAC session, 4 cycles of adjuvant chemotherapy according to the FLOT scheme. The safety assessment was carried out according to the classification of surgical complications according to Clavien-D indo and the international scale for toxicity scaling NCI–CTCAE v5.0.Results. Postoperative complications were diagnosed in 25 %, &gt;III grade complications were revealed in 11 % of cases according to the Clavien-D indo classification. The postoperative mortality rate was 0 %.Conclusion. Preventive PIPAC of locally advanced GC and CET in combined treatment is a reproducible and safe method, which is characterized by the absence of an increase in the number of postoperative complications and mortality rate.

ПРЕДОПЕРАЦИОННАЯ ДИАГНОСТИКА У ПАЦИЕНТОВ С ЗАБОЛЕВАНИЯМИ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ ПЕРЕД ОПЕРАЦИЕЙ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ (ОБЗОР ЛИТЕРАТУРЫ)

The subject of the study. Dental implantation for patients with cardiovascular diseases is an urgent and important area, but requires special attention from doctors and patients. Cardiovascular diseases can be a risk factor for implant rejection due to the fact that they often have a direct effect on blood flow to tissues. A review of literature sources in the period from 2017 to 2023 showed that there is no common point of view in the scientific community regarding the implementation of implantation in patients with hypertension and coronary heart disease. &#x0D; Objectives. To study the specifics of preoperative diagnosis in patients with cardiovascular diseases before dental implantation surgery, reflected in the scientific literature. &#x0D; Methodology. Currently, the article analyzes sources from databases: Pub Med, Cyberleninka, eLibrary, ResearchGate, CohraneOral Health. The search for scientific literature on the problem under consideration was carried out using keywords. The key criteria for reviewing the scientific publications available in the databases were the availability of indications for dental implantation in the studied individuals.&#x0D; Results. An analysis of the scientific literature on the use of dental implantation in patients with diseases of the cardiovascular system did not reveal a single point of view. The authors agree that patients with cardiac pathology need to hold a consultation with a cardiologist, an anesthesiologist, and a surgeon before elective surgery in order to make a joint decision. At that time, there are different points of view regarding the criteria for assessing the risk and scope of preoperative diagnosis of patients with cardiovascular diseases, there is no systematization and classification of complications, as well as criteria for evaluating the complications of dental implantation surgery in cardiac patients. &#x0D; Conclusions. It seems advisable to identify criteria that determine the general condition and dental status of patients with diseases of the cardiovascular system, which will allow assessing the possibility of using dental implants for them.

Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery.

Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery. The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss' and Cohen's kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively. Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3. The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.

Robot-Assisted Urological Oncology Procedures, Outcomes, and Safety in Frail Patients: A Narrative Review of Available Studies.

In this study, we assess the impact of frailty on the success rate and risk of complications of robot-assisted urological procedures and introduce effective preoperative screening tools to evaluate frail patients' fitness to tolerate robot-assisted urological surgery. We performed a search of electronic databases for available studies, published up to August 2023, investigating the outcomes of robot-assisted urological oncology procedures and their safety in frail patients. Sixteen studies were ultimately selected, investigating the implications of frailty in robot-assisted radical cystectomy, robotassisted partial nephrectomy, and robot-assisted radical prostatectomy. All the studies used the Clavien-Dindo classification of complications with serious complications considered as Clavien-Dindo 3. Frail patients significantly benefit from robot-assisted urological procedures in comparison to open surgery, with lower rates of blood transfusion and a shorter length of stay. However, they also have a higher risk of postoperative complications than non-frail patients, as well as increased rates of conversion to open, total hospital costs, and in-hospital mortality after robot-assisted procedures. Robot-assisted urological procedures can improve the postoperative recovery of frail patients in comparison to open surgery. Reliable frailty indexes such as the Johns Hopkins indicator and simplified frailty index, as well as the Geriatric 8 screening tool, should be routinely used in the preoperative assessment of frail patients to optimize surgical decision-making.

Minimally Invasive Approaches in the Surgical Treatment of Intracranial Meningiomas: An Analysis of 54 Cases.

Intracranial meningiomas, being a fairly common disease in the population, often require surgical treatment, which, in turn, can completely heal the patient. The localization of meningiomas often influences treatment even if they are asymptomatic. By modernizing approaches to surgical treatment, it is possible to minimize intra- and postoperative risks, while achieving complete removal of the tumor. One of these methods is minimally invasive neurosurgery, the development of which in recent years allows it to compete with standard surgical methods. The purpose of this study was the objectification of minimally invasive approaches, such as the calculation of the craniotomy area and the ratio of craniotomy area to the resected tumor volume. The retrospective study consisted of a group of 54 consecutive patients who were operated on in our neurosurgery clinic specialized on minimally invasive neurosurgery. Preoperative planning was carried out using the Surgical Theater visualization platform. Using this system, the tumor volume and craniotomy surface area were calculated. During the analysis, the symptoms before and after the surgery, classification of tumors, postoperative complications, further treatment and follow-up results were assessed. Twelve (22.2%) patients were men and 42 (77.8%) were women. The mean age of the group was 64.2 years (median 67.5). The craniotomy area ranged from 202 to 2,108 mm² (mean 631 mm²). Tumor volume ranged from 0.85 to 110.1 cm3 (mean 21.6 cm3). The craniotomy size of minimally invasive approaches to the skull base was 3-5 times smaller than standard approaches. Skull base meningiomas accounted for 19 cases (35.2%), convexity meningiomas for 26 cases (48.1%), and falx and tentorium meningiomas for 9 cases (16.7%). Three complications were reported: postoperative hemorrhage, CSF leakage, and ophthalmoplegia. Relapse was detected in 2 patients with a mean follow-up of 26.3 months (median 20). Minimally invasive approaches in the surgical treatment of intracranial meningiomas reduce the possibility of operating trauma by several times; they are safe and sufficient for complete removal of the tumor.

Phase angle as a prognostic indicator of surgical outcomes in patients with gastrointestinal cancer.

In patients with gastrointestinal cancer with planned elective surgery, malnutrition increases the risk of adverse outcomes in the postoperative period. The phase angle, measured by the bioelectrical impedance analysis is an indicator of the metabolic and functional status of the patient. It may be an important prognostic indicator for the clinical outcome of post-surgical treatment in patients with gastrointestinal cancer. In this prospective study, 70 patients with gastrointestinal cancer had their phase angles measured by the bioelectrical impedance analysis before the surgery. During the first month after the surgery, we documented the postoperative complications from the patient's records and classified them according to the Clavien Dindo classification of surgical complications. The time of hospitalization was also recorded. The data was statistically analysed in SPSS. We found a statistically significant difference (p = 0.036) in the average value of phase angles between the group of patients who had postoperative complications (phase angle 5.09°) and the group without postoperative complications (5.64°). We noted a correlating trend of decreasing phase angle values and increasing hospitalization time (Pe R = -0,40, p = 0,001). The phase angle cut-off value (5.5°) was calculated using the ROC curve method, predicting a higher risk of the postoperative complications (p = 0,037) in patients with lower phase angle. Lower phase angle values before surgery were associated with more complications during the first month after surgery and longer hospitalization time. We found that a phase angle below than 5.5° could serve as a marker that predicts a greater risk of postoperative complications.

Classification of Metal Handwritten Digits Based on Microwave Diffractive Deep Neural Network

AbstractRecently, optical diffractive deep neural networks (D2NNs) have shown unprecedented superiority in terms of processing speed and power consumption. However, in the microwave band, complicated classification based on D2NN needs further investigation, which may accelerate the artificial intelligent tasks and simplify systems. Here, a three‐layer D2NN is constructed for handwritten digit classification in the microwave frequency. The excited electromagnetic wave, which passes through the metal plane engraved with different digit patterns as the input, will focus on the target plane at designated focal points through the D2NN platform. A detector array is deployed to collect the target plane energy for direct digit classification. Each layer of the proposed D2NN is composed of 1024 phase modulating meta‐units, and the phase distribution is generated through the stochastic gradient descent algorithm applied on the dataset. The network realizes an accuracy rate of 90% in numeric simulations, together with a 100% accuracy rate on the eighteen fabricated samples on the built‐up platform. The average focal efficiency reaches 18.7% and 11.7% in the simulation and experiment, respectively. The system can be seen as an alternative method for seamless in situ monitoring of security checks and near‐field sensing.

The application of flipped classroom combined with team-based learning in the orthopedic clinical teaching.

Medical education has evolved rapidly, with the development of flipped classrooms and team-based learning based on lecture-based learning, but the novel model of combining flipped classrooms with team-based learning has been poorly investigated in orthopedic education. A femoral neck fracture teaching mode was chosen to 109 clinical internship students to explore the effectiveness of flipped classroom combined with team-based learning in internship education. They were enrolled and randomly divided into either the flipped classroom combined with team-based learning group (FTG, n = 55) or the traditional lecture-based classroom group (n = 54). All students completed the learning according to the course flow and took before-class and after-class tests. The questionnaires were used to compare students perceptions and satisfaction with the different teaching methods and were utilized to assess the strengths and weaknesses of the 2 groups. The post-class test scores of both groups significantly improved compared to pre-class test scores. Regarding the post-class test scores, FTG's was significantly higher than the traditional lecture-based classroom group's, mainly in clinical areas such as imaging analysis, fracture classification, treatment options, and management of postoperative complications, but there was no significant difference in the mastery of basic theoretical knowledge. The students were more satisfied with the FTG and believed that it improved their various competencies, but with significantly more time spent. FTG is generally recognized as a promising option for training clinical interns and is worth spreading as it has outstanding merits in developing students clinical competence.

Criteria of enterostomy complications: classification and grading (2023 edition)

Enterostomy-related complications are common in abdominal surgery. The incidence enterostomy-related complications varies according to the type and location of stoma, surgical procedure, and patient characteristics. Currently, there are no uniform criteria wopldwide for the classification of enterostomy complications. Previous classification of enterostomy-related complications were based on time of occurrence, clinical manifestations, or anatomical changes, etc., lacking uniformity and reproducibility. The concept and diagnostic criteria of complications are not yet clearly defined; and it is difficult to accurately determine the relationship between their severity, intervention, and medical cost. Moreover, surgeons and enterostomal therapists differ significantly in their concerns, cognition, and management principles for stoma-related complications. Therefore,the Chinese Ostomy Collaboration Group (COCG), together with the Wound, Ostomy, and Continence Nursing Committee of Chinese Nursing Association, the Colon and Rectal Surgeon Committee of Surgeon Branch of Chinese Medical Doctor Association, the Committee of Colorectal Cancer of Chinese Anti-Cancer Association, and the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, jointly drafted the criteria for the classification and grading of enterostomy complications. We hope this criteria will facilitate prospective data collection, clinical diagnosis, treatment, medical training and education.

Exploring the Research Landscape of High Myopia: Trends, Contributors, and Key Areas of Focus.

BACKGROUND Myopia results when light rays focus before reaching the retina, causing blurred vision. High myopia (HM), defined by a refractive error of ≤-6 diopters (D) or an axial length of ≥26 mm, is an extreme form of this condition. The progression from HM to pathological myopia (PM) is marked by extensive ocular axis elongation. The rise in myopia has escalated concerns for HM due to its potential progression to pathological myopia. The covert progression of HM calls for thorough analysis of its current research landscape. MATERIAL AND METHODS HM-related publications from 2003-2022 were retrieved from the Web of Science database. Using VOSviewer and Citespace software, we conducted a bibliometric and visualized analysis to create document co-citation network maps. These maps detailed authors, institutions, countries, key terms, and significant literature. RESULTS From 9,079 articles, 8,241 were reviewed. An increasing trend in publications was observed, with Kyoko Ohno-Matsui identified as a top contributor. The Journal of Cataract and Refractive Surgery was the primary publication outlet. Chinese researchers and institutions were notably active. The document citation network identified five focal areas: refractive surgery, clinical manifestations/treatment, prevention/control, genetics, and open angle glaucoma. CONCLUSIONS Research emphasis in HM has shifted from refractive surgery for visual acuity enhancement to the diagnosis, classification, prevention, and control of HM complications. Proposals for early myopia intervention to prevent HM are gaining attention. Genetics and HM's link with open angle glaucoma, though smaller in focus, significantly enhance our understanding of HM.

Feasibility of transanal minimally invasive surgery for total pelvic exenteration for advanced primary and recurrent pelvic malignancies.

The purpose of this study was to clarify the efficacy and safety of transanal minimally invasive surgery (TAMIS) for total pelvic exenteration (TPE) in advanced primary and recurrent pelvic malignancies. Using a prospectively collected database, we retrospectively analyzed the clinical, surgical, and pathological outcomes of TAMIS for TPE. Surgery was performed between September 2019 and April 2023. The median follow-up period was 22months (2-45months). Fifteen consecutive patients were included in this analysis M:F = 14:1 and median (range) age was 63 (36-74). Their diagnoses were as follows: primary rectal cancer (n = 5; 33%), recurrent rectal cancer (n = 4; 27%), primary anorectal cancer (n = 5; 33%), and gastrointestinal stromal tumor (n = 1; 7%). Bladder-sparing TPE was selected for two patients (13%). In nine of 15 patients (60%) the anal sphincter could be successfully preserved, five patients (33%) required combined resection of the internal iliac vessels, and two (13%) required rectus muscle flap reconstruction. The median operative time was 723min (561-1082), and the median intraoperative blood loss was 195ml (30-1520). The Clavien-Dindo classifications of the postoperative complications were as follows: grade0-2 (n = 11; 73%); 3a (n = 3; 20%); 3b (n = 1; 7%); and ≥ 4 (n = 0; 0%). No cases of conversion to laparotomy or mortality were observed. The pathological results demonstrated that R0 was achieved in 14 patients (93%). The short-term outcomes of this initial experience proved that this novel approach is feasible for TPE, with low blood loss, acceptable postoperative complications, and a satisfactory R0 resection rate.