Complications In Female Patients Research Articles

Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery

Objective: To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications (MC) following long-segment spinal correction surgery in female patients with degenerative scoliosis (DS). Methods: The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed. According to whether restoring the ideal Roussouly classification after surgery, the patients were divided into R group(recovery group) (n=51) and N group(non-recovery group) (n=21). According to whether mechanical complications occurred after operation within two years, the patients were divided into MC (mechanical complications)group (n=24) and NMC(non-mechanical complications) group (n=48). The RM group (n=14) experienced mechanical complications in the R group, while the RN group (n=37) did not. The NM group (n=10) experienced mechanical complications in the N group, while the NN group (n=11) did not.Radiographic assessment included Sagittal parameters of spine and pelvis, standardized cross-sectional area (SCSA) and fat infiltration rate (FI%) of paraspinal muscle at each lumbar disc level. Results: The age of DS patients in this study was (61.4±6.2) years.The incidence of MC was 33.33%(n=24)in all patients. The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10) in group N. The correction amount of pelvic tilt angle (PT) (-11.62°±10.06° vs -7.04°±8.45°, P=0.046) and T1 pelvic angle(TPA)(-12.88°±11.23° vs -7.31°±9.55°, P=0.031)during surgery were significantly higher in MC group compared to the NMC group. In group R, the FI% of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC (P<0.05). In the R and N groups, there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level (all P>0.05). Multivariate logistic regression analysis showed that the average FI% of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI% of lumbar PSM≥22.63% was a risk factors for MC after spinal fusion (P=0.010,OR=1.088, 95%CI:1.020-1.160). Conclusions: Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications. For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.

Adjusting Current Hemoglobin Thresholds: A Way to Improve Outcome in Women Undergoing Major Surgery.

Background/Objective: In the perioperative setting, a suboptimal total hemoglobin (Hb) mass puts women and men at an unreasonable disadvantage. Anemia is an independent risk factor for transfusion, postoperative complications, and mortality. The Hb cut-off value for women was set at <12.0 g/dL by the World Health Organization (WHO) and has been rigorously debated for decades. The aim of this study was to elucidate the risk for postoperative complications in female patients with Hb levels < 12.0, 12.0-12.9, and ≥13.0 g/dL. Material and Methods: Single-center retrospective analysis of female patients undergoing major surgery. Results: In total, 6,516 patients ≥18 years of age had major surgery between 2018 and 2019 and 2,446 female patients were included in analysis. Mean age was 67.4 ± 16.6, 66.4 ± 15.6, and 64.5 ± 15.5 years in female patients with preoperative Hb levels <12.0, 12.0-12.9 and ≥13.0 g/dL, respectively. The transfusion rate of red blood cells (RBCs) was significantly higher in female patients with Hb <12.0 g/dL (53%) and with Hb 12.0-12.9 g/dL (31%) compared to female patients ≥13.0 g/dL (22%). Rates of pneumonia, acute kidney injury, and sepsis were significantly higher in patients with Hb <12.0 and 12.0-12.9 g/dL compared to patients with Hb ≥13.0 g/dL. Total length of hospital stay was significantly longer in female patients with Hb <12.0 g/dL than patients with Hb 12.0-12.9 g/dL and Hb ≥13.0 g/dL (10 days vs. 8 days). Conclusion: Taken together, our data show that Hb values below 12.9 g/dL are associated with increased probability of RBC transfusions and increased risk of postoperative complications. In addition, our results indicate that postoperative outcomes for women might be optimized by increasing cut-off values for anemia. The call to revise the anemia threshold for women by the WHO can no longer be disregarded.

Методы коррекции сочетанных форм генитального пролапса лапароскопическим доступом

Aim: to evaluate the efficacy and safety of a combined technique — pectopexy, and the most common — laparoscopic sacrocolpopexy for pelvic organ prolapse correction. Patients and Methods: the study included 32 female patients with a similar nosological form of pelvic organ prolapse. All the subjects were divided into two groups depending on the surgical treatment method. Group 1 (main group) included 14 female patients who had a combined laparoscopic correction of pelvic organ prolapse with transverse and longitudinal fixation of synthetic implants — combined pectopexy. Group 2 (control group) included 18 female patients who underwent sacrocolpopexy. Comprehensive clinical and instrumental examination of female patients was performed before and within 24 months after surgery. Results: there were no intraoperative complications in female patients of both groups. In all cases, the surgical intervention result was recognized as positive both according to the patient assessment and medical researcher assessment. There was a significant improvement in indicators reflecting the central compartment condition (apical prolapse), as well as the anterior and posterior vaginal walls. All female patients showed an improvement in their life quality. The patients also showed positive tendency according to pelvic ultrasound after surgery. No pelvic mesh complications were reported. The parameters of the Pelvic Organ Prolapse Quantification (POP-Q) system assessment did not differ significantly in female patients from both groups 1, 6, 12 and 24 months of follow-up after surgery. Conclusion: based on the obtained follow-up data, correction of central, posterior and partially anterior prolapse was achieved in patients after combined transverse and longitudinal fixation of synthetic implants. Pectopexy is safe and comparable to sacrocolpopexy, which is currently considered the most common surgery, gives a positive effect in correcting pelvic organ prolapse and improves the life quality of female patients. KEYWORDS: genital prolapse, combined laparoscopic surgery, mesh implants, surgical treatment of pelvic organ prolapse, laparoscopic sacrocolpopexy, laparoscopic pectopexy, life quality. FOR CITATION: Pyatkina A.N., Bryunin D.V., Chushkov Yu.V. Laparoscopic correction methods of pelvic organ prolapse. Russian Journal of Woman and Child Health. 2024;7(1):18–25 (in Russ.). DOI: 10.32364/2618-8430-2024-7-1-3.

Human UC-MSC-derived exosomes facilitate ovarian renovation in rats with chemotherapy-induced premature ovarian insufficiency.

Premature ovarian insufficiency (POI) induced by chemotherapy is an intractable disorder with a considerable incidence that commonly results in insufficient fertility and concomitant complications in female patients. Due to limitations in the current progress in POI diagnosis and treatment, there is an urgent need to develop novel remedies to improve ovarian function and protect fertility. The ameliorative effect of human umbilical cord mesenchymal stem cells (hUCMSCs) and exosomes derived from them in POI treatment could be a new hope for patients. Herein, we identified exosomes from hUCMSCs (hUCMSC-Exos). Then, systematic infusion of hUCMSC-Exos was accomplished via tail intravenous injection to investigate the feasibility of the treatment of rats with chemotherapy-induced POI by intraperitoneal injection of cyclophosphamide (CTX) and busulfan (BUS). Ovarian functions in the indicated group were evaluated, including oestrous cycle, serum sex hormone levels, follicle counts, ovarian pathological changes, proliferation and apoptosis of granulosa cells (GCs), and reproductive ability testing. Furthermore, the potential influence of hUCMSC-Exos on ovarian tissues was illuminated by conducting RNA-seq and multifaceted bioinformatics analyses. POI rats with hUCMSC-Exos transplantation exhibited a decrease in follicle-stimulating hormone (FSH) and apoptosis of GCs but an increase in oestradiol (E2), anti-Müllerian hormone (AMH), and the number of ovarian follicles and foetuses in the uterus. And the immunomodulation- and cellular vitality-associated gene sets in rats had also undergone moderate changes. Our data indicated the feasibility of hUCMSC-Exos in improving ovarian function and protecting fertility in chemotherapy-induced POI rats. HUCMSC-Exos can improve the local microenvironment of ovarian tissue in POI rats by participating in immune regulation, cellular viability, inflammation regulation, fibrosis and metabolism, and other related signal pathways.

Does Progesterone Affect Perioperative Blood Loss during Posterior Spinal Fusion Surgeries in Female Patients with Adolescent Idiopathic Scoliosis? A Retrospective Study.

Menstruation is considered a contraindication for elective surgery for higher operative blood loss. Progesterone is often used to postpone menstruation to avoid surgery during menstruation. This study aimed to explore whether using progesterone to postpone menstruation affects perioperative blood loss and complications in female patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) surgery. A retrospective study was performed for female patients diagnosed with AIS who underwent PSF surgery between March 2013 and January 2021. Patients scheduled to undergo PSF surgery from 2 days before menstruation to 3 days after menstruation were treated with progesterone preoperatively. The patients were divided into two groups according to progesterone use (progesterone injection group; control group). Demographic and surgical data including intraoperative blood loss (IBL), normalized blood loss (NBL), total blood loss (TBL), transfusion rate, perioperative complications, postoperative drainage time, postoperative hospital stay, and preoperative coagulation function data were collected. A total of 206 patients were included in the study. Among them, the progesterone injection group included 41 patients, with an average age of 14.8 years. While the control group included 165 patients, with an average age of 14.9 years. The two groups were matched for age, height, weight, operation time, Risser sign, correction rate, mean curve Cobb angle, bending Cobb angle, number of internal fixations, and number of fused levels (all P > 0.05). Regarding coagulation function, no significant differences were found in thrombin time, activated partial thromboplastin time, fibrinogen, prothrombin time, and platelet count between the two groups (all P > 0.05). IBL, NBL, and TBL were higher in progesterone injection group; however, the difference was nonsignificant (all P > 0.05). Transfusion rate, perioperative complications, postoperative drainage time, and postoperative hospital stay were not statistically different between groups (all P > 0.05). Intramuscular injection of progesterone to avoid menstruation during PSF surgery did not affect perioperative blood loss and complications in AIS patients. It may be a safe method for AIS patients to avoid menstrual problems affecting the operation time and receive PSF surgery as scheduled.

STUDY ON THE CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH SURGICAL DRAINS FOLLOWING ELECTIVE ABDOMINAL SURGERIES

Aims And Objectives- To determine the surgical prole and outcome of patients with surgical drains following MATERIALS AND METHODS- Study design: observational study Period of study: december 2020 to January 2022 sample size :79 .All patients undergoing elective abdominal surgeries w INCLUSION CRITERIA: EXCLUSION ith drain placement CRITERIA: 1.Age &lt;18yrs 2.Patients with pre-existing infection at surgical site 2.Patients with pre-existing infection at surgical site Results &amp; Conclusion-Obese patients undergoing elective laparotomy suffer from local wound complications such as seroma, hematoma, pain at wound site, wound dehiscence, and surgical site infections. These complications occur because of increased subcutaneous fat thickness, poorly controlled bleeding points in subcutaneous plane. These will lead to increased morbidity for the obese patients and prolonged hospital stay. In this study, we have observed that there is positive correlation between SSI and BMI, with the Rate of SSI was seen more in BMI &gt;25 as compared to BMI &lt;25, there is increased wound complication associated with increase in age because of varied factors mentioned above. We observed less wound complications in female patients compared to males due to the probable benecial effect of estrogen on wound healing. Also we observed that patients with higher BMI are more prone for wound complications thus further increasing their length of hospital stay

Post Covid-19 Women Complications

Post-covid-19 women complications, Post covid-19 is Clinical symptoms that persist or worsen after acute COVID It is contains both ongoing symptomatic COVID-19 between 4 to 12 weeks or post COVID-19 more than 12 weeks. As of June 2020, given the terminology "post COVID-19". Reported studies are related to complications of the female patient, including effects on the immune system, physiology, or psychological health, and effects on pre-existing diseases, including hypertension, diabetes mellitus, neurodegenerative disease, rheumatoid arthritis, and tuberculosis (TB). However, six months after recovery from COVID-19, complications arise, including cough, fever, breathlessness, muscle aches, joint pain, fatigue, gastrointestinal complaints, anosmia, dyspepsia, sleep difficulties, anxiety or depression, higher stress levels, physical decline, post-activity polypnea, alopecia, chest tightness, palpitations, intestinal blockages, impaired respiratory functions, neurological issues, olfactory dysfunction, cognition, dexterity, conversation, disabilities of sight, or listening. Along with other miscellaneous complications such as Miller-Fisher syndrome. Overall, these reviews summarise studies conducted on pre-existing diseases in female patients after COVID-19, complications in female patients with immune dysfunction, including hormonal imbalances, and CSF-insufficiency in female patients with neurodegeneration complications. It observed high levels of molecular markers such as tau protein (t-tau, p-tau), plasma amyloid-beta (A42), glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament light chain protein. In Female patients with diabetes mellitus (Type 1 and Type 2) complications reported higher levels of sCr, C-reactive protein, TN-I, white blood cell, and erythrocyte sedimentation rate levels, enzymes, electrolytes, and coagulation factors, and female patients with tuberculosis (TB) complications had lower aggressive angiomyxoma (AAM) and E2 hormone levels.

Telemedical cardiac risk assessment by implantable cardiac monitors in post-infarction patients with autonomic dysfunction (SMART-MI-DZHK9): gender differences and outcomes

Abstract Background Cardiac autonomic dysfunction identifies high-risk patients after myocardial infarction (MI). Telemedical cardiac risk assessment by implantable cardiac monitors (ICM) after MI was recently identified as an effective method to early detect subclinical, but prognostically relevant serious arrhythmic events (SArE). Clinical complications in female patients after MI usually present with atypical symptoms. Therefore, early detection of prognostically relevant SArE in females would be of great clinical interest. Purpose In this pre-specified analysis of the SMART-MI trial we aimed to assess the impact of gender on detection of SArE and subsequent clinical complications. Methods SMART-MI was a prospective, randomised trial. Survivors of acute MI with preserved left-ventricular ejection fraction (LVEF 36–50%) and abnormal periodic repolarization dynamics (≥5.75deg2) and/or deceleration capacity (≤2.5ms) were randomly assigned to ICM-based telemedical monitoring or conventional follow-up. Primary endpoint was time to detection of SArE defined as the composite of atrial fibrillation ≥6 minutes, atrioventricular block ≥IIb, or fast non-sustained (&amp;gt;187 bpm;≥40 beats)/sustained ventricular tachycardia/fibrillation. Clinical complications were defined as the composite of mortality, stroke, systemic arterial thromboembolism, and hospitalization for decompensated heart failure. The effect of intervention on the primary endpoint was tested using Cox-regression analysis. The effect of SArE on clinical complications was evaluated by introducing SArE as time-dependent covariate. Results Between May 12, 2016, and July 20, 2020, 1305 individuals were screened and 400 patients were randomly assigned to ICM-implantation (N=201; 49 females) or conventional follow-up (control group; N=199; 29 females). During a median follow-up of 21±23 months, SArE were detected in 60 (30%; 12 females) patients in the ICM and 12 (6%; 1 female) patients in the control group. In both males and females ICM-implantation was associated with a higher detection rate of SArE (HR 6.33; 3.28–12.23; p&amp;lt;0.001 in males and HR 8.49; 1.10–65.66; p=0.040 in females; p-interaction = 0.790; Figure 1). In both male and female patients, detection of SArE was prognostic for subsequent clinical complications (HR 3.64; 1.89–7.02; p&amp;lt;0.001 in males and HR 16.19; 4.76–55.11 in females; p&amp;lt;0.001). The association between SArE and clinical complications was significantly higher in females than males. Among the 13 females with detected SArE, 6 developed clinical complications within a median period of 25±18 months, compared to 12 complications out of 59 SArE within 18±13 months among males (Figure 2; p-interaction = 0.030). Conclusion Telemedical monitoring with ICM was highly effective in early detection of subclinical, prognostically relevant SArE in both female and male patients. However, the association of a detected SArE with a subsequent clinical complication was significantly higher among females. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsches Zentrum für Herz und Kreislaufforschung (DZHK) and Medtronic Bakken Research Center

Risk factors for motor complications in female patients with Parkinson's disease.

To investigate the risk factors of motor complications in female patients with Parkinson's disease (PD) and the correlation between the occurrence of motor complications and sex hormone levels. According to the occurrence and types of motor complications, 103 female PD patients were divided into two groups: patients with or without the wearing-off phenomenon, patients with or without dyskinesia. Binary logistic regression analysis was performed respectively to screen for the risk factors of the wearing-off phenomenon and dyskinesia in female PD patients. Among 103 female PD patients, 44 (42.72%) had motor complications. Patients with the wearing-off phenomenon and patients with dyskinesia had higher prolactin levels than patients without the wearing-off phenomenon and patients without dyskinesia, respectively. However, the difference was no longer significant when the two groups were corrected for multiple comparisons (P < 0.0028). Multivariate analysis found that younger age at onset and higher Hoehn-Yahr (H&Y) stage were identified as independent risk factors for the wearing-off phenomenon and younger age of onset was an independent risk factor for dyskinesia in female PD patients (P < 0.05). Female PD patients have a higher incidence of motor complications. Younger age of onset and higher H&Y stage were the risk factors of the wearing-off phenomenon, and younger onset age was the risk factor of dyskinesia in female PD patients. There may be a certain correlation between the occurrence of motor complications and sex hormone levels in female PD patients, which requires further verification.

Reduction of bleeding complications on puncture site after percutaneous coronary intervention using a 6.5-French sheathless guiding catheter.

Reducing complications at the puncture site after percutaneous coronary intervention (PCI) is important. The diameter of a 6.5-French (Fr) sheathless guiding catheter (GC) is smaller by approximately 2-Fr compared to a 6-Fr conventional sheath. In the present study, we investigated the post-PCI puncture site complications of a transradial approach in each gender while using a 6.5-Fr sheathless GC. Our study consisted of 332 patients who underwent transradial coronary intervention (TRI) between August 2017 and July 2019. We classified the patients into either the 6.5-Fr sheathless GC (Asahi, Intecc, Aichi, Japan) Group (Sheathless group: n = 182 males, 58 females) or the 6-Fr sheathed GC Group (Sheathed group: n = 150 males, 36 females). We determined the complications at the puncture site: oozing, subcutaneous hemorrhage, formation of hematoma, pseudoaneurysms, and peripheral neuropathy. The body mass index of the patients was greater in the sheathless GC group compared to the sheathed GC group (24.5 ± 3.5kg/m2 vs. 23.6 ± 3.7kg/m2, p = 0.02). In males, there was no significant difference in the complication rate at the puncture site between the sheathless GC and sheathed GC groups (19.3% vs. 18.6%, p = 0.88). However, the complication rate at the puncture site in females was higher in the sheathed GC group than in the sheathless GC group (36% vs. 15.5%, p = 0.02). A multiple logistic regression analysis revealed that the use of a 6.5-Fr sheathless GC independently reduced the complications in female patients (p = 0.006). The use of the 6.5-Fr sheathless GC system in a transradial approach reduced the complications at the puncture site in female patients. The 6.5-Fr sheathless GC system may be a safe option for them compared to the conventional sheath system.

The clinical spectrum of X-linked adrenoleukodystrophy: from Addison's-only in men to middle-age neurologic manifestations in women.

X-linked adrenoleukodystrophy (X-ALD) is caused by a mutation in the ABCD1 gene which encodes for a peroxisomal very long-chain fatty acid (VLCFA) transporter. Clinically, X-ALD can present a wide range of phenotypes, from slowly progressive myelopathy to rapid demyelination of brain white matter (cerebral X-ALD-CALD). Adrenocortical insufficiency (AI) occurs mainly in the pediatric age group, and it can be the first manifestation of the disease. Female carriers may also develop manifestations of myelopathy, but later in life. We present two cases of patients who show the heterogeneous clinical manifestations of X-ALD. Case 1 was a man with AI diagnosed at 6years old and with the first manifestations of myelopathy at 44years old, which led to the diagnosis of X-ALD. At 47years, he developed rapidly progressive CALD. Case 2 was a woman with progressive spastic gait disturbance that started at 49years old. The diagnosis of X-ALD was confirmed at 54years old after the discovery of a family history of the disease. Mild progression of the neurologic manifestations was noted, but with no signs of AI nor CALD. She is currently 60years old and under surveillance. We review the current knowledge on X-ALD as concerns its genetic and pathophysiological mechanisms, clinical presentations, diagnosis, treatment, and follow-up. This condition is a real diagnostic challenge. The early detection of AI and CALD, potentially life-threatening complications in men, is very difficult. The surveillance of these complications in female patients still raises controversy.

P346More procedural complications in female patients undergoing pulmonary vein ablation in atrium fibrillation: results from 12,430 patients in the Netherlands Heart Registry

Abstract Introduction Pulmonary vein isolation (PVI) has become a cornerstone of the treatment of atrial fibrillation (AF). Several technologies have been developed to improve procedural and long-term outcomes. Depending on type of AF and rhythm recording used, 1-year freedom of AF varies between 55–82%. However, severe complications are reported in 1–3%. Purpose To describe procedural complications of PVI with either single tip radiofrequency ablation (STRF), multi electrode phased RF ablation (PVAC) or cryoballoon (CB). Methods Data was extracted from the Netherlands Heart Registry in which 14 Dutch heart centres participate. Procedural complications in patients treated with the 3 different ablation modalities (STRF, PVAC and CB ablation) were compared. Complications included: pericardial tamponade, persistent phrenic nerve palsy (PNP) beyond 24hrs, thromboembolic events, vascular- and bleeding complications. Patient characteristics: gender, age, BMI, CHA2DS2 -VASc, type of AF and previous left atrium ablation were assessed in a univariate and multivariate regression model. Results In total, 12,430 patients were included (STRF n=5,106, PVAC n=2,341, CB n=4,983) between January 2013 and December 2017, of whom, 69% were male, 74% had a history of paroxysmal AF, 24% persistent AF and 2% longstanding persistent AF. The incidence of complications within 30 days was 3.6%. Pericardial tamponade requiring intervention, occurred more frequently in the STRF group (STRF: 0.8% vs PVAC 0.3% vs CB 0.3% p= &lt;0.01). PNP was present in 0.1% of patients after STRF ablation, in 0.2% of patients after PVAC ablation and in 1.5% of patients treated with CB ablation (p= &lt;0.001). Thromboembolic events were observed in 0.4% with no statistical difference between the 3 modalities. Patients treated with STRF had more vascular complications (STRF 1.7% vs PVAC 1.2% vs CB 1.3% p= &lt;0.001). In the PVAC and CB group there were significant less bleeding complications (STRF: 1.1% vs PVAC: 0.5% vs CB: 0.7% p=0.01). Female patients and patients with a higher CHA2DS2-VASc had an increased risk for pericardial tamponade, vascular- and bleeding complications (figure) with adjusted odds ratios for female patients of 2.97 (95% CI 1.77–5.00), 2.24 (95% CI 1.41–3.56) and 2.84 (95% CI 1.88–4.28) respectively. Univariate analysis Conclusion PVI was associated with a complication rate of 3.6%. Compared to PVAC and CB ablation, patients treated with STRF ablation more often developed a pericardial tamponade and vascular- and bleeding complications. PNP occurred most frequent in patients undergoing CB ablation. Female gender and CHA2DS2-VASc were independent predictors for pericardial tamponade, vascular- and bleeding complications.

A comprehensive assessment of postoperative complications in female patients undergoing robot versus open radical cystectomy.

490 Background: Radical cystectomy (RC) is the standard of care for non-metastatic, muscle invasive bladder cancer. Studies comparing robotic to open RC have found that the robotic approach confers non-inferior oncologic outcomes while potentially decreasing morbidity, but to date there have been no comparisons performed exclusively within female patients, who have unique anatomic considerations. Women undergoing RC may be at higher risk for urethral margin positivity, wound complications, and bleeding. Methods: Female patients who underwent either open or robot-assisted RC at the MD Anderson Cancer Center from 1/2014-6/2018 were identified. We assessed co-morbidities, pathologic data, and outcomes including complications. Descriptive statistics, along with uni- and multivariable logistic regression, were performed. Results: 122 female patients underwent either open (n=76) or robotic (n=46) RC. There were no statistically significant differences in age, BMI, smoking history, exposure to neoadjuvant chemotherapy, Charlson comorbidity index, or cTNM stages between the groups. In both uni- and multivariable models, open RC in females was associated with greater blood loss (median EBL 775 mL, IQR 600 mL) compared with robotic RC (median EBL 300 mL, IQR 350 mL), p&lt;0.001. Female open RC was also associated with greater risk of transfusion compared to robotic RC (OR 6.2, 95% CI 2.7-14.3, p&lt;0.001). Robotic RC conferred a higher median lymph node yield (27 nodes (range 7,57) vs 20 nodes (0,57), p, &lt;0.001). Operative times were longer in the robotic cohort (median 507 min vs 388 min, p&lt;0.001). There were no differences between robotic vs open groups in margin positivity (5.3% vs 4.4%, p≥0.99), length of stay (6.3 vs 6.9 days, p=0.32), or readmission rates at 30 (26.1% vs 22.7%, p=0.67) and 90 days (32.6% vs 28%, p=0.68). Conclusions: In this cohort of women undergoing RC, the robotic approach was associated with a lower risk of transfusion and EBL, and a higher median lymph node yield and operative time. Unique anatomic considerations in female patients and the improved visualization conferred by the robotic approach may be responsible for these findings, particularly with respect to blood loss.

Ultrasound-Guided Erector Spinae Plane Block Compared to Modified Pectoral Plane Block for Modified Radical Mastectomy Operations.

Background:Modified radical mastectomy (MRM) is the most common surgery for cancer breast that is associated with marked postoperative pain. Effective control of this pain suppresses the surgical stress response and decreases the opioids and general anesthetics’ needs. This study compared the erector spinae plane (ESP) block and the pectoral plane (PECS) block effects on the opioid consumption postoperatively, stress response, fentanyl needs intraoperatively, pain scores, and incidence of complications in female patients subjected to MRM surgery.Patients and Methods:Fifty patients were allocated randomly and divided into two groups. Forty-seven patients were included in the final analysis after exclusion. ESP block group (E group, n = 24) received 20 mL of 0.25% levobupivacaine plus 0.5 μ/kg dexmedetomidine that was injected in-between erector spinae muscle and transverse process. PECS block group (P group, n = 23) received 30 mL of 0.25% levobupivacaine plus 0.5 μg/kg dexmedetomidine divided into 10 mL that was injected between the two pectoralis muscles in the interfascial plane and the other was 20 mL injected between the serratus anterior and the pectoralis minor.Results:Postoperative morphine consumption and stress hormone level in P group were significantly lower than E group. The pain scores and number of patients requested analgesic postoperatively showed significantly higher values in E group. Hemodynamic parameters, fentanyl needed intraoperatively and the incidence of postoperative complications recorded no significant difference between the two groups.Conclusion:The current study demonstrated that PECS block provides better quality of analgesia than ESP block in patients subjected to MRM operations.

Estudio de la Relación Topográfica del Tercer Molar Inferior con el Conducto Mandibular. Frecuencia y Complicaciones

Introducción:El conocimiento de la anatomía de la región mandibular es fundamental para la realización de intervenciones quirúrgicas debido a la relación de vecindad existente entre las estructuras dentarias y óseas. Los objetivos de este trabajo fueron determinar el trayecto del conducto mandibular como conducto verdadero hasta el agujero mentoniano en maxilares secos, establecer la frecuencia de relación del tercer inferior molar con el conducto y registrar las complicaciones que se presentaron durante la erupcióndel tercer molar inferior, antes ydespués del tratamientoquirúrgico, según sexo y edad. Métodos: Se utilizaron 50 huesos mandibulares secos, silicona con agregado de sulfato de bario, alambre de ortodoncia, compás de punta seca, regla milimetrada y películas radiográficas. Se practicaron cortes frontales y sagitales para obtener las distancias base, reborde alveolar y diente-conducto. Se emplearon el método porcentual y la prueba de Chi-cuadrado (x~) para la cuantificación y la validación de los datos con una significación estadística de p &lt; 0,05. Resultados: Se determinó que el conducto dentario inferior es verdadero en el 80% de los casos. En cortes frontales el conducto se ubicó más cercano al reborde alveolar. En cortes sagitales la distancia diente-conducto fue íntima. Los datos arrojaron mayor frecuencia de complicaciones en pacientes del sexo femenino, en edades comprendidas entre 17 a 25 años y con posición mesioangular y retenida de la pieza dentaria. Las complicaciones más evidentes fueron trismus, pericoronaritis, dolores de tipo neurálgico y otitis.

(336) - Gynecological Complications in Female Patients with Left Ventricular Assist Device Support

(336) - Gynecological Complications in Female Patients with Left Ventricular Assist Device Support

Female Gender of the Recipient Is Independently Associated With Prolonged Ventilation Time and Hospital Stay After Liver Transplantation

BackgroundAlthough female patients are associated with several complications after liver transplantation (OLT), its role in short-term postoperative outcomes is not known. The aims of this study were to investigate the relationship between female gender and ventilation time and hospital stay after OLT. MethodsAfter receiving institutional review board approval, we studied adult patients who underwent OLT at our center between 2004 and 2013. Female and male recipients were compared by using Student t and χ2 tests. Risk factors were confirmed in multivariate logistic models. ResultsOf 1476 patients, 490 were female. Compared with male counterparts, female recipients had more severe disease and comorbidities. Intraoperatively, the 2 groups were similar except for blood transfusion. Postoperatively, female recipients required significantly longer ventilation time (median, 3 days [interquartile range (IQR), 2–5], vs median, 2 [IQR, 1–5]; P = .009) and duration of hospital stay (median, 23 [IQR, 15–46] vs median, 18 [IQR, 12–34]; P < .001) compared with male recipients. Female gender was an independent risk factor for prolonged posttransplant ventilation time (≥3 days; odds ratio [OR], 1.65; P < .001) and hospital stay (≥19 days; OR, 1.48; P = .003). ConclusionsFemale gender of the recipient is associated with significantly longer ventilation time and hospital stay after OLT and the management should be tailored to the unique characteristics and susceptibility to postoperative complications in female patients.

AKT1 Gene Polymorphisms and Obstetric Complications in the Patients with Schizophrenia

ObjectiveWe performed a genetic association study with schizophrenic patients to investigate whether the V-akt murine thymoma viral oncogene homolog 1 (AKT1) gene plays a role in obstetric complications.MethodsOne-hundred-eighty patients with schizophrenia (male, 113; female, 67) were included. All patients fulfilled DSM-IV criteria for schizophrenia. Obstetric complications were measured by the Lewis scale. Prenatal and perinatal information was retrospectively collected from the patients' mothers. We selected six single nucleotide polymorphisms (SNPs) for the AKT1 gene: SNP1 (rs3803300), SNP2 (rs1130214), SNP3 (rs3730358), SNP4 (rs 1130233), SNP5 (rs2494732), and SNPA (rs2498804). The genotype data were analyzed for an association with the Lewis total score in terms of allele, genotype, and haplotype distribution.ResultsThe mean total Lewis scores were 1.30±1.61 for males and 1.54±1.87 for females. Higher total score tended to be correlated with an earlier age of onset of schizophrenia in females. In the total sample, no SNP was associated with obstetric complications. However, the additional analyses for male and female subgroups found a significant association between SNPA and SNP4 and Lewis score in females (p=0.02 for SNPA, p=0.04 for SNP4). The SNP5-SNPA haplotype showed a positive association with obstetric complications (p=0.03) in the female patient group.ConclusionWe found an association between SNPs in the AKT1 gene and total Lewis score measuring obstetric complications in female patients with schizophrenia. Because these findings did not survive a correction for multiple testing, the significance should be interpreted carefully and replication studies are required.

Body iron stores in relation to the metabolic syndrome, glycemic control and complications in female patients with type 2 diabetes

Background and aim Studies suggest that iron plays a significant role in the development of diabetes and its complications. This study evaluates the associations of iron metabolism parameters with the metabolic syndrome (MS), control and complications in female patients with type 2 diabetes mellitus (T2DM). Methods and results Ferritin, soluble Transferrin Receptor (sTfR), sTfR/Log ferritin ratio (sTfR-F index), iron, full blood count and high-sensitivity C-reactive protein (hs-CRP) were determined in 110 female patients with T2DM. Steady state beta cell function (%B), insulin sensitivity (%S) and insulin resistance were assessed with homeostasis model. Patients were divided into tertiles of ferritin and sTfR-F index and according to the presence or absence of the MS and diabetic complications. Patients within the lowest tertile of the sTfR-F index had significantly higher fasting insulin, percent B, low-density lipoprotein cholesterol and Apolipoprotein B than those in the highest tertile. Ferritin showed significant correlations with insulin, percent B and inverse correlations with adiponectin and percent S. The sTfR-F index was significantly correlated with insulin, percent B and lipid parameters. Correcting for hs-CRP abolished the correlations with ferritin but not the sTfR-F index. Higher indices of body iron were significantly associated with diabetes complications but no associations were found with MS, glucose or glycemic control. Multiple regression analysis with confounding variables showed ferritin and the sTfR-F index were not independently associated with diabetes complications. Conclusions Association of ferritin with metabolic derangements and complications in diabetes is partly dependent on association with inflammation. Iron status, estimated with the sTfR-F index, is associated with metabolic derangements and complications but the associations are dependent on other risk factors. Prospective studies that use the sTfR-F index as a marker of iron status are required to confirm the role of iron in the etiopathogenesis of T2DM and its complications.

1245: The Incidence and Risk Factors of Post-Operative Complications in Female Patients Undergoing Radical Cystectomy

1245: The Incidence and Risk Factors of Post-Operative Complications in Female Patients Undergoing Radical Cystectomy