Difference In Conversion Rate Research Articles

Photo/mechanical/acidic multi-stimuli responses and information encryption design of acylhydrazone derivative.

Stimuli-responsive crystalline materials have received much attention for being potential candidates of smart materials. However, the occurrence of polymorphism-driven stimuli responses in crystalline materials remains interesting but rare. Herein, three polymorphs of an acylhydrazone derivative, N'-[(E)-(1-benzofuran-2-yl) methylidene] pyridine -4-carbohydrazide (BFMP) were prepared. Form-1 undergoes a photomechanical response via E→Z photoisomerization under UV irradiation, accompanied by a decrease in fluorescence intensity and a change from colorless to yellow. Two types of Z→E thermal isomerization mechanisms with significant differences in conversion rate were observed at different temperatures in form-1. The solid-melt-solid transition has a faster conversion rate compared to the solid-solid transition due to freedom from lattice confinement. The transition from form-2 to form-3 can be achieved under grinding, coupled with a significant decrease in fluorescence intensity. The similar molecular stacking pattern of form-2 and form-3 provides a structural basis for the grinding-induced crystalline transition behavior. In addition, the presence of the pyridine moiety imparts an acid chromic property. The combination of photochromism and acid chromism explores the possible applications of acylhydrazone derivatives in information encryption.

Robotic-assisted versus conventional laparoscopic surgery in the management of obese patients with early endometrial cancer in the sentinel lymph node era: a randomized controlled study (RObese)

BackgroundNearly 65% of patients with endometrial cancer who undergo primary hysterectomy have concurrent obesity. Retrospective data show advantages in using robotic surgery in these patients compared with conventional laparoscopy, namely...

(347) A Single Center Review of Access to Gender Affirming Surgical Care: Analysis of Consultation to Surgery Conversion Rates and Patient Wait Times

Abstract Introduction The demand for gender-affirming surgical care has grown exponentially throughout the United States throughout the last decade. Even within gender care programs, patients face complex barriers to receiving multidisciplinary, gender-affirming care. The differences in access to care among different gender-affirming procedures remain understudied. Understanding the barriers that patients face within our multidisciplinary gender care program is imperative to addressing the needs of our population. Objective To assess the differences in wait times and successful completion of surgery following initial consultation across multiple gender-affirming surgical procedures. Methods Records of all patients seeking an initial consultation for gender-affirming surgical care at a single center from February 2018 to March 2022 were reviewed. Recorded demographic data of patients included age, sex assigned at birth, gender identity, insurance type, race, and ethnicity. We categorized gender-affirming surgical care into the following procedures: vaginoplasty, phalloplasty, mastectomy, breast augmentation, facial feminization, orchiectomy, hysterectomy, and other. The conversion rate was defined as the percentage of patients who completed surgery after an initial consult. Patients were followed until April 2023, a minimum of >365 days. Contact to consult was defined as the time between a patient’s initial contact for scheduling an appointment and a formal in-office consult, and consult to surgery was determined by the time from the first consult to the actual surgery. Comparisons were analyzed in SPSS with Pearson chi-square test or one-way ANOVA with post-hoc comparisons as appropriate. Results Our comprehensive gender care program conducted 621 consultations and 438 surgeries between February 2018 and March 2022. The difference between conversion rates among surgeries was statistically significant by Pearson chi-square test (p <0.001), with vaginoplasty and phalloplasty having the lowest conversion rate at 31%, with post-hoc adjusted residuals < -2. Facial feminization and mastectomy had a higher conversion rate (88% and 79%, respectively). Regarding time between major events, the time from patient contact to in-office consult was not statistically significant with one-way ANOVA between gender-affirming procedures at p= 0.53. However, the time from consult to surgery was statistically significant between groups at p= 0.002. Phalloplasty had a statistically longer consult to surgery time at 416 days (p<0.02) than any other surgery on post-hoc testing. Vaginoplasty had a statistically lengthier wait at 289 days (p<0.05) than mastectomy and breast augmentation. Conclusions Phalloplasty and vaginoplasty have the lowest conversion rates of all gender-affirming procedures. Among patients who undergo a phalloplasty, the consult to surgery wait time is statistically longer than any other surgery. For vaginoplasty patients, the consult to surgery wait is statistically longer than for mastectomy and breast augmentation. The differences in conversion rates and wait times from consult to surgery raise questions about disparities and access to care, particularly for more complex gender-affirming surgical procedures, that will be further explored in the dataset. Disclosure No.

Optimization of diesel oxidation catalyst for enhanced emission reduction in engines

With tightening emission regulations and the advent of Zero-Carbon targets, curbing emissions from engines has become imperative. To enhance the emissions reduction of engines, a diesel oxidation catalyst (DOC) inserted within a three-layer porous media is proposed. Effects of Pd/Pt blended ratios, porous media settings, and boundary conditions on pollutant conversion are simulated and analyzed. The results indicate that increasing the Pd/Pt blended ratio and reducing the porosity favor the conversion of CO and C3H6 but hinder the generation of NO2, and there exists a balancing effect of porosity and multi-layer porous media on emission conversion. With mean porosity augment from 0.4 to 0.6, NO conversion rate is improved by 2.1 % in the DOC with incremental porous media setting at Vin = 10 m/s, Tin = 550 K, and 100 % Pt. Moreover, the differences in conversion rates are enlarged with an increased Pd catalyst content, by 3.2 %, 5.9 %, 9.6 %, and 10.6 % respectively. Besides, 50 sets of DOCs are simulated, using orthogonal experiment analysis to optimize the boundary conditions and DOC setting. The maximum conversion rate is achieved when Vin = 10 m/s, Tin = 600 K, mO2 = 0.04, and Pd/Pt catalyst blended ratio and porosity is 100%Pt+1/4 + 1/4 and 0.5 + 0.4+0.4 in porous media.

Dynamic Changes in Pre- and 3 Months Post-Transplant NGS MRD Status May Predict the Allogeneic Stem Cell Transplant Outcome of Patients with AML

Introduction: To deal with the high propensity for relapse and substantial genetic heterogeneity of AML, monitoring measurable residual disease (MRD) has become an effective approach to evaluate the response to chemotherapy and to predict relapse. However, the clinical implications of NGS MRD change after allogeneic hematopoietic cell transplantation (alloHCT) are still under investigation. The aims of this retrospective study are to verify whether alloHCT improved the outcome of AML patients with NGS MRD positive status in pre-transplant and to investigate how pre- and post-transplant NGS MRD status changes affect the outcome of patients with AML. Methods: This study analyzed patients of age more than 18 years who underwent alloHCT between 2018 and 2022 at single center. NGS mutation test was obtained at diagnosis, and every 3 months after stem cell transplant for 2 years with synchronized peripheral blood chimerism tests. Requirement for inclusion in this retrospective cohort study was availability of NGS mutation results at pre-transplant and at 3 months, as well as donor chimerism results after alloHCT. Patients with no mutations by NGS at diagnosis and at pre-transplant were excluded. Patients were classified by the NGS MRD status in pre-transplant and at 3 months post-transplant: Positive MRD to Positive MRD (Group A), Positive MRD to Negative MRD (Group B), Negative MRD to Positive MRD (Group C), and Negative MRD to Negative MRD (Group D). Patient characteristics are in Table 1. The Kaplan-Meier method and log-rank tests were used to estimate the survival and to compare the differences in survival. Statistical analyses were performed with GraphPad Prism version 9.1.0 (Prism Inc), Microsoft Excel (Microsoft Corporation). Results: Median follow-up was 21 months (range, 3-66). One hundred sixty-five patients met inclusion criteria. Among these, 104 (63.0%) were MRD positive, and 61 (37.0%) were MRD negative by NGS at pre-alloHCT. Fifty-one of the MRD positive patients (49%) became MRD negative by NGS at 3 months after alloHCT. The conversion rate to MRD negative from positive by NGS was not different by conditioning regimen (myeloablative (MA) 54.3% versus reduced intensity (RIC) 49.2%, p=0.67), or by AML risk group (intermediate 48.9% versus adverse 44.7%, p=0.84). Four years cumulative incidence of relapse (CIR) of each group was statistically different between Group A and the others (Group A 47.3%, Group B 17.7%, Group C 25.9%, and Group D 10.9%, p<0.001), but not different between Group B, C and D (p>0.5). Median OS was 17 months for Group A, 27 months for Group C, but the other groups did not reach. Four-year OS of each group was statistically different between Group A, Group B, and Group D (Group A 21.1% (95% CI: 2.0 - 53.8), Group B 55.2% (95% CI: 38.7 - 68.9), Group C 50.0% (95% CI: 20.8 - 73.6), and Group D 79.3% (95% CI: 63.7 - 94.9), respectively, p< 0.05). Among 12 patients who were MRD positive by NGS in post-alloHCT, but not in pre-alloHCT (Group C), 3 had clinical relapse, at 4 months, 6 months, and 26 months, respectively. Five patients had NGS mutations different from the initial diagnosis. They did not show clinical relapse and maintained 100% peripheral blood lymphoid (CD3) donor chimerism throughout the observation. Conclusion: This study showed alloHCT could convert 49% of pre-transplant MRD positive patients to MRD negative by NGS. However, there were no differences in conversion rate by intensity of conditioning regimen or by AML risk group. Combining pre- and 3 months post-transplant MRD status by NGS could discriminate prognostic subgroups in post-transplant MRD positive and negative group each and may be useful in designing post-alloHCT therapies.

Medical cardioversion of atrial fibrillation and flutter with class IC antiarrhythmic drugs in young patients with and without congenital heart disease.

The use of flecainide and propafenone for medical cardioversion of atrial fibrillation (AF) and atrial flutter/intra-atrial reentrant tachycardia (IART) is well-described in adults without congenital heart disease (CHD). Data are sparse regarding their use for the same purpose in adults with CHD and in adolescent patients with anatomically normal hearts and we sought to describe the use of class IC drugs in this population and identify factors associated with decreased likelihood of success. Single center retrospective cohort study of patients who received oral flecainide or propafenone for medical cardioversion of AF or IART from 2000 to 2022. The unit of analysis was each episode of AF/IART. We performed a time-to-sinus rhythm analysis using a Cox proportional hazards model clustering on the patient to identify factors associated with increased likelihood of success. We identified 45 episodes involving 41 patients. As only episodes of AF were successfully cardioverted with medical therapy, episodes of IART were excluded from our analyses. Use of flecainide was the only factor associated with increased likelihood of success. There was a statistically insignificant trend toward decreased likelihood of success in patients with CHD. Flecainide was more effective than propafenone. We did not detect a difference in rate of conversion to sinus rhythm between patients with and without CHD and were likely underpowered to do so, however, there was a trend toward decreased likelihood of success in patients with CHD. That said, medical therapy was effective in >50% of patients with CHD with AF.

Patients Undergoing Revision Hip Arthroscopy Demonstrate Comparable Survivability and Improvement but Worse Postoperative Outcomes Compared to Patients Undergoing Primary Hip Arthroscopy: A Propensity Matched Study at Five-Year Follow-Up

To compare mid-term clinical outcomes between patients undergoing primary hip arthroscopy (HA) versus revision hip arthroscopy (RHA) for femoroacetabular impingement syndrome (FAIS). A retrospective cohort study was conducted on 1,862 patients who underwent hip arthroscopy for FAIS from January 2012 to April 2017. Patients who underwent RHA were propensity matched in a 1:4 ratio by age, sex, body mass index (BMI), and exercise status to patients who underwent primary HA. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes before and at 5 years after surgery, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction, were compared between groups. Minimally clinically important difference and patient-acceptable symptomatic state (PASS) achievement rates were compared using previously published thresholds. Fifty-one patients who underwent RHA (35 female, 16 male; age 36.2 ± 10.2 years; BMI 26.5 ± 5.9) were followed up for 63.9 ± 9.2 months and then propensity matched in a 1:4 ratio by sex, age, and BMI to 204 control patients who underwent primary HA. At midterm follow-up, patients in the RHA cohort had significantly lower scores for HOS-SS (RHA 64.9 ± 32.5 vs HA 75.3 ± 26.2, P= .044), mHHS (RHA 72.2 ± 22.4 vs HA 80.1 ± 18.1, P= .039), and iHOT-12 (RHA 61.4 ± 29.3 vs HA 71 ± 27.6, P= .043) compared to primary HA patients. Rates of achieving PASS were significantly decreased for HOS-SS (RHA 38.3% vs HA 55.4%, P= .039) and iHOT-12 (RHA 41.9% vs HA 59.9%, P= .035) in the RHA cohort. There were no significant differences in rates of conversion to THA or subsequent reoperation on the index hip between groups. Patients undergoing revision hip arthroscopy demonstrate comparable survivability and magnitude of improvement but may experience worse overall outcome scores and meet thresholds for clinically significant outcomes less often when compared to primary hip arthroscopy patients. Level III; retrospective comparative study.

Allograft reconstruction of acetabular labrum has comparable outcomes to labral refixation.

The acetabular labrum plays an important role in hip stability, intra-articular fluid pressurization and force distribution. For irreparable labral pathology, labral reconstruction is an increasingly adopted technique shown to decrease hip pain and improve function. We evaluated survivorship and clinical outcomes of allograft labral reconstruction using the mini-open anterior surgical approach. Twelve patients who underwent labral reconstruction using a semitendinosus tendon allograft (reconstruction group) were matched 1:3 based on age, gender, body mass index, year of surgery, preoperative Tönnis grade, previous hip surgery, residual hip pathology and extent of acetabular chondral lesion to a control group of 36 patients who underwent direct labral repair with anchors (refixation group). At a minimum follow-up of 2 years, patient-reported outcomes, radiological findings and failure rates were compared. The average age was 31.3 years (±13.6) for reconstruction and 34.7 (±10.2) for refixation. Both groups had similar preoperative symptomatic periods (P = 0.3), prevalence of residual hip pathology (P = 1.0) and prevalence of prior hip surgeries (P = 1.0). both groups had a significant improvement of modified Harris Hip scores and 36-Item Short-Form Health Survey physical scores. There was no statistically significant difference in conversion rates to total hip arthroplasty (25% versus 8.3%, P = 0.2); however, time to conversion was significantly longer in the reconstruction group (3.58 years ±1.04) compared to the refixation group (1.20 years± 0.93; P = 0.04). In conclusion, at a minimum of 2 years of follow-up, mini-open labrum reconstruction for severe insufficiency of acetabular labrum demonstrated comparable improvements in functional outcomes and significantly longer survivorship compared to labral refixation.

Outcomes of associated both-column acetabular fractures with and without a posterior wall fracture- A retrospective observational cohort study

Aims & objectivesOur study sought to determine if posterior wall (PW) involvement in associated both-column acetabular fractures (ABCAFs) is associated with different clinical outcomes, primarily rate of conversion to total hip arthroplasty (THA), in comparison to ABCAFs with no PW involvement. Materials & methodsThis retrospective observational cohort study was performed at two academic Level 1 trauma centers. Two study groups were identified. The first study group consisted of 18 patients who sustained an ABCAF with PW involvement (+PW). The second study group consisted of 26 patients who sustained an ABCAF with no PW involvement (-PW). All patients achieved a minimum 12-months of follow-up and/or received a THA conversion procedure at a time remote to their index open reduction internal fixation (ORIF) procedure. The primary outcome of this study was subsequent conversion to THA on the injured hip. The secondary outcome was the presence of post-operative pain at ≥6 months and/or complications. ResultsNo difference in rate of conversion to THA between + PW (n = 4, 22.2%) and -PW (n = 3, 11.5%) groups was demonstrated (p = 0.419). Similarly, no differences were seen between groups regarding complication rate (p = 0.814) and post-operative pain (p = 0.142). ConclusionInvolvement of the PW does not appear to create worse clinical outcomes in comparison to no involvement in ABCAFs particularly as it relates to ipsilateral joint replacement.

Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes.

Robotic hepatectomy has gained increasing acceptance across the US. Although the robotic approach offers significant technical advantages, it is still bound by the individual surgeon's learning curve. Proficiency in this approach should theoretically lead to improved peri-operative outcomes. Between 2017 and 2020, data on 148 consecutive robotic hepatectomies performed by a single surgeon was retrospectively analyzed. Using cumulative sum (CUSUM) method, intraoperative blood loss (EBL) and operative time were used to assess learning curves for robotic major (n = 58) and minor (n = 90) hepatectomy patients. Perioperative outcomes were compared in regards with proficiency. Proficiency for robotic major and minor hepatectomy was achieved after 22 cases and 34 cases, respectively. No significant differences were observed in patient demographics or tumor characteristics. For robotic major hepatectomy, when compared to early experience, proficiency was associated with a significant improvement in mean EBL (242mL vs 118mL, p = 0.0004), operative time (330min vs 247min, p = 0.0002), decreased overall complication rate (23% vs 3%, p = 0.039), and length of hospital stay (5.7days vs 4.1days, p = 0.004). No difference in conversion rate, mortality or 30day readmission was seen. For robotic minor hepatectomy, proficiency was associated with significantly decreased mean EBL (115mL vs 54mL, p = 0.005), operative time (168 vs 125min, p = 0.014), and length of hospital stay (2.8days vs 2.1days, p = 0.021). No difference was observed in conversion rate, overall complications, mortality or 30day readmission. In the modern era, robotic hepatectomy offers a safe approach with excellent perioperative outcomes. Post learning curve proficiency is associated with significant improvements in perioperative outcomes in both major and minor hepatectomy. Results from our study can serve as a guide to surgeons and programs looking to adopt this technique.

Hand-assisted versus straight laparoscopy for colorectal surgery — a systematic review and meta-analysis

PurposeHand-assisted laparoscopic surgery (HALS) is an alternative to straight laparoscopy (LAP) in colorectal surgery. Many studies have compared the two in terms of efficacy, complications, and outcomes. This meta-analysis aims to uncover if there are any significant differences in conversion rates, operative times, body mass index (BMI), incision lengths, intraoperative and postoperative complications, and length of stay.MethodsComprehensive searches were performed on databases from their respective inceptions to 16 December 2021, with a manual search performed through Scopus. Randomized controlled trials (RCTs), cohort studies, and case series involving more than 10 patients were included.ResultsA total of 47 studies were found fitting the inclusion criteria, with 5 RCTs, 41 cohort studies, and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates (odds ratio [OR] 0.41, 95%CI 0.28–0.60, p < 0.00001), shorter operative times (Mean Difference [MD] − 8.32 min, 95%CI − 14.05– − 2.59, p = 0.004), and higher BMI (MD 0.79, 95%CI 0.46–1.13, p < 0.00001), but it was also associated with longer incision lengths (MD 2.19 cm, 95%CI 1.66–2.73 cm, p < 0.00001), and higher postoperative complication rates (OR 1.15, 95%CI 1.06–1.24, p = 0.0004). Length of stay was not different in HALS as compared to Lap (MD 0.16 days, 95%CI − 0.06–0.38 days, p = 0.16, and intraoperative complications were the same between both techniques.ConclusionsHand-assisted laparoscopy is a suitable alternative to straight laparoscopy with benefits and risks. While there are many cohort studies comparing HALS and LAP, more RCTs would be needed for a better quality of evidence.

Specialist-led urgent cholecystectomy for acute gallstone disease.

BackgroundDespite overwhelming evidence of the clinical and financial benefit of urgent cholecystectomy, there is variable enthusiasm and uptake across the UK. In 2014, following the First National Emergency Laparotomy Audit Organisational Report, we implemented a specialist-led urgent surgery service, whereby all patients with gallstone-related pathologies were admitted under the direct care of specialist upper gastrointestinal surgeons. We have analysed 5 years of data to investigate the results of this service model.MethodsComputerised operating theatre records were interrogated to identify all patients within a 5-year period undergoing cholecystectomy. Patient demographics, admission details, length of stay, duration of surgery, and complications were analysed.ResultsBetween 01/01/2016 and 31/12/2020, a total of 4870 cholecystectomies were performed; 1793 (36.8%) were urgent cases and 3077 (63.2%) were elective cases. All cases were started laparoscopically; 25 (0.5%) were converted to open surgery—14 of 1793 (0.78%) urgent cases and 11 of 3077 (0.36%) elective cases.Urgent cholecystectomy took 20 min longer than elective surgery (median 74 versus 52 min). No relevant difference in conversion rate was observed when urgent cholecystectomy was performed within 2 days, between 2 and 4 days, or greater than 4 days from admission (P = 0.197). Median total hospital stay was 4 days.ConclusionUrgent laparoscopic cholecystectomy is safe and feasible in most patients with acute gall bladder disease. Surgery under the direct care of upper gastrointestinal specialist surgeons is associated with a low conversion rate, low complication rate, and short hospital stay. Timing of surgery has no effect on conversion rate or complication rate.

Metaphyseal fixation in revision knee arthroplasty: a systematic review of the literature and meta-analysis of mid-long-term outcomes of metaphyseal sleeves and cones.

Metaphyseal augmentation has in recent years formed a key strategy in management of bone loss in revision knee arthroplasty. There are studies reporting excellent short-term results, however long- term data is lacking. There is also a paucity of studies comparing the most frequently utilised augments, metaphyseal sleeves, and cones. We conducted a systematic review and meta-analysis to evaluate and compare the mid to long term outcomes of metaphyseal cones and sleeves. We conducted systematic search of 4 databases (Medline, Embase, CINALH and PubMed). Seventeen studies were found to be eligible for inclusion of which ten investigated metaphyseal sleeves and the remaining seven investigated cones. Mean follow up across all studies was 6.2 years. The total number of patients included in the studies was 1319 and the number of knees operated on was 1431. We noted a higher revision rate of metaphyseal cones when compared to sleeves 10.85% vs 6.31 (p=0.007). Reoperation rates were also higher in cones compared to sleeves, 13.78% vs 3.68% (p<0.001). Prosthetic joint infection was the most common reason for revision. The difference in conversion rates, based on augment location was statistically significant p=0.019. When undertaking further sub-analysis; there was no statistically significant difference when comparing revision rates of; tibial vs femoral augments p=0.108, tibial vs tibial & femur p=0.54 but a difference was seen between femoral vs tibial & femoral augments p=0.007. Based on our data, metaphyseal sleeves demonstrate significantly lower revision rates compared to metaphyseal cones. However overall, both demonstrate reliable mid to long-term outcomes.

No Difference in Conversion Rate to Hip Arthroplasty After Intramedullary Nail or Sliding Hip Screw for Extracapsular Hip Fractures: An Observational Cohort Study of 19,604 Individuals.

The widespread use of intramedullary nails (IMNs) compared with sliding hip screws (SHSs) in extracapsular hip fractures (AO/OTA 31-A1, 31-A2, 31-A3) has been questioned because of a higher complication rate, although the outcome might have improved through more recent implant designs and the learning curve. This study aimed to investigate if there is a difference with regard to the cumulative incidence of conversion to arthroplasty or any reoperation during the first 5 years after IMN or SHS fixation of extracapsular hip fractures. In this nationwide, observational cohort study, individuals who were ≥60 years of age and were registered in the Swedish Fracture Register (SFR) from 2012 to 2018 due to extracapsular fracture and were primarily treated with an IMN or SHS were followed in the SFR and the Swedish Arthroplasty Register (SAR) for a minimum of 1 year. The primary outcome was the cumulative incidence of conversion to arthroplasty (conversion rate). The secondary outcome was the cumulative incidence of all reoperations (reoperation rate). Both were calculated in a competing risk analysis during the first 5 years. We included 19,604 individuals (70% women), with a median age of 85 years (range, 60 to 107 years). The 31-A2 fracture was most prevalent (52%), followed by the 31-A1 fracture (28%). No significant differences were seen in the 1-year conversion rate after IMN or SHS use (1.0% compared with 0.9% in the 31-A1 fractures, 1.7% compared with 1.3% in the 31-A2 fractures, and 1.3% compared with 1.5% in the 31-A3 fractures) or in the 1-year reoperation rate (1.9% compared with 1.9% in the type-A1 fractures, 3.4% compared with 2.5% in the type-A2 fractures, and 4.0% compared with 5.2% in the type-A3 fractures). Only in 31-A2 fractures were more reoperations seen after IMN use at 2 and 5 years (p < 0.05). The crude 1-year-mortality was 26.4% (5,178 of 19,604), without significant differences between implants. Considering conversion arthroplasty, IMNs and SHSs performed equally well in general. IMN use was associated with more reoperations than SHS use in 31-A2 fractures at 2 years. However, from a clinical perspective, the differences between the implants were small, in particular when considering the competing risk of dying. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

A trial of arbidol hydrochloride in adults with COVID-19.

Background:To date, there is no effective medicine to treat coronavirus disease 2019 (COVID-19), and the antiviral efficacy of arbidol in the treatment for COVID-19 remained equivocal and controversial. The purpose of this study was to evaluate the efficacy and safety of arbidol tablets in the treatment of COVID-19.Methods:This was a prospective, open-label, controlled and multicenter investigator-initiated trial involving adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients were stratified 1:2 to either standard-of-care (SOC) or SOC plus arbidol tablets (oral administration of 200 mg per time, three times a day for 14 days). The primary endpoint was negative conversion of SARS-CoV-2 within the first week. The rates and 95% confidential intervals were calculated for each variable.Results:A total of 99 patients with laboratory-confirmed SARS-CoV-2 infection were enrolled; 66 were assigned to the SOC plus arbidol tablets group, and 33 to the SOC group. The negative conversion rate of SARS-CoV-2 within the first week in patients receiving arbidol tablets was significantly higher than that of the SOC group (70.3% [45/64] vs. 42.4% [14/33]; difference of conversion rate 27.9%; 95% confidence interval [CI], 7.7%–48.1%; P = 0.008). Compared to those in the SOC group, patients receiving arbidol tablets had a shorter duration of clinical recovery (median 7.0 days vs. 12.0 days; hazard ratio [HR]: 1.877, 95% CI: 1.151–3.060, P = 0.006), symptom of fever (median 3.0 days vs. 12.0 days; HR: 18.990, 95% CI: 5.350–67.410, P < 0.001), as well as hospitalization (median 12.5 days vs. 20.0 days; P < 0.001). Moreover, the addition of arbidol tablets to SOC led to more rapid normalization of declined blood lymphocytes (median 10.0 days vs. 14.5 days; P > 0.05). The most common adverse event in the arbidol tablets group was the elevation of transaminase (5/200, 2.5%), and no one withdrew from the study due to adverse events or disease progression.Conclusions:SOC plus arbidol tablets significantly increase the negative conversion rate of SARS-CoV-2 within the first week and accelerate the recovery of COVID-19 patients. During the treatment with arbidol tablets, we find no significant serious adverse events.Trial registration:Chinese Clinical Trial Registry, NCT04260594, www.clinicaltrials.gov/ct2/show/NCT04260594?term=NCT04260594&draw=2&rank=1

Minimally invasive adrenalectomy – Operative and perioperative results of transperitoneal and retroperitoneal adrenalectomies performed at the University of Szeged Department of Surgery during 23 years

Aim. Our goal was to evaluate operative and perioperative data of retroperitoneal (RP) and transperitoneal (TP) adrenalectomies performed at the University of Szeged Department of Surgery. Patients and method. During aretrospective cohort study including 174 adrenalectomies (28 RP; 146 TP) performed between 1998 and 2021, the following parameters were evaluated: rate of previous abdominal surgeries, conversion rate, operative time, intraoperative blood loss, tumor size, histology, hospital stay, early and late complications. Results. With significantly higher rate of previous abdominal surgeries [TP vs RP: 68 (46.57%) vs 4 (14%)P= 0.0021], there was no markable difference in conversion rate [TP vs RP: 7 (4.79%) vs 5 (18%),P= 0.312]. Significantly larger tumours were removed with TP (TP vs RP: 58.05 vs 34.8 mm,P= 0.016), with no markable difference in intraoperative blood loss (TP vs RP: 67.85 vs 50.2 ml,P= 0.157). Operative time was significantly shorter in TP (TP vs RP: 86.3 vs 134.5 min;P= 0.024). The most frequent histology was adenoma (TP vs RP:n= 95; 65.06% vs 64.3%). Pheochromocytoma occurred in 11 (7.53%) and 5 (17.8%) cases in TP and RP, respectively. We found no significant difference in hospital stay (TP vs RP: 5.125 vs 4.61 day;P= 0.413). Five- and 2 cases of early complications were seen in TP (splenic injury, postoperative fever, severe intraoperative bleeding, severe hypokalemia, surgical site infection) and RP (2 severe intraoperative bleeding), respectively. One lethal case of ventricular fibrillation and one delayed complication (postoperative abdominal wall hernia) were observed in TP. Conclusions. Both TP and RP are safe and simply reproducible minimally invasive techniques. According to our observation, RP adrenalectomy seems to be reserved for smaller lesions, while TP proves to be successful in removing enlarged and also malignant lesions with significantly shorter operative time.

Lower Rates of Unplanned Conversion to Open in Robotic Approach to Esophagectomy for Cancer.

Minimally invasive approaches to esophagectomy have gained popularity worldwide; however, unplanned conversion to an open approach is not uncommon. This study sought to investigate risk factors associated with converting to an open approach and to evaluate outcomes following conversion. Patients undergoing minimally invasive esophagectomy (MIE) for cancer were identified using the 2016-2019 Procedure Targeted NSQIP Database. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with unplanned conversion to open esophagectomy. Propensity-matched comparison of robotic (RAMIE) to traditional MIE was performed. A total of 1347 patients were included; 140 patients (10%) underwent conversion to open. Morbid obesity, diabetes, hypertension, American Society of Anesthesiologists class, and squamous cell carcinoma were associated with a higher likelihood of conversion. A robotic approach was associated with a lower likelihood of conversion to open (OR .57, 95% CI 0.32-.99). On multivariable analysis, squamous cell carcinoma pathology was the only variable independently associated with higher odds of conversion (OR 2.66, 95% CI 1.02-6.98). Propensity-matched comparison of RAMIE vs MIE showed no significant difference in conversion rate (6.5% vs 9.1%, P = .298), morbidity, or mortality. A robotic approach to esophagectomy was associated with a lower likelihood of unplanned conversion to open, and patients who were converted to open experienced worse outcomes. Future studies should aim to determine why a robotic esophagectomy approach may lead to fewer open conversions as it may be an underappreciated benefit of this newest operative approach.

Evaluating the learning curve of robotic radical antegrade modular pancreatosplenectomy: A retrospective cohort study

BackgroundRadical antegrade modular pancreatosplenectomy (RAMPS), a new surgical approach for pancreatic ductal adenocarcinoma of the body and tail, has become increasingly accepted and performed in recent years. Robotic surgery has advantages over open and laparoscopic surgeries in terms of surgical vision and instrument flexibility. However, the lack of comprehension of the learning curve has limited its generalization. This study aimed to evaluate the learning curve of robotic posterior RAMPS. MethodsPatients who underwent robotic posterior RAMPS between February 2017 and April 2021 at our institution were included in this study. Data on patient characteristics, perioperative outcomes, and pathological outcomes were summarized and analyzed. The cumulative sum (CUSUM) method was used to assess the learning curve and inflection points based on operation time and estimated blood loss. ResultsOne hundred consecutive patients who underwent robotic posterior RAMPS were enrolled. The median operation time was 235.0 (interquartile range [IQR], 210.0–270.0) min, and the estimated blood loss was 210.0 (IQR, 165.0–245.0) mL. The grade 3/4 Clavien–Dindo complication rate was 8% (8/100). According to the CUSUM plot, the inflection points of the learning curve were 25 and 65 cases, dividing the case series into the learning (1–25 cases), plateau (26–65 cases), and maturation (66–100 cases) phases. The operation time was relatively high in the learning phase, reached a plateau between 25 and 65 cases (270.0 min vs. 220.0 min, p < 0.01), and decreased significantly in the maturation phase (p < 0.01). Estimated blood loss improved in the maturation phase compared to the learning phase (150.0 vs. 245.0 mL, p < 0.01). No significant differences in conversion rate, complications, or mortality were observed among the three phases. ConclusionThe inflection points of the learning and plateau phases were the 25th and 65th cases, respectively. Robotic RAMPS is safe and feasible even in the learning phase.

Laparoscopic and Robotic Technically Major Liver Resections for Lesions Involving Segment 7: A Single Surgeon Experience of 123 Cases

Patients with lesions involving segment 7 have been considered poor candidates for minimally invasive liver resections.This study aims to compare short-term outcomes of laparoscopic liver resections (LLR) and robotic resections (RLR) for tumors involving segment 7. Retrospective analysis of prospective database on operative and postoperative characteristics and surgical outcomes of patients whom underwent a resection of a tumor involving segment 7. Of 555 patients undergoing LLR or RLR between October 2011 and September 2021,123 patiens underwent a technically major minimally invasive resection for tumors involving segment 7(101 LLR and 22 RLR).The type of resection was decided on the basis of tumor size and location.Both groups were comparable for age,sex,ASA score,tumor diameter,and number of patients with additional liver resections outside segment 7.Operative time was similar in both groups (median LRR 150 (70-300)min vs RLR 175 (145-190)min;p=0.25).Blood loss was less in the RLR-group (80 (30-110)cc vs 150(130-190)cc in the LLR;p<0.001).Median hospital stay was shorter for RLR (2 (1-3)days vs 4 (3-6)days for LLR;p<0.001) .There was no significant difference in postoperative complications (LLR:10.9% vs RRL13.6;p=0.72).In RLR less staplers were used (0 (0-0) vs 2 (0-4) for LLR).There was no difference in conversion rate (LLR: 5% vs RLR 0%;p=0.58) or redo-hepatectomies (LLR:17.8% vs 22.7% for RLR;p=0.59).There was no significant difference in R1 resection rate (LLR: 5.2% vs RLR: 0%;p=0.58). This study suggests thar RLR for tumors involving segment 7 can be performed with comparable short-term outcomes as similar LLR. However RLR were associated with less intraoperative blood loss and a shorter hospital stay.

Conversions in pediatric robot-assisted laparoscopic surgery

BackgroundNew technology attracts necessary concerns regarding safety and effectiveness, including the risk and circumstances of conversions. This study analyses our 11-year experience of conversions from a dedicated pediatric robot-assisted laparoscopic surgery service. MethodsConsecutive patients were evaluated from a prospective database for the period March 2006 to May 2017. Descriptive and quantitative data for conversions were analysed. Variables were investigated including year of surgery, patient age, operation type, surgeon, and experience. ResultsA total of 539 children underwent 601 procedures. There were 45 different types of procedures. Mean (± SD) age was 7.0 ± 5.2 years, and youngest 4 weeks old. There were 31 conversions (5.8%). Conversion rates were significantly higher in younger children, with rates of 10.0%, 6.1% and 4.2% for age groups 0–2, 2–6, and 6–18 years respectively (p = 0.01). There was a significant difference in conversion rates amongst procedures (p<0.001). Intravesical (9/26, 34.6%), liver cyst (2/8, 25.0%) and choledochal cyst (8/60, 13.3%) procedures were the highest. The most frequent reason for conversion was anesthetic related issues caused by dilated intestine and/or inadequate muscle relaxation (16/31, 52%). Three conversions were attributable to mechanical failures, none attributed to intraoperative complication. ConclusionsConversion rates are low even in the learning phase and comparable favourably to conventional laparoscopy, supporting the safety and effectiveness of robot-assisted technology for advanced laparoscopy in children. The importance of optimization of surgical conditions cannot be overemphasised.