Effects Of Different Surgical Procedures Research Articles

Interaction between alimentary surgery and risk of dementia: a nationwide population-based case-control study.

Based on current research, it is known that the gastrointestinal tract microbiota and its genome play a crucial role in mental illnesses. Studies indicate a direct correlation between gastrointestinal tract microbiota and the onset of dementia, mediated by metabolic diseases and low-grade inflammation. The association between various gastrointestinal symptoms and neurodegenerative diseases has been recently discussed. However, there is a lack of research regarding the comparative effects of different surgical procedures on neurodegenerative diseases. Therefore, this study primarily focuses on comparing the association between various gastrointestinal surgeries and dementia, aiming to provide guidance for future clinical practice. A nationwide study using the Taiwanese National Health Insurance Research Database included 26 059 patients diagnosed with dementia or Alzheimer's disease and 104 236 controls without diseases. Primary exposures were defined as alimentary surgeries, encompassing cholecystectomy, gastrectomy, bowel resection, and appendectomy. Conditional logistic regression was used to examine the odds ratio and 95% confidence interval for prior alimentary surgery between cases and controls. The results showed that individuals with dementia had a higher rate of gastrectomy. Additionally, individuals with dementia seemed to exhibit a reduced rate of cholecystectomy and appendectomy. Regarding Alzheimer's disease, all four alimentary surgeries showed comparable trends to those observed with dementia. No significant interaction was observed between alimentary surgery and dementia among the four types of surgery evaluated. Our study demonstrates that gastrectomy is associated with an elevated risk of dementia. We aim to uncover more direct evidence in future experiments.

Biomechanical Comparison of Different Surgical Strategies for Skip-level Cervical Degenerative Disc Disease: A Finite Element Study.

We constructed finite element (FE) models of the cervical spine consisting of C2-C7 and predicted the biomechanical effects of different surgical procedures and instruments on adjacent segments, internal fixation systems, and the overall cervical spine through FE analysis. To compare the biomechanical effects between the zero-profile device and cage-plate device in skip-level multistage anterior cervical discectomy and fusion (ACDF). ACDF is often considered the standard treatment for degenerative cervical spondylosis. However, the selection of surgical methods and instruments in cases of skip-level cervical degenerative disk disease is still controversial. Three FE models were constructed, which used noncontiguous 2-level Zero-P (NCZP) devices for C3/4 and C5/6, a noncontiguous 2-level cage-plate (NCCP) for C3/4 and C5/6, and a contiguous 3-level cage-plate (CCP) for C3/6. Simulate daily activities in ABAQUS. The range of motion (ROM), von Mises stress distribution of the endplate and internal fixation system, and intervertebral disk pressure (IDP) of each model were recorded and compared. Similar to the stress of the cortical bone, the maximum stress of the Zero-P device was higher than that of the CP device for most activities. The ROM increments of the superior, inferior, and intermediate segments of the NCZP model were lower than those of the NCCP and CCP models in many actions. In terms of the IDP, the increment value of stress for the NCZP model was the smallest, whereas those of the NCCP and CCP models were larger. Similarly, the increment value of stress on the endplate also shows the minimum in the NCZP model. Noncontiguous ACDF with zero profile can reduce the stress on adjacent intervertebral disks and endplates, resulting in a reduced risk of adjacent segment disease development. However, the high cortical bone stress caused by the Zero-P device may influence the risk of fractures.

Two-level Anterior Cervical Corpectomy and Fusion versus Posterior Open-door Laminoplasty for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: A Comparison of the Clinical Impact on the Occipito-Atlantoaxial Complex.

Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP. This was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. In the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS. The loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.

Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience

ObjectiveAccording to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated.MethodsOne hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed.ResultsThe marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%.ConclusionThe three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.

Effects of Different Surgical Procedures on the Therapeutic Effects, Prognosis, and Major Complications of Acetabular Fractures in the Elderly of China: A Systematic Review and Meta-Analysis.

Objective Different surgical approaches were systematically evaluated to provide an evidence-based medical rationale for the application and promotion of acetabular fractures in the elderly of China. Methods Randomized controlled trials (RCT) of different surgical methods in the treatment of elderly acetabular fractures were searched in the PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM). The search time threshold was set from the time the database was created to the current time. Investigators obtained data independently, and the bias risk of each included writing was reviewed using the Cochrane Manual 5.1.0 criterion. The meta data was analyzed using RevMan 5.4 statistical package. Results 6 RCT articles were included in the end. A total of 445 samples were analyzed by meta. All the six RCT literatures included in this meta-analysis reported the baseline status of patients, only 3 RCT mentioned “random assignment” without any explanation, and the rest did not mention “random” information. The five studies included all gave detailed intervention measures. The number and reasons of blind method and lost follow-up or withdrawal were not described in detail in 6 RCT articles. Through the meta-analysis excellent and good rate between the experimental group and the control group through 6 RCT studies, the heterogeneity test results were chi2 = 6.11, df = 4, P = 0.19 > 0.05, and I2 = 35%, without obvious heterogeneity at Z = 2.68 and P = 0.007. These results suggested that the total hip arthroplasty application has the same excellent rate as other surgical treatment methods, indicating that total hip arthroplasty has a significant effect on the treatment of elderly acetabular fractures. Through the meta-analysis hip-joint function score, the heterogeneity test results were chi2 = 56.16, df = 4, P < 0.00001, and I2 = 93%, with obvious heterogeneity. The great difference was discovered in hip function score between total hip arthroplasty and other surgical methods, showing that total hip arthroplasty can greatly improve hip-joint function. Then, the incidence of hip complications between the experimental cases and the control cases was calculated by meta. The heterogeneity test results were chi2 = 3.17, df = 4, P = 0.53 > 0.05, and I2 = 0%, without remarkable heterogeneity at Z = 3.05 and P = 0.002. This demonstrated that a significant difference was observed in the complication incidence, indicating that total hip arthroplasty displayed a lower incidence of hip-joint functional complications. Conclusion Total hip arthroplasty has a good prognosis and a low complication rate in the treatment of acetabular fractures in the elderly. However, more studies and longer follow-ups are needed to further validate the findings of this study.

Comparison of the decompressive effect of different surgical procedures for dysthyroid optic neuropathy using 3D printed models

PurposeTo compare the decompressive effect around the optic nerve canal among 3 different decompression procedures (medial, balanced, and inferomedial) using 3D printed models.MethodsIn this experimental study, based on data obtained from 9 patients (18 sides) with dysthyroid optic neuropathy, a preoperative control model and 3 plaster decompression models were created using a 3D printer (total, 72 sides of 36 models). A pressure sensor was placed at the optic foramen, and the orbital space was filled with silicone. The surface of the silicone was pushed down directly, and changes in pressure were recorded at 2-mm increments of pushing.ResultsAt 10 mm of pushing, there was significantly lower pressure in the medial (19,782.2 ± 4319.9 Pa, P = 0.001), balanced (19,448.3 ± 3767.4 Pa, P = 0.003), and inferomedial (15,855.8 ± 4000.7 Pa, P < 0.001) decompression models than in the control model (25,217.8 ± 6087.5 Pa). Overall, the statistical results for each 2-mm push were similar among the models up to 10 mm of pushing (P < 0.050). At each push, inferomedial decompression caused the greatest reduction in pressure (P < 0.050), whereas there was no significant difference in pressure between the medial and balanced decompression models (P > 0.050).ConclusionAll 3 commonly performed decompression procedures significantly reduced retrobulbar pressure. Because inferomedial decompression models obtained the greatest reduction in pressure on the optic nerve canal, inferomedial decompression should be considered the most reliable procedure for rescuing vision in dysthyroid optic neuropathy.

Comparative effectiveness of different surgical procedures for traumatic acute epidural haematoma: study protocol for Prospective, Observational Real-world Treatments of AEDH in Large-scale Surgical Cases (PORTALS-AEDH)

IntroductionControversy and variation exist in surgical management for acute epidural haematoma (AEDH). Although craniotomy for AEDH is conventionally employed, no specific evaluation on the necessity of decompressive craniectomy (DC) followed...

Tricuspid annular abnormalities following different surgical strategies in adults with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study).

Although there is an increasing number of patients with corrected tetralogy of Fallot (cTOF), who reach adulthood due to recent successful surgical procedures, some of them suffers from late complications, including functional tricuspid regurgitation (FTR). The purpose of the present study was to examine tricuspid annular (TA) abnormalities in adult cTOF patients and their relationship right atrial (RA) volumes respecting the cardiac cycle assessed by three-dimensional speckle-tracking echocardiography (3DSTE). Moreover, the effect of different surgical procedures on TA morphologic and functional parameters was examined as well. The study comprised 24 cTOF patients (32.8±13.5 years, 9 males) in which early palliative surgery and late total correction were performed in 12 cases (pcTOF), while early total reconstruction was performed in 12 subjects (etrTOF). Their results were compared to those of 33 matched healthy adults (36.7±7.2 years, 15 males). Dilated end-systolic and end-diastolic TA morphologic parameters and their body surface area-indexed counterpart could be detected in cTOF patients as compared to that of controls. TA fractional area change and TA fractional shortening proved to be reduced in cTOF patients as well as in etrTOF and pcTOF patients compared to controls. None of the TA morphologic and functional parameters showed any differences between etrTOF and pcTOF patients. Increased maximum, preatrial contraction and minimum RA volumes could be detected in cTOF patients compared to controls, which correlated with TA dimensions. TA is dilated with reduced function in adult patients with cTOF. TA dilation is related to RA volumes. etrTOF and pcTOF patients have similar TA dimensions and TA functional properties. Fallot; tricuspid annulus; three-dimensional (3D); speckle-tracking; echocardiography.

Impact of surgery on survival in breast cancer with bone metastases only: a SEER database retrospective analysis

BackgroundIt was controversial to operate on the primary site of breast cancer (BC) with bone metastasis only. We investigated the impact of surgery on BC patients with bone metastases via a SEER database retrospective analysis.MethodsA total of 2917 BC cases with bone metastasis, first diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and Results Database (SEER) of National Cancer Institute were selected. We assessed the effect of different surgical procedures on survival and prognosis.ResultsCompared with the non-surgical group, the primary tumor surgical group showed longer median survival time (χ2 = 146.023, P < 0.001), and the breast-conserving subgroup showed the highest median survival time of 70 months (χ2 = 157.117, P < 0.001). Compared with the non-surgery group, the median overall survival (OS) of primary surgery group was longer (HR = 0.525, 95%CI = 0.467–0.590, P < 0.001), and the breast-conserving subgroup showed the longest median operative OS (HR = 0.394, 95%CI = 0.325–0.478, P < 0.001).ConclusionThis study showed that primary surgery could improve the median survival time and OS of BC patients with bone metastasis. Moreover, under the condition of low tumor burden, breast conserving surgery was a better choice.

Total hip arthroplasty or hemiarthroplasty for femoral neck fractures in elderly patients with neuromuscular imbalance.

This study aimed at comparing clinical outcomes between total hip arthroplasty (THA) and hemiarthroplasty (HA) inelderly patients with neuromuscular imbalance (stroke, Parkinsonism, etc.). A total of 226 elderly patients with neuromuscular imbalance and femoral neck fractures treated with THA or HA were recruited at a single center, and their clinical data retrospectively reviewed. Mean follow-up time was 40.5months (range 24-78), the primary outcome was secondary hip procedure while secondary outcomes included function, pain, health-related quality of life, complications, and death. Kaplan-Meier survival curves were used to determine the estimated survivorship, with re-operation as the end point. Logistic regression analyses were performed to assess the effects of different surgical procedures on mortality while linear regression analysis was used to evaluate the function, pain and quality of life. Kaplan-Meier survivorship, with an end point of re-operation for any reason in the THA group, was 90.3% (95% CI 82.3-98.3), which was not significantly different from 95.9% (95% CI 93.0-98.8) for the HA group (p = 0.137). The most common cause of re-operation in both groups was dislocation. There were no significant differences with regards to postoperative complications (including dislocation). Compared to HA, THA exhibited better functional outcomes, quality of life and low pain intensity. Notably, there was no difference in 2year mortality rates between the groups, however, HA was associated with a higher mortality rate beyond 2years (OR 0.137; 95% CI 0.030-0.630; p = 0.011). THA is an effective therapeutic procedure for femoral neck fractures in elderly patients with neuromuscular imbalance.

Impact of thyroid cancer treatment on assisted reproductive technology outcomes in women with infertility

PurposeWe investigated the effect of different surgical procedures and radioactive iodine treatment (RAIT) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes and evaluated whether possible risk factors, including age, thyroid-stimulating hormone (TSH) levels, and thyroid antibody positivity, were associated with adverse IVF/ICSI outcomes.MethodsThis retrospective study included 76 women with infertility who had received thyroid cancer (TC) treatment among 137,698 infertile women who underwent IVF/ICSI cycles at the Peking University Third Hospital between 2010 and 2019. Clinical pregnancy and live birth rates were assessed.ResultsWe found that the clinical pregnancy and live birth rates in women who underwent partial thyroidectomy were 7- and 6-fold higher, respectively, than those in women who underwent total thyroidectomy. We observed no significant differences in the clinical pregnancy and live birth rates between the RAIT and non-RAIT groups, even after adjusting for age, TSH levels, surgical treatment, and thyroid antibody positivity. Multivariate logistic regression analysis showed that age and TSH levels were not associated with decreased clinical pregnancy and live birth rates. Women with thyroid antibody positivity had significantly lower clinical pregnancy and live birth rates than women without thyroid antibody positivity.ConclusionOur study showed lower clinical pregnancy and live birth rates in women who underwent total thyroidectomy than in women who underwent partial thyroidectomy. Thyroid antibody positivity is an important risk factor for adverse IVF/ICSI outcomes in women who have received TC treatment.

Effects of different surgical procedures for meniscus injury on two-year clinical and radiological outcomes after anterior cruciate ligament reconstructions. -TMDU MAKS study

BackgroundThe treatment of meniscus injuries combined with anterior cruciate ligament (ACL) reconstruction would be important to improve outcomes after ACL reconstruction. However, the effects of treatment methods for meniscus after ACL reconstruction have not been thoroughly investigated. The objective of this study was to investigate the effects of treatment methods for meniscus on clinical and radiological outcomes at 2 years after ACL reconstruction. MethodsThree-hundred and eighteen patients with primary ACL reconstruction using autologous hamstring tendon registered in our multicenter study database and who were followed up for 2 years were included. They were then divided into 3 groups, the no meniscal lesion/untreated group (n = 149), the meniscal repair group (n = 139), and the meniscal resection group (n = 30). Patient-based subjective evaluations (Lysholm score, Knee injury and Osteoarthritis Outcome score and International Knee Documentation Committee subjective score), objective evaluations (Lachman test, pivot shift test and KT measurement), and radiological measurements (medial and lateral joint space width) were compared among the 3 groups preoperatively and at 2 years follow-up. ResultsAll subjective scores and objective evaluations significantly improved in all groups without significant differences among the groups postoperatively. Regarding radiological findings, the medial joint space width significantly decreased only in the resection group during the 2-year period, and the medial joint space width in the resection group was significantly smaller than that of the other groups at the 2-year follow-up. Moreover, the medial joint space width significantly decreased during the 2-year period when MM was resected. ConclusionsIn radiological findings, medial meniscus resection decreased medial joint space width two years after ACL reconstruction. On the other hand, treatment methods for meniscus neither significantly affected subjective nor objective findings until the 2-year follow-up. Level of evidenceⅡ, Cohort study.

Effect of bariatric surgery on circulating FGF-19: A systematic review and meta-analysis.

Fibroblast growth factor-19 (FGF-19) is a gut hormone which interacts with metabolism and is depleted in obesity. There is some indication that the hormone undergoes a resurgence following bariatric surgery (BS), an effect which may contribute to the beneficial outcomes of such procedures. This systematic review and meta-analysis aims to synthesize the available literature on FGF-19 levels before and after BS. MEDLINE, Scopus and Web of Science databases were searched, and the effect of different surgical procedures and degrees of body mass index (BMI) reduction on FGF-19 levels was assessed by DerSimonian and Laird random-effects model in meta-analysis and dose-response analyses. This meta-analysis, which included 474 patients from 25 arms undergoing one of five BS procedures, revealed a significant increase in the levels of circulating FGF-19 following all-type BS. Vertical sleeve gastrectomy, duodenal-jejunal bypass liner and Roux-en-Y gastric bypass all significantly increased circulating FGF-19 levels from baseline. However, gastric banding failed to achieve the same, and in fact, biliopancreatic diversion was associated with decreased circulating FGF-19. Finally, an inverse association between FGF-19 and the degree of BMI-reduction post-operatively was noted. FGF-19 is increased by BS and may represent a pharmaceutical target in efforts to reproduce the beneficial effects of BS in a medical setting.

Surgical techniques for management hepatic hydatid cysts in fallujah teaching hospital: A prospective study

Background: Hepatic hydatid cysts (HHCs) are a parasitic infestation caused by several species of Echinococcus, even though surgery is the mainstay in the management of hydatid disease of the liver, controversies still exist about the preferred operating technique. Aim of study: To assess the effectiveness of different surgical procedures for managing the hepatic hydatid cyst at Baghdad Teaching Hospital and study the incidence of post-operative complications. Patients and Method: Sixty-four patients aged between12 and 60 years underwent surgery for HHCs within a one-year period from the first of January 2018 to end of December 2018. We recorded demographic data, location of the cysts in liver, surgical procedures used, postoperative complication, morbidity, mortality and hospital stay. Results: Most of the patients were females 48(75%) from rural area and the mean age was 40 years, the most common symptom was abdominal pain in 51 patients (79.6%) and the right lobe of the liver was mostly affected 39(60.9%). The External drainage technique was used in 28 patients (43.3%). Omentoplasy technique was used in 19 patients (29.6%)Conclusion: The morbidity and hospital stay were highest in external drainage method and least in omentoplasty. The method of omentoplasty is simple and can be performed in the majority of patients.

Analysis of the Effects of Different Surgical Procedures for the Treatment of Thyroid Cancer on the Expression Levels of IL-17, IL-35, and SIL-2R and the Prognostic Factors

Analysis of the Effects of Different Surgical Procedures for the Treatment of Thyroid Cancer on the Expression Levels of IL-17, IL-35, and SIL-2R and the Prognostic Factors

Perioperative mortality at Tibebe Ghion Specialized Teaching Hospital, Ethiopia: A longitudinal study design

BackgroundPerioperative mortality rate is the basic indicator of anesthesia and surgery safety in a country of health policy. However, documentation is poor in low and middle income countries. So we developed a simple prospective data collection tool for perioperative mortality determination at Tibebe Ghion Specialized Teaching Hospital, Ethiopia. Material and methodsThe prospective electronic based data collection was done at Tibebe Ghion Specialized Teaching Hospital, Ethiopia with case specific of perioperative data. We compared patients with mortality at 24 h, and 48 h by Kaplan-Meier (KM) survival analysis. Logistic regression model was used to evaluate the effect of different surgical procedures on mortality. ResultsFrom August 2019, to December 2019 data were taken from 946 cases at Tibebe Ghion Specialized Teaching Hospital. We excluded 61 (6.44%) cases with missing data information. The logistic regression analysis for 24 h mortality showed that urology and general surgery (OR = 8.03 [95% CI, 3.98 to 47.33]; P = 0.0002),neurosurgery (OR = 4.77, [95% CI,2.58–17.70]; P = 0.01), orthopedics (OR = 1.21, [95% CI,0.56–6.89]; P = 0.003), emergency surgery (OR = 2.76 [95% CI,1.03–10.51]; P = 0.04) and trauma (OR = 6.94 [95% CI,3.43–26.32]; P = 0.002) were associated with high risk of mortality (Table 3) as compared to cesarean section delivery. These significant relations were also revealed at 48 h of mortality. Other Surgeries and pediatrics category were not correlated to 24 h and 48 h of mortality. Conclusion and recommendationThere were a significant higher magnitude of mortality recorded over Urology and general surgeries, neurosurgery, orthopedic surgery, emergency surgery and trauma compared with cesarean section delivery at Tibebe Ghion Specialized Teaching Hospital. In addition, we observed the mortality rate differences between each surgical category.Tibebe Ghion Specialized Teaching Hospital should emphasis on monitoring and evaluation of patients’ outcome for the reduction of mortality. We also recommended doing this research work at multiple centers of referral hospitals for better valid information.

SimCP: A Simulation Platform to Predict Gait Performance Following Orthopedic Intervention in Children With Cerebral Palsy.

Gait deficits in cerebral palsy (CP) are often treated with a single-event multi-level surgery (SEMLS). Selecting the treatment options (combination of bony and soft tissue corrections) for a specific patient is a complex endeavor and very often treatment outcome is not satisfying. A deterioration in 22.8% of the parameters describing gait performance has been reported and there is need for additional surgery in 11% of the patients. Computational simulations based on musculoskeletal models that allow clinicians to test the effects of different treatment options before surgery have the potential to drastically improve treatment outcome. However, to date, no such simulation and modeling method is available. Two important challenges are the development of methods to include patient-specific neuromechanical impairments into the models and to simulate the effect of different surgical procedures on post-operative gait performance. Therefore, we developed the SimCP framework that allows the evaluation of the effect of different simulated surgeries on gait performance of a specific patient and includes a graphical user interface (GUI) that enables performing virtual surgery on the models. We demonstrated the potential of our framework for two case studies. Models reflecting the patient-specific musculoskeletal geometry and muscle properties are generated based solely on data collected before the treatment. The patient's motor control is described based on muscle synergies derived from pre-operative EMG. The GUI is then used to modify the musculoskeletal properties according to the surgical plan. Since SEMLS does not affect motor control, the same motor control model is used to define gait performance pre- and post-operative. We use the capability gap (CG), i.e., the difference between the joint moments needed to perform healthy walking and the joint moments the personalized model can generate, to quantify gait performance. In both cases, the CG was smaller post- then pre-operative and this was in accordance with the measured change in gait kinematics after treatment.

Pelvic Floor Distress Inventory Scores Improve After Prolapse Surgery Regardless of Surgical Approach but Not After Observation Alone

To evaluate the effect of different surgical procedures on Pelvic Floor Distress Inventory (PFDI) scores in women with pelvic organ prolapse. Women with prolapse were enrolled from 2008 to 2014. Baseline data and outcomes at 1 year were collected including subscales of the PFDI. Patients who had surgery (SGY) within the first year were compared to those who did not (N-SGY). Subanalyses of SGY included vaginal vs abdominal, with or without concurrent hysterectomy (HYST, N-HYST), placement of mesh (MESH, N-MESH), and concurrent posterior repair/perineorrhaphy (POST, N-POST). A total of 233/239 patients underwent surgery in the first year. For SGY vs N-SGY, SGY had significant improvements in PFDI and all subscale scores at 1 year while N-SGY did not. When comparing vaginal to abdominal approach, MESH to N-MESH and HYST to N-HYST, there were no differences between any scores at baseline or 1 year between the groups. However, all within group symptom scores improved from baseline to 1 year (P <.0001 for all). In comparing POST to N-POST, there were no differences between groups at 1 year in PFDI and Urogenital Distress Inventory and Pelvic Organ Prolapse Distress Inventory subscale scores. Colorectal-Anal Distress Inventory scores were significantly higher at baseline for POST (P <.0001) but not at 1 year (P = 0.37). All within group scores statistically significant improved at 1 year. Women who underwent surgical repair for prolapse had significantly improved overall PFDI and subscale scores regardless of surgical approach and concurrent procedures.

Effects of different surgical procedures on stress hormones, vascular inflammatory factors, tissue damage inflammatory factors in patients with renal calculi

Objective: To investigate the effects of Percutaneous Nephroscope Ultrasonic Lithotripsy (PNUL) and Percutaneous Nephroscope Pneumatic Lithotripsy (PNPL) on stress hormones, vascular inflammatory factors and tissue damage inflammatory factors in patients with renal calculi. Methods: 120 patients with renal calculi in our hospital from January 2016 to June 2017 were divided randomly into observation group (PNUL group) and control group (PNPL group), 60 cases in each group. At 24 h before and after operation, the levels of Angiotensin-II (Ang-II), Adrenocorticotropic Hormone (ACTH), Cortisol (Cor), Norepinephrine (NE), Prostaglandin E2 (PEG2), Substance P (SP), Bradykinin (BK), Nitric Oxide (NO), Advanced Oxidation Protein Products (AOPP) and Lipid Peroxide (LPO) were compared in all patients. Results: There were no statistical differences in the levels of Ang-II, ACTH, Cor, NE, PEG2, SP, BK, NO, AOPP and LPO before operation between the two groups (P>0.05); at 24 h after operation, the level of each index was higher than that before operation in both groups. The levels of above-mentioned indexes in the observation group were (53.38 ± 4.65 pg/ml), (27.28 ± 3.06 pg/ml), (172.76 ± 10.65 ng/ml), (276.19 ± 24.12 ng/ml), (161.51 ± 16.70 pg/ml), (4.71 ± 0.51 μg/ml), (8.32 ± 0.64 μg/L), (13.42 ± 1.56 μmol/L), (202.38 ± 31.74 μmol/L), (4.29 ± 0.63 mmol/ml) respectively, were lower than those during the same period in the control group and the differences were statistically significant (P<0.05). Conclusion: PNUL has a less effect on stress hormones, vascular inflammatory factors, tissue damage inflammatory factors in patients with renal calculi and has a smaller trauma than PNPL. Thus, PNUL is recommended to be widely used in clinical practice.

A Meta-analysis on effectiveness of different surgical procedures in treating esophageal variceal bleeding in patients with portal hypertension

Objective To compare the effectiveness of surgical procedures (devascularization, shunt and combined shunt and devascularization) in treating recurrent variceal bleeding and other complications in patients with portal hypertension. Methods A systematic literature search was carried out on patients with portal hypertension, and a Meta-analysis was conducted using Revman 5.3 software to evaluate the effectiveness of different surgical procedures on recurrent esophageal variceal bleeding, hepatic encephalopathy, operative mortality and survival rates. Results A total of 24 trials were finally selected using pre-determined inclusion criteria. Meta-analysis showed there was no significant difference among the three ope-rations on operative mortality (P>0.05). The rebleeding rate of the combined group was significantly lower than the devascularization group (P 0.18). The 1-year and 3-year survival rates were not significantly different between the combined and the shunt groups (both P>0.05). Conclusions Combined shunt and devascularization had better therapeutic effectiveness than either devascularization alone or shunt alone in patients with portal hypertension with a high rebleeding risk. There were no significant difference among the three surgical procedures in operative mortality. The survival rates of combined surgery were significantly better than devascrlarization alone. Key words: Portal hypertension; Devascularization; Shunt; Rebleeding; Hepatic encephalopathy