Efficacy Of Procedure Research Articles

Robotic versus manual diagnostic and stenting procedures: a systematic review and meta-analysis.

Endovascular procedures are associated with improved outcomes and patient satisfaction compared to open surgery in selected cases. However, this is at the cost of increased radiation exposure. Robotic procedures are thought to minimize radiation exposure and may confer procedural efficacy due to the lack of operator fatigue. Our systematic review and meta-analysis compares procedural efficacy of robotic versus manual diagnostic and stenting procedures. PubMed, Embase and Scopus were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Articles reporting comparative outcomes between robotic and manual diagnostic and stenting procedures were included. Articles related to stereotactic radiosurgery and open surgical procedures were excluded. The Newcastle Ottawa Scale was used to assess risk of bias. Effect sizes (mean difference for robotic and manual procedures) and variances were calculated for procedure time. The random effects model was used to calculate pooled estimates for technical success using the "metafor" package in R (R software v4.2.1, Vienna, Austria). 6465 articles were identified through our search strategy. After 4683 articles were excluded through a title and abstract screen and 30 articles were excluded through a full text review, 3 articles reporting outcomes in 175 patients undergoing robotic procedures and 185 patients undergoing manual procedures were included. These studies reported comparative outcomes for carotid artery stenting, diagnostic cerebral angiograms and transverse sinus stenting. There was no significant difference in procedure time (mean difference: 0.14min [95% confidence interval (CI): -0.58, 0.86, p = 0.64, I2 = 68%]. Technical success was 0.05-fold lower for robotic procedures compared to manual procedures [95% CI: 0.00- 0.84), P = 0.04]. One study was considered high quality using the NOS. Robotic procedures confer significantly lower rates of technical success with no significant difference in procedure time. Further studies are necessary to draw conclusions about potential benefits of robotic procedures including lower radiation exposure.

The impact of diabetes on aesthetic procedures

Diabetes may have an impact on aesthetic medicine, influencing both the safety and efficacy of various aesthetic procedures. Key aspects of the impact of diabetes on aesthetic medicine are summarized. Individuals with diabetes often experience dry skin, acondition known as xerosis, which may affect the overall texture and appearance of the skin. Diabetes can compromise the immune system, making individuals more susceptible to skin infections. Aesthetic procedures involve the introduction of foreign substances, and compromised skin integrity may heighten the risk of infection. This underscores the importance of strict hygiene and postprocedure care to minimize the risk of complications. Delayed wound healing can be asignificant concern in aesthetic procedures where incisions, injections, or other manipulations are made, as impaired healing may affect the final outcome and increase the risk of complications. Collagen metabolism, affecting the elasticity and structural integrity of the skin, may influence the long-term results of procedures such as dermal fillers, where collagen plays acrucial role in maintaining skin volume and firmness. Diabetes is linked to vascular complications, including poor blood circulation, which may have implications for procedures like laser treatments or other interventions that rely on adequate blood supply for optimal results.

Supine versus prone percutaneous nephrolithotomy: Surgeon and anesthesiologist perspective. Can agile supersede traditional?

Background: Percutaneous nephrolithotomy (PCNL) is the most common surgical procedure for the removal of renal stone of size >2 cm. It has evolved over the years both in terms of surgical technique and plan of anesthesia. The procedure is performed most commonly in the prone position. This position provides edge in offering greater anatomical feasibility due to the posterior retroperitoneal position of kidneys. Supine position bestows several perks over prone in terms of better access to patient’s airway, lower cardiopulmonary complications, better patient comfort, repositioning issues addressal along with convenient access to the patient by anesthesiologist in case of untoward medical emergency. Aims and Objectives: The primary aim to compare the safety and efficacy of prone versus supine PCNL. The objective Visual Analog Scale Score, patient satisfaction rate, stone-free rate, procedure time (calculated from placement of ureteric catheter to skin closure), overall complication rate. Materials and Methods: This prospective randomized study of 80 patients was conducted at our institute from December 2022 to June 2023. Institutional Ethical Committee clearance was sought and the inclusion criteria were all adult patients aged between 16 and 65 years with single renal, upper ureteric calculus of size 10–25 mm with ASA physical status 1 and 2 having normal renal function and a sterile urine culture. Results: All the patients completed the study and there were no dropouts. Male/female ratio, age, and stone size were comparable in both the groups. The mean time taken in supine PCNL was 48.3 min and in prone PCNL was 68.7 min, which was significant. Conclusion: Supine PCNL is a safe and efficacious procedure for renal stone disease in the selected group of patients with results comparable to prone PCNL, having additional advantages like less time-consuming, better upper calyceal access through lower calyx, less radiation exposure to surgeon’s hand, overcoming positional difficulties of prone position, simultaneous accessibility for performing flexible ureteroscopy and more convenient airway access to anesthesiologist and better pain scores.

Short-Term Weight Loss Outcomes of 104 Mini-Gastric Bypass or One-Anastomosis Gastric Bypass Operations: Retrospective study.

This study aimed to examine the short-term effects of mini-gastric bypass (MGB) or one-anastomosis gastric bypass (OAGB) procedures on weight loss in individuals with obesity. This retrospective study was conducted in Medicano Hospital, Erbil, Iraq, from January 2019 to May 2020. Preoperative body mass index (BMI), age, height and preoperative weight were recorded as baseline measures. Weight-related changes were evaluated during a follow-up phase of 48 weeks. A total of 104 patients with obesity underwent MGB or OAGB surgery. The mean baseline parameters of the subjects before surgery included 1.64 m for height, 122.9 kg for weight and 45.6 kg/m2 for BMI. During the 48-week follow-up period, there was a substantial reduction in mean weight, which dropped from 122.9 kg at baseline to 75.5 kg at week 48. The weight change (in percentage) gradually increased from -11.8% at week 12 to -37.9% at week 48, without statistically significant association with demographic factors or chronic diseases. From week 12 to week 48, the percentage of excess weight loss (%EWL) increased substantially from 26.8% to 86.1%. The results of the subgroup analysis indicated that the %EWL was considerably higher among those aged 30 or older at week 36 and singles at week 48. This study's results illustrate the efficacy of MGB or OAGB procedures in significantly reducing weight in the short term. The %EWL increased with the follow-up time and was significantly associated with age and marital status.

TAVI with the ACURATE neo2 in severe bicuspid aortic valve stenosis: the Neo2 BAV Registry.

The ACURATE neo2 is a contemporary transcatheter aortic valve implantation (TAVI) system approved for the treatment of severe aortic stenosis in Europe. The ACURATE neo2 has not been evaluated in bicuspid aortic valve (BAV) stenosis. We sought to evaluate the safety and efficacy of ACURATE neo2 in patients with BAV stenosis. We retrospectively analysed consecutive severe BAV stenosis patients undergoing TAVI with ACURATE neo2 at 10 European centres. Imaging data from preprocedural multislice computed tomography, pre- and postprocedural echocardiography, and procedural cinefluoroscopy were evaluated by a core laboratory. Valve Academic Research Consortium 3 (VARC-3)-defined 30-day procedure safety and efficacy were the primary endpoints. Adverse events were site-reported according to VARC-3 criteria. Among 181 patients with BAV stenosis treated with the ACURATE neo2, the mean age was 77.5±7.2 years, 58.0% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score was 2.3% (1.6-3.7%). Most procedures were transfemoral, and predilatation was performed in all cases. A second valve was required in 4 cases (2.2%). VARC-3-defined technical success was 95.6%. The primary endpoints of device success and early safety occurred in 90.6% and 82.3%, respectively. At 30 days, cardiovascular death occurred in 2.2% (N=4) and stroke in 1.6% (N=3). Core laboratory-adjudicated echocardiography reported an effective orifice area of 2.0 (1.7-2.5) cm2 and a mean transvalvular gradient of 6.5 (4.6-9.0) mmHg. Half of all cases (51.2%) had no paravalvular leak, while moderate leak occurred in 4.3%. A new permanent pacemaker was required in 11 patients (6.5%). The ACURATE neo2 demonstrated favourable clinical outcomes and bioprosthetic valve performance at 30 days in selected patients with severe BAV stenosis.

Conduction system pacing in heart failure: Time for a paradigm shift?

Heart failure (HF) is a major clinical challenge characterized by significant morbidity and mortality. Electrical conduction abnormalities play a critical role in HF pathophysiology and progression, often leading to suboptimal outcomes with conventional pacing techniques. Con-duction system pacing (CSP), encompassing His bundle pacing and left bundle branch area pacing, has emerged as a novel approach. Despite data come from observational studies, recent guidelines recommend that a specific population may benefit from CSP. However, significant practical considerations and challenges need to be clarified before CSP can be routinely implemented in clinical practice. The reliance on observational studies means that long-term clinical outcomes for HF patients remain uncertain until data from randomized controlled trials (RCTs) become available. Current CSP practices face challenges with lead implantation, mechanical stress on leads, and the need for more advanced tools and artificial intelligence integration to improve procedure efficacy and safety. Future large-scale RCTs are essential to identify optimal candidates and address these technical challenges, potentially leading to a paradigm shift in HF management.

Acupoint Catgut Embedding Therapy for Abdominal Obesity Treatment.

As the global economy grows and living standards improve, the rise in overweight and obese individuals poses a significant public health challenge. This trend is predominantly linked to lifestyle changes and poor dietary habits, resulting in increased abdominal obesity characterized by fat accumulation in the abdominal region and associated symptoms such as indigestion, constipation, and fatigue. Acupoint embedding therapy uses absorbable sutures inserted into specific acupoints for continuous stimulation, aiding in the treatment of abdominal obesity, metabolic issues, and digestive disorders. Its main goals are to regulate metabolism, improve digestion, and reduce fat. This paper offers a thorough exploration of the comprehensive management of thread-embedding acupuncture for obesity treatment. It meticulously outlines critical aspects of patient management and material preparation and provides precise guidance on acupoint selection, surgical procedures, and postoperative care. This structured treatment protocol aims to ensure procedural safety and efficacy, thereby optimizing clinical outcomes for patients with abdominal obesity and ultimately improving their overall quality of life.

Small-scale magnetic soft robotic catheter for in-situ biomechanical force sensing

Miniaturized magnetic soft robotic catheters offer significant potential in minimally invasive surgery by enabling remote active steering and reduced radiation exposure. However, existing magnetic catheters are limited by the absence of in-situ biomechanical force sensing, which is crucial for controlling the contact force exerted on surrounding tissues during surgical procedures. Here, we report an in-situ force sensing strategy for small-scale magnetic robotic catheters. A coaxial integration of ring-shaped permanent and fibre-based force sensors at the catheter's distal end enables both active steering and precise force measurement. The force sensor is designed to be sensitive exclusively to contact forces perpendicular to its plane, achieving a sensitivity of 0.69 nm/kPa (or 0.38 nm/mN). By manipulating magnetic field patterns, the catheter can actively generate and control contact forces to tissues, using real-time feedback from the force sensor. We demonstrate the system's force-sensing and force-control capability in isolated organs and tissue phantom during passage, verifying the catheter's high force sensitivity and high steerability. The feedback-loop force control enhances procedural safety and efficacy for minimally invasive surgery, making it especially suitable for procedures such as transbronchial microwave ablation of lung nodules and cardiac ablation for atrial fibrillation.

Ultrasonographic Mapping of the Location and Depth of Labial Arteries Prior to Lip Augmentation: A Pilot Study

Aims: This study aims to map the superior and inferior labial arteries in terms of their anatomical location and depth using ultrasound imaging to optimise the planning of lip augmentation procedures in a Brazilian cohort. Study Design: Observational cross-sectional pilot study. Place and Duration of Study: The examinations were conducted at the dental clinic of the University of Fortaleza during October-November 2023. Methodology: Nineteen volunteers (both sexes, aged 18 to 55 years) with no history of previous lip augmentation participated in this study. Imaging was performed using a high-frequency ultrasound machine (Evus 5, Alliage S/A), equipped with a 7–14 MHz linear transducer, in both B-mode and Doppler modes. Statistical analyses included the Shapiro-Wilk test, Levene's test, analysis of variance (ANOVA), T-test, Pearson's correlation coefficient, standard deviation, confidence intervals, and Fisher's exact test, all conducted using Python software. Results: The superior labial artery was predominantly located in the intramuscular region in 68.42% of cases, followed by the submucosa in 31.58%, with no instances in the subcutaneous layer. For the inferior labial artery, a similar distribution was observed: 63.16% intramuscular, 31.58% submucosal, and 5.26% subcutaneous. Statistically significant differences (p < 0.05) were identified in the depth and location of the labial arteries based on sex and specific anatomical regions. Conclusion: This study demonstrates the variation in the depth and location of labial arteries, with a significant predominance in the intramuscular layer. Ultrasound serves as an essential tool for mapping vascular anatomy in the planning of lip augmentation, underscoring the value of thorough anatomical assessment to enhance procedural safety and efficacy.

Endoscopic cardiac mucosal ligation: a novel minimally invasive procedure for gastroesophageal reflux disease

Background Our objective in this study was to evaluate the short-term clinical efficacy and safety of endoscopic cardiac mucosal ligation, a novel endoscopic procedure, in the treatment of gastroesophageal reflux disease (GERD). Methods Patients diagnosed with refractory GERD or recurrent patients due to drug withdrawal admitted to our hospital were recruited in this clinical trial. All GERD patients were treated with endoscopic cardiac mucosal ligation. Postoperatively, all patients received subsequent follow-ups for approximately four months to evaluate the efficacy and safety of this endoscopic procedure. Results A total of 13 GERD patients were enrolled. Endoscopic cardiac mucosal ligation was successfully performed in all cases. Postoperatively, relevant symptoms were significantly alleviated in 10 patients (76.9%). The average Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score in all participants significantly decreased from preoperative 10.0 ± 3.5 to postoperative 7.8 ± 2.9 (p = .022). The average GERD symptom questionnaire score was 27.0 ± 12.0 prior to surgery, which significantly decreased to 18.3 ± 7.5 postoperatively (p = .032). No severe postoperative complications were observed during subsequent follow-ups. Conclusions Endoscopic cardiac mucosal ligation might be a novel effective and safe endoscopic procedure for GERD.

Dexmedotomidina

Procedural sedation is often required in paediatrics to execute diagnostic procedures. There are many sedative drugs that may be used, but all of them carry not negligible side effect risks and may not be easy to manage. The use of dexmedetomidine has increased in the last few years because of its sedation efficacy in painless procedures. Paediatricians should know the use of dexmedetomidine because of its sensational safety profile even in neonates, its administration route versatility, its neuroprotective properties and its in-home palliative care role in children with otherwise untreatable sleep disorders. This article summarizes the main characteristics of dexmedetomidine, its use, strengths and weaknesses.

Ethical Principles in AI Use for Assessment: Exploring Students’ Perspectives on Ethical Principles in Academic Publishing

Students’ comprehension of ethical principles and their application in the realm of AI technology play a crucial role in shaping the efficacy and morality of assessment procedures. This study seeks to explore students’ viewpoints on ethical principles within the context of AI-driven assessment activities to illuminate their awareness, attitudes, and practices concerning ethical considerations in educational environments. A systematic review of articles on this topic was conducted using scientometric methods within the Web of Science database. This review identified a research gap in the specialized literature regarding studies that delve into students’ opinions. Subsequently, a questionnaire was administered to students at Transilvania University of Brasov as part of the Information Literacy course. Statistical analysis was performed on the obtained results. Ultimately, students expressed a desire for the Information Culture course to incorporate a module focusing on the ethical use of AI in academic publishing.

Single and consecutive 10-day remote ischemic preconditioning modify physical performance, post-exercise exerkine levels, and inflammation.

Remote ischemic preconditioning (RIPC) is a method of protection against induced ischemia reperfusion injury, and an increasing number of studies showed some of its inconclusive ergogenic effects in sports. RIPC involves short cycles of cuff inflation followed by its deflation which may affect many body systems. While most of the studies focus on single RIPC effects, there is insufficient data regarding training-like repeated RIPC interventions. Thus, in this study, we analyzed the effect of a single- and consecutive 10-day RIPC procedure on a single leg, focusing on the exerkine levels and changes in inflammation markers following the Wingate Anaerobic Test (WAnT). Two single-blinded, sham-controlled protocols were designed to evaluate the 1) single (crossover study) and 2) consecutive 10-day (parallel study) RIPC effects on the WAnT performance and exercise-induced lactate, glucose, exerkine, and inflammation markers (BDNF; IL-6; IL-10; IL-15; LIF; oncostatin M). In each protocol, 37 physically active men (19.98 ± 1.17 years) were randomly assigned into two groups according to a particular study design. An increase in participants' mean (4.81%, p < 0.05) and peak power (6.25%, p < 0.05) during the WAnT was observed only after the consecutive 10-day RIPC. Similarly, a significant 15.5% (p < 0.05) decrease in the IL-6 concentration 120 min after the WAnT was observed only in the consecutive 10-day RIPC protocol, as well as a 12.2% (p < 0.01) increase in oncostatin M 60 min after the WAnT. The results demonstrate the efficacy of the consecutive 10-day RIPC procedure in modulating exercise performance and post-exercise inflammation markers.

Is Gastric Balloon Implantation Still an Effective Procedure for the Management of Obesity and Associated Conditions? Findings from a Multi-Center Study.

Both surgical and endoscopic procedures represent a mainstay of obesity treatment. Several procedures have been developed in recent years, although their impact on obesity is variable. This study examines and presents the results of a 6-month gastric balloon implantation (GBI). The data from the German Bariatric Surgery Registry (GBSR) for the period from 2005 to 2021 were subjected to a multi-center analysis. Six months following GBI, demographic data, the peri-interventional course, weight, BMI reduction, as well as the development of comorbidities (arterial hypertension (aHTN), diabetes mellitus (T2D), reflux (GERD), and sleep apnea syndrome (OSAS)), were evaluated in male and female patients. Of 3754 patients, 788 (45.3% male, 54.7% female) met the inclusion criteria for the study. Following 6 months of therapy, an average weight loss of 19.3 ± 15.2 kg was observed in male patients, while female patients exhibited an average weight loss of 16.3 ± 13.1 kg (p = 0.013). The EWL was found to be significantly higher in female patients than in male patients (24.8 vs. 18; p < 0.001). BMI reduction, %TWL, and mortality rate showed no significant disadvantage in either group (p > 5%). After 6 months of therapy, there was a significant advantage for women in the remission of aHTN. The remaining comorbidities did not differ significantly between the two groups (p > 5%). GBI is an efficacious procedure for the treatment of obese patients with mild obesity and comorbidities or as a bridging procedure prior to planned bariatric surgery.

Arthroscopic Bone Block and Arthroscopic Latarjet for Anterior Shoulder Dislocation—Technical Note with Tricks and Tips for Conversion and Successful Surgery

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors.

No ureteral catheter mini percutaneous nephrolithotomy (NUC-mPCNL) achieves enhanced recovery after surgery (ERAS)

Conventional mini percutaneous nephrolithotomy (mPCNL) typically necessitates the pre-operative placement of ureteral catheters. With the development of enhanced recovery after surgery (ERAS), we introduce a novel approach: no ureteral catheter mini percutaneous nephrolithotomy (NUC-mPCNL). To evaluate the efficacy and safety of this innovative procedure compared to mPCNL, we compared the total operative time, stone clearance rate (SCR), stone-free rate (SFR), and complications among patients undergoing either modality from January to September 2021. Our findings revealed a statistically significant reduction in the mean total operative time for the NUC-mPCNL group (42.6 ± 2.4 vs. 60.2 ± 3.4 min, p < 0.001). The SCR, SFR and CSFR were comparable between two groups (98.5% vs. 97.8%, 84.3% vs. 76.0%, 64.7% vs. 60.0%, p = 0.337, 0.295, 0.625). WBC rise, hemoglobin drop and neutrophil percentage rise were similar in both groups. The overall complication rate in the NUC-mPCNL group was lower; however, the difference was not statistically significant (Clavien I, II and III; 11 vs. 13, 1 vs. 2 and 1 vs. 1). Consequently, we conclude that NUC-mPCNL effectively shortens the operative time and holds potential for expedited postoperative recovery.

Deep learning for surgical instrument recognition and segmentation in robotic-assisted surgeries: a systematic review

Applying deep learning (DL) for annotating surgical instruments in robot-assisted minimally invasive surgeries (MIS) represents a significant advancement in surgical technology. This systematic review examines 48 studies that utilize advanced DL methods and architectures. These sophisticated DL models have shown notable improvements in the precision and efficiency of detecting and segmenting surgical tools. The enhanced capabilities of these models support various clinical applications, including real-time intraoperative guidance, comprehensive postoperative evaluations, and objective assessments of surgical skills. By accurately identifying and segmenting surgical instruments in video data, DL models provide detailed feedback to surgeons, thereby improving surgical outcomes and reducing complication risks. Furthermore, the application of DL in surgical education is transformative. The review underscores the significant impact of DL on improving the accuracy of skill assessments and the overall quality of surgical training programs. However, implementing DL in surgical tool detection and segmentation faces challenges, such as the need for large, accurately annotated datasets to train these models effectively. The manual annotation process is labor-intensive and time-consuming, posing a significant bottleneck. Future research should focus on automating the detection and segmentation process and enhancing the robustness of DL models against environmental variations. Expanding the application of DL models across various surgical specialties will be essential to fully realize this technology’s potential. Integrating DL with other emerging technologies, such as augmented reality (AR), also offers promising opportunities to further enhance the precision and efficacy of surgical procedures.

Advancements in Autologous Stem Cell Transplantation for Parkinson's Disease.

Parkinson's disease (PD) is a progressive neurodegenerative disease marked by comparatively focal dopaminergic neuron degeneration in the substantia nigra of the midbrain and dopamine loss in the striatum, which causes motor and non-motor symptoms. Currently, pharmacological therapy and deep brain stimulation (DBS) are the primary treatment modalities for PD in clinical practice. While these approaches offer temporary symptom control, they do not address the underlying neurodegenerative process, and complications often arise. Stem cell replacement therapy is anticipated to prevent further progression of the disease due to its regenerative capacity, and considering the cost of immunosuppression and the potential immune dysfunctions, autologous stem cell transplantation holds promise as a significant method against allogeneic one to treat Parkinson's disease. In this review, the safety concerns surrounding tumorigenicity and complications associated with transplantation are discussed, along with methods utilized to evaluate the efficacy of such procedures. Subsequently, we summarize the preclinical and clinical studies involving autologous stem cell transplantation for PD, and finally talk about the benefits of autologous stem cell transplantation against allogeneic transplants.

The effectiveness of various CSF diversion surgeries in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Idiopathic normal pressure hydrocephalus (iNPH) is commonly treated using cerebrospinal fluid (CSF) diversion procedures, most commonly ventriculoperitoneal (VP) but also lumboperitoneal (LP), ventriculoatrial (VA) shunting, and endoscopic third-ventriculostomy (ETV). Despite the prevalence of these interventions and recent advancements in iNPH diagnostic processes, there is limited up-to-date evidence regarding surgical outcomes. A systematic review and meta-analysis were conducted to analyse the effects of CSF diversion surgeries among iNPH patients. The primary outcome was efficacy of the CSF diversion procedure, defined as symptomatic improvement, and secondary outcomes included surgical complications. Several major databases were searched for original studies from inception up to June 4, 2024, which were evaluated using random-effects meta-analyses, meta-regression, and influence analyses. This study was registered with PROSPERO: CRD42023458526. Out of the 1963 studies screened, 54 were included in this review, and 4811 patients were pooled. Overall, more than 74% of patients experienced improvement after surgical treatment (95% CI: 70-78%). VP shunting demonstrated an efficacy of 75% (95% CI 70-79%), VA shunting at 75% (95% CI: 70-80%), and LP shunting at 70% (95% CI: 52-83%). ETV had a success rate of 69% (95% CI: 58-78%). Gait improvement was high at 72% (95% CI: 67-77%), while urinary and cognitive dysfunction each improved in approximately 50% of patients. The efficacy of surgery did not increase between 2005 and 2024 (p=0.54). Complications occurred in 20.6% of cases, with a surgery revision rate of 15.1%. This meta-analysis found that the overall efficacy of CSF diversion procedures for iNPH remained unchanged from 2005 to 2024, with 74% of cases showing improvement. No procedure was found to be clearly superior, and only half of the patients saw improvements in urinary and cognitive dysfunction. The stagnant efficacy over time and frequent complications highlight the need for improved patient selection criteria to best identify those most likely to benefit from CSF shunting. None for this study.

Transcatheter aortic‐valve implantation with or without on‐site cardiac surgery: The TRACS trial

Transcatheter aortic valve implantation (TAVI) has emerged as an effective and safe treatment for patients with symptomatic aortic stenosis. The indication to TAVI should be agreed upon by a Heart Team, and the procedure should be performed in centers with on-site cardiac surgery. However, TAVI complications requiring emergent cardiac surgery (ECS) have become very rare. Concurrently, access disparities and prolonged waiting times are pressing issues due to increasing clinical demand of TAVI. Many solutions have been proposed and one of them is the possibility of performing TAVI in centers without on-site cardiac surgery. The Transcatheter Aortic-Valve Implantation with or without on-site Cardiac Surgery (TRACS) trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with symptomatic severe aortic stenosis and deemed inoperable, at high surgical risk, or presenting with at least 1 clinical factor compromising the benefit/risk ratio for ECS, will be randomized to undergo TAVI either in centers with or without on-site cardiac surgery. The primary endpoint will be the composite occurrence of all-cause death, stroke, and hospital readmission for cardiovascular causes at one year. The safety endpoint will include death attributable to periprocedural complications actionable by ECS. The study aims to enroll 566 patients. The TRACS trial aims to address critical gaps in knowledge regarding the safety and efficacy of TAVI procedures performed in centers without on-site cardiac surgery, potentially improving access and outcomes for high-risk patients. ClinicalTrials.gov NCT05751577.