Favorable Postoperative Outcomes Research Articles

P515 Exclusive enteral nutrition downstages complicated Crohn’s disease prior to surgical resection: A feasibility study

Abstract Background Exclusive enteral nutrition (EEN, oral or enteral liquid feeds only) is an established first-line therapy to induce remission in Crohn’s disease (CD) in children, but not in adults where low tolerance has been reported. Recently, smaller studies have suggested advantages of EEN in preoperative optimisation in adults. We hypothesise that in this setting, EEN is feasible and is associated with improved inflammatory and nutritional markers. Methods Consecutive patients with small bowel or ileocolic Crohns disease, who started preoperative EEN at two large IBD centres 2020-2023 were retrospectively studied. EEN was part of a 4-6week preoperative optimisation pathway. Outcomes were compliance and serum albumin, c-reactive protein and body weight, respectively. Medians (range) & Wilcoxon tests used. Results Thirty-two patients started EEN for stricturing (n=10) or penetrating disease (n=14). Six patients (19%) did not tolerate EEN and received parenteral nutrition (n=2) or reverted to normal diet (n=4), while 26 patients (81%) completed EEN until surgery. This group received EEN during 38 (17-70) days. C-reactive protein concentrations decreased from 8.5 (1-157) to 3 (1-96) mg/L (p = 0.0051), and albumin levels increased from 33.5 (27-44) to 38 (26-42) g/L (p< 0.001), while body weight did not change, from 67 (48.5-107) to 66.6 (48.5-105.7) kg (p = 0.25). 21 (81%) EEN patients underwent minimally invasive surgery, 22 (85%) had a primary anastomosis and 4 a stoma. Median postoperative length of stay was 4 (2-11) days. One patient with a severe complication, no one with an anastomotic leakage. Conclusion EEN was well tolerated in this cohort of patients undergoing surgery for complicated CD. EEN was associated with improved systemic inflammation, a maintained nutritional status, and favourable postoperative outcomes despite the complexity of disease in this group of patients. These results align with previous studies that have shown the effectiveness of EEN in reducing disease activity and promoting mucosal healing in CD patients.By reducing inflammation and uphold nutritional status, EEN might help to create a more favourable surgical environment, potentially leading to better outcomes and decreased postoperative complications.

Association between Removal of High-Frequency Oscillations and the Effect of Epilepsy Surgery: A Meta-Analysis.

High-frequency oscillations (HFOs) are spontaneous electroencephalographic (EEG) events that occur within the frequency range of 80 to 500 Hz and consist of at least four distinct oscillations that stand out from the background activity. They can be further classified into "ripples" (80-250 Hz) and "fast ripples" (FR; 250-500 Hz) based on different frequency bands. Studies have indicated that HFOs may serve as important markers for identifying epileptogenic regions and networks in patients with refractory epilepsy. Furthermore, a higher extent of removal of brain regions generating HFOs could potentially lead to improved prognosis. However, the clinical application criteria for HFOs remain controversial, and the results from different research groups exhibit inconsistencies. Given this controversy, the aim of this study was to conduct a meta-analysis to explore the utility of HFOs in predicting postoperative seizure outcomes by examining the prognosis of refractory epilepsy patients with varying ratios of HFO removal. Prospective and retrospective studies that analyzed HFOs and postoperative seizure outcomes in epilepsy patients who underwent resective surgery were included in the meta-analysis. The patients in these studies were grouped based on the ratio of HFOs removed, resulting in four groups: completely removed FR (C-FR), completely removed ripples (C-Ripples), mostly removed FR (P-FR), and partial ripples removal (P-Ripples). The prognosis of patients within each group was compared to investigate the correlation between the ratio of HFO removal and patient prognosis. A total of nine studies were included in the meta-analysis. The prognosis of patients in the C-FR group was significantly better than that of patients with incomplete FR removal (odds ratio [OR] = 6.62; 95% confidence interval [CI]: 3.10-14.15; p < 0.00001). Similarly, patients in the C-Ripples group had a more favorable prognosis compared with those with incomplete ripples removal (OR = 4.45; 95% CI: 1.33-14.89; p = 0.02). Patients in the P-FR group had better prognosis than those with a majority of FR remaining untouched (OR = 6.23; 95% CI: 2.04-19.06; p = 0.001). In the P-Ripples group, the prognosis of patients with a majority of ripples removed was superior to that of patients with a majority of ripples remaining untouched (OR = 8.14; 95% CI: 2.62-25.33; p = 0.0003). There is a positive correlation between the greater removal of brain regions generating HFOs and more favorable postoperative seizure outcomes. However, further investigations, particularly through clinical trials, are necessary to justify the clinical application of HFOs in guiding epilepsy surgery.

Mini-access ascending aorto-bifemoral bypass surgery for the treatment of aortic steno-occlusive disease

ObjectivesMid-aortic syndrome is a rare condition characterized by severe aortic narrowing, leading to high upper body blood pressure and organ hypoperfusion, necessitating surgical intervention. Although central bypassing is considered ideal, it involves extensive incisions. To overcome these limitations, less-invasive approaches have been developed. This study aims to introduce a mini-access approach using video-endoscopy and to evaluate the feasibility and outcomes of mini-access ascending aorto-bifemoral bypass surgery. MethodsFrom November 2020 to May 2022, we performed ascending aorta to bifemoral artery bypass operations on 7 patients to treat steno-occlusive diseases in the downstream aorta. A Y-graft was created, and procedures were conducted under general anesthesia using video-endoscopy with limited skin incisions. ResultsIntraoperatively, there were no major complications, and none of the patients required cardiopulmonary bypass support. Furthermore, there were no postoperative mortalities or major complications. Postoperatively, the mean ankle-brachial index significantly improved from 0.59/0.59 to 0.96/0.92 (P = .004), and the mean glomerular filtration rate increased from 61.1 to 85.3 mL/min/1.73 mm2 (P = .012). Additionally, symptoms of claudication resolved in all patients. ConclusionsVideoscope-assisted mini-access aortic bypass surgery not only provides favorable early postoperative outcomes but also represents a technically feasible alternative to traditional surgical approaches for the treatment of steno-occlusive aortic diseases.

What is the crux of successful living-donor liver transplantation for recipients aged 70 and beyond?

There is limited evidence regarding the feasibility of living-donor liver transplantation (LDLT) for patients aged over 70. The aims of this study were to assess postoperative outcomes in elderly recipients and to ascertain the potential feasibility and acceptability of LDLT. Data were collected from 762 recipients, including 26 in the elderly group (aged ≥70) and 736 in the younger group (aged <70), and reviewed even by propensity score matching (PSM). No significant differences were observed in the frequency of postoperative complications between the two groups. Additionally, both groups exhibited a comparable 30-day mortality rate after LDLT (3.9% in both) and similar hospital stays (36 days vs. 40 days). The 1-, 3-, and 5-year graft survival rates in the elderly group were 92.0%, which was comparable to those in the younger group (p = 0.517), as confirmed by PSM. Notably, all donors for elderly patients were the children of the recipients, with an average age of 41.6 years, and grafts from donors aged ≥50 years were not utilized, signifying the use of high-quality grafts. Our inclusion criterion for elderly recipients was strictly defined as an ECOG-PS score of 0-2, which played a pivotal role in achieving favorable postoperative outcomes. LDLT can be performed safely for elderly patients aged 70 years or older, provided they have a preserved PS and receive high-quality grafts from younger donors, inevitably all children of elderly recipients. This approach yields acceptable long-term outcomes. Consequently, age alone should not serve as an absolute contraindication for LDLT.

Comparative efficacy of laparoscopic choledocholithotomy with T-tube insertion vs. primary suture in the management of cholecystolithiasis complicated by choledocholithiasis.

To evaluate the efficacy of laparoscopic choledocholithotomy with either an indwelling T-tube or primary suture in treating cholecystolithiasis complicated by choledocholithiasis. We conducted a retrospective analysis of 133 patients with cholecystolithiasis complicated by choledocholithiasis treated at Inner Mongolia Aerospace Medical Baogang Hospital from March 2020 to March 2023. Patients were divided into a control group (laparoscopic choledocholithotomy with T-tube placement) and an observation group (laparoscopic choledocholithotomy with primary suture). We compared general and surgery-related data between groups. Factors correlated with favorable postoperative outcomes were identified using univariate and multivariate logistic regression analyses. The observation group exhibited significantly shorter surgical times, faster intestinal function recovery, reduced postoperative hospital stays, and lower total hospitalization costs compared to the control group (all P < 0.05). No significant differences were observed in postoperative total bilirubin (TBIL), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) levels between the groups (all P > 0.05). Both primary suture technique and the absence of postoperative complications were independent predictors of favorable outcomes. Laparoscopic choledocholithotomy with primary suture is associated with shorter operation times, reduced medical costs, decreased hospitalization duration, and quicker gastrointestinal recovery compared to the traditional T-tube approach. This method is safe and feasible, provided clinicians are well-versed in its indications.

Clinical Features and Etiology of Recurrent Hypertension after Adrenalectomy

Patients who undergo adrenalectomy for unilateral primary aldosteronism (PA) may still develop post-surgery hypertension; however, the clinical characteristics and etiology of patients developing recurrent hypertension after adrenalectomy are unclear. We analyzed the records of 43 patients with recurrent elevated blood pressure after adrenalectomy, who were treated at our center. Standard routine clinical screening workup was used to identify the cause of recurrent hypertension. Causes of recurrent hypertension after adrenalectomy included essential hypertension, primary aldosteronism, obstructive sleep apnea, renal artery stenosis, and Takayasu arteritis. Before adrenalectomy, 39.5% of patients were diagnosed with confirmed or suspected PA, primarily through CT imaging. Adrenal venous sampling (AVS) tests were not conducted on any patients, and 72.1% patients underwent partial adrenalectomy. Among all patients, elevated blood pressure was observed in 44.2% immediately post-operation, 18.6% within 1 month, 16.3% in 1–6 months, and 20.9% &gt;6 months after operation. Most patients had hypertension of grade 2 and above. Standard endocrine functional assessment and AVS tests should be performed before adrenalectomy to ensure more accurate diagnosis and favorable post-operative outcomes. Additionally, individuals often develop essential hypertension regardless of past adrenal disease.

Preoperative Predictors of Arthroscopic Partial Meniscectomy Outcomes: The APM Index Score

Background: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. Purpose: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. Results: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. Conclusion: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively.

The efficacy and safety of continuous blanket suture for severe recurrent pterygium with symblepharon.

Managing recurrent pterygium combined with symblepharon presents significant challenges in ophthalmology. Clinicians aim to reconstruct the ocular surface, alleviate eye movement restrictions, and minimize recurrence risks. Evaluation of efficacy and safety of continuous blanket sutures (CBS) for fixation of large autologous conjunctival grafts in patients with severe recurrent pterygium with symblepharon. Retrospective, observational case series. Thirty-nine patients (40 eyes) were included, all with severe recurrent pterygium with symblepharon. During surgery, CBS was employed to affix large autologous conjunctival grafts to the exposed sclera, aiming to restore the ocular surface to smoothness as much as possible. All patients were followed up for more than one year. Main outcome measures include the rate of recurrence, improvement of eye movement, and intraoperative and postoperative complications. Nearly all patients exhibited a smooth ocular surface and largely restored physiological structures during the follow-up period. There were no graft loss or contraction cases until the last follow-up, with only three eyes experiencing a pterygium recurrence (recurrence rate 7.5%, 3/40). Preoperative eye movement limitations improved significantly from 2.10 ± 0.71 (range 1-3) to 0.33 ± 0.53 (range 0-2; p < 0.001) post-surgery. Other postoperative complications included varying degrees of corneal scarring and a single instance of conjunctival granulomatous hyperplasia (1 eye, 2.5%). When addressing severe recurrent pterygium with Symblepharon, using CBS to secure large autologous conjunctival grafts during surgery can achieve favorable postoperative outcomes. This surgical method is safe and feasible and effectively rebuilds a smooth ocular surface, improves the appearance of the ocular surface, and reduces the recurrence rate of pterygium after excision.

Mixed epithelial and stromal tumor of the seminal vesicle: A case report and literature review

A mixed epithelial and stromal tumor of the seminal vesicle gland is an uncommon neoplasm characterized by a dual population of epithelial and stromal cells. In this case report, we present a 59-year-old male patient who presented with a large, 10 cm mass in the left seminal vesicle, which was preliminarily suspected to be a malignant tumor of the seminal vesicle based on magnetic resonance imaging findings. Histopathological evaluation, however, revealed a tumor with biphasic epithelial–mesenchymal differentiation, predominantly displaying mesenchymal characteristics. The epithelium and stroma displayed papillary and foliar structures, respectively. The epithelial cells were bland, arranged in either single or multi-layered cuboidal patterns, and the stromal cells were spindle shaped with a sparse distribution. The patient experienced a favorable postoperative outcome. The diagnosis of mixed epithelial and stromal tumor is challenging based on clinical and imaging findings alone, and definitive diagnosis relies on pathological examination. This case report addresses a rare presentation of low-grade mixed epithelial and stromal tumor in the seminal vesicle gland and aims to expand the understanding of this entity by reviewing the relevant literature.

Efficacy of various surgical approaches in treating hematospermia using transurethral seminal vesiculoscopy

PurposeTo explore the efficacy of different approaches of seminal vesiculoscopy surgery and the predictive factors of good treatment outcome.Materials and MethodsA retrospective analysis of 68 patients who underwent seminal vesiculoscopy for hematospermia in our hospital from January 2015 to January 2021. According to different surgical approaches, they were divided into three groups: natural ejaculatory ducts (method A, 45 cases), assisted transurethral resection/incision of ejaculatory ducts (method B, 14 cases), fenestration in prostatic utricle (method C, 9 cases). We analyzed the recurrence rate of the three surgical approaches and the predictive factors of treatment efficacy.ResultsThe total recurrence rate after the seminal vesiculoscopy for hematospermia in this group was 32.35%. The postoperative recurrence rates of the three methods were 24.44% for method A, 50.00% for method B and 44.44% for method C, and there was no significant difference among the three methods (P > 0.05). The data of five predictors of 45 cases in method A group were included in the Univariate Logistic analysis, the results suggest that whether complicated with seminal tract stones/cysts was an effective predictor (OR 0.250, P = 0.022), which was still an effective predictor in the Multivariate Logistic analysis model (OR 0.244, P = 0.010).ConclusionsThe Transurethral seminal vesiculoscopy technique demonstrates a low postoperative recurrence rate in treating hematospermia. Among the various approaches, the intraoperative use of natural orifices through the ejaculatory duct exhibits the lowest recurrence rate. Additionally, seminal tract stones/cysts effectively predict favorable postoperative outcomes.

Surgical quality assessment for the prospective study of oncologic outcomes after laparoscopic modified complete mesocolic excision for nonmetastatic right colon cancer (PIONEER study).

The modified complete mesocolic excision (mCME) procedure for right-sided colon cancer is a tailored approach based on the original complete mesocolic excision (CME) methodology. Limited studies evaluated the safety and feasibility of laparoscopic mCME using objective surgical quality assessments in patients with right colon cancer. The objectives of the PIONEER study were to evaluate oncologic outcomes after laparoscopic mCME and to identify optimal clinically relevant endpoints and values for standardizing laparoscopic right colon cancer surgery based on short-term outcomes of procedures performed by expert laparoscopic surgeons. This is an ongoing prospective, multi-institutional, single-arm study conducted at five tertiary colorectal cancer centers in South Korea. Study registrants included 250 patients scheduled for laparoscopic mCME with right-sided colon adenocarcinoma (from the appendix to the proximal half of the transverse colon). The primary endpoint was 3-year disease-free survival. Secondary outcomes included 3-year overall survival, incidence of morbidity in the first 4 weeks postoperatively, completeness of mCME, central radicality, and distribution of metastatic lymph nodes. Survival data will be available after the final follow-up date (June 2024). The postoperative complication rate was 12.9%, with a major complication rate of 2.7%. In 87% of patients, central radicality was achieved with dissection at or beyond the level of complete exposure of the superior mesenteric vein. Mesocolic plane resection with an intact mesocolon was achieved in 75.9% of patients, as assessed through photographs. Metastatic lymph node distribution varied by tumor location and extent. Seven optimal clinically relevant endpoints and values were identified based on the analysis of complications in low-risk patients. Laparoscopic mCME for right-sided colon cancer produced favorable short-term postoperative outcomes. The identified optimal clinically relevant endpoints and values can serve as a reference for evaluating surgical performance of this procedure.

Effectiveness and Safety of Burr Hole Evacuation in Chronic Subdural Hematoma Patients – Experience from a Low-Income Country

Background: In contemporary neurosurgery, burr holes are fundamental in cranial procedures, primarily for the evacuation of chronic subdural hematomas (CSDH). CSDH is prevalent, and its clinical course, though not life-threatening, carries morbidity and mortality risks. This study evaluates the effectiveness and safety of Burr Hole Evacuation (BHE) for CSDH, aiming to assess clinical outcomes, immediate postoperative complications, and patient satisfaction. Methodology: This retrospective cohort study analyzed data from patients who underwent BHE for CSDH between March 2015 and August 2023. Inclusion criteria encompassed well-documented CSDH diagnoses, comprehensive medical records, and primary BHE cases, excluding previous neurosurgical interventions and pediatric cases. Data included patient demographics, clinical presentation, imaging findings, surgical details, post-operative outcomes, and patient satisfaction. Analysis was performed using SPSS version 25. Results: The study included 86 patients, predominantly male (85%) with a mean age of 54 years. Clinical presentations varied, with headaches (85%) being the most common symptom. CT scans were pivotal for diagnosis, revealing hypodensities primarily over the convexity. BHE was performed without complications, resulting in favorable post-operative outcomes (93% significant recovery, 7% extended hospital stays). No intraoperative or post-operative mortality occurred, and there were no recurrent hematomas. Patient satisfaction with BHE was high (97%). Conclusion: BHE is a viable primary surgical intervention for CSDH in low-income settings, with positive outcomes, safety, and patient satisfaction. Further studies and collaborative efforts are essential to enhance neurosurgical treatment in these settings and explore long-term outcomes.

Right Mini-Thoracotomy in the Surgical Treatment of Structural Heart Diseases (SHDs): An Institutional Experience

Introduction: Surgical treatment of structural heart diseases continues to predominantly involve median sternotomy, despite the ongoing trends favoring minimally invasive approaches that have persisted for many years. In this study, we present data on structural heart disease (SHD) surgeries conducted by our institute using a right mini-thoracotomy approach. Patients and Methods: This single-center retrospective study included 58 patients who underwent right minithoracotomy procedures between February 2018 and June 1, 2023. Preoperative demographic and medical data were collected from patient files and records. Perioperative and 30-day outcome data were obtained through the national electronic record system. Results: The average age of the participants was 39.9. Female patients accounted for 31.6% (n= 18) of the participants. The majority of surgeries in this study involved peripheral cannulation and conventional cardioplegia. Mitral valve repair and atrial septal defect closure were the most common procedures performed. Intraoperative outcomes showed favorable results, with no instances of significant bleeding, structural complications, or mortality. Regarding the postoperative 30-day outcomes, the stroke rate was 1.8% (n= 1) among the patients. There were no reported cases of transient ischemic attack (TIA), myocardial infarction (MI), and mortality. The conversion to median sternotomy occurred in 3.4% (n= 2) of the cases. Reoperation and reexploration were required in 1.8% (n= 1) of the cases. The mean length of stay in the ICU was 1.7 days, while the mean length of ward stay was 4.2 days. Conclusion: This study contributes to the evidence supporting the shift towards minimally invasive approaches in the surgical management of structural heart disease. The low rate of intraoperative conversion, absence of major complications, and favorable postoperative outcomes highlight the safety and feasibility of right mini-thoracotomy. Continued advancements in surgical techniques and clinical expertise are expected to further optimize patient outcomes and improve the quality of care in this field.

Effectiveness of Intravenous Non-Opioid Analgesics for Postoperative Pain Management of in Patients Undergoing Hip Surgery: A Systematic Review and Meta-Analysis.

Background and Objectives: Intravenous (IV) non-opioid analgesics (NOAs) have been extensively investigated as a multimodal analgesic strategy for the management of acute pain after hip surgery. This pair-wise meta-analysis examined IV NOA effects following hip surgery. Materials and Methods: A systematic search of the MEDLINE (PUBMED), Embase, and Cochrane Library databases was performed for studies investigating the effect of IV NOA for postoperative pain management following hip surgery up to 7 June 2023. We compared in-admission opioid use, postoperative VAS (visual analogue scale) score, hospital stay duration, and opioid-related adverse events between IV NOA and control groups. Results: Seven studies were included with a total of 953 patients who underwent hip surgery. Of these, 478 underwent IV NOA treatment, and 475 did not. The IV NOA groups had lower opioid use within 24-h following hip surgery (SMD, -0.48; 95% CI, -0.66 to -0.30; p < 0.01), lower VAS score (SMD, -0.47; 95% CI, -0.79 to -0.16; p < 0.01), shorter hospital stay (SMD, -0.28; 95% CI, -0.44 to -0.12; p < 0.01), and lower incidence of nausea and vomiting (OR, 0.32; 95% CI, 0.15 to 0.67; p < 0.01) compared with the control groups. Conclusions: This meta-analysis demonstrated that IV NOA administration following hip surgery may have more favorable postoperative outcomes than those in control groups.

Association between ventricular CSF biomarkers and outcome after shunt surgery in idiopathic normal pressure hydrocephalus

IntroductionThe relationship between neurochemical changes and outcome after shunt surgery in idiopathic normal pressure hydrocephalus (iNPH), a treatable dementia and gait disorder, is unclear. We used baseline ventricular CSF to explore associations to outcome, after shunting, of biomarkers selected to reflect a range of pathophysiological processes.MethodsIn 119 consecutive patients with iNPH, the iNPH scale was used before and after shunt surgery to quantify outcome. Ventricular CSF was collected perioperatively and analyzed for biomarkers of astrogliosis, axonal, amyloid and tau pathology, and synaptic dysfunction: glial fibrillary acidic protein (GFAP), chitinase-3-like protein 1 (YKL40/CHI3L1), monocyte chemoattractant protein-1 (MCP-1) neurofilament light (NfL), amyloid beta 38 (Aβ38), Aβ40, Aβ42, amyloid beta 42/40 ratio (Aβ42/40), soluble amyloid precursor protein alfa (sAPPα), sAPPβ, total tau (T-tau), phosphorylated tau (P-tau), growth-associated protein 43 (GAP43), and neurogranin.ResultsThe neurogranin concentration was higher in improved (68%) compared to unimproved patients (median 365 ng/L (IQR 186–544) vs 330 (205–456); p = 0.046). A linear regression model controlled for age, sex and vascular risk factors including neurogranin, T-tau, and GFAP, resulted in adjusted R2 = 0.06, p = 0.047. The Aβ42/40 ratio was bimodally distributed across all samples, as well as in the subgroups of improved and unimproved patients but did not contribute to outcome prediction. The preoperative MMSE score was lower within the low Aβ ratio group (median 25, IQR 23–28) compared to the high subgroup (26, 24–29) (p = 0.028). The T-Tau x Aβ40/42 ratio and P-tau x Aβ40/42 ratio did not contribute to shunt response prediction. The prevalence of vascular risk factors did not affect shunt response.DiscussionA higher preoperative ventricular CSF level of neurogranin, which is a postsynaptic marker, may signal a favorable postoperative outcome. Concentrations of a panel of ventricular CSF biomarkers explained only 6% of the variability in outcome. Evidence of amyloid or tau pathology did not affect the outcome.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

Comparative study between open lumbopelvic fixation and percutaneous iliosacral fixation for management of sacral fractures

BackgroundThe main aim of surgical intervention for unstable sacral fractures is to obtain a solid construct across the lumbopelvic junction to allow for early mobilization. Both iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) are widely used surgical techniques used for treatment of unstable sacral fractures. Nevertheless, it is unclear whether one technique provides more favorable postoperative outcomes than the other.ObjectiveTo compare the three-year outcome of ISF versus LPF in patients with unstable sacral fractures as regard effectiveness and safety of both techniques.MethodsThe study included 54 patients with sacral fractures who underwent sacral fusion using either ISF or LPF at a single institution. Patients were followed up for at least 3 years. Operative and postoperative data were collected and statistically calculated.ResultsThirty patients were included in the ISF group and 24 patients in the LPF group. The operative time was notably higher in the LPF group (mean 107 min compared to 33 min in the ISF group; p = 0.002). Blood loss was also higher in the LPF group (mean 320 ml compared to 96 ml in the ISF; p = 0.004). Assessment of pelvic fusion was done via Majeed and Matta scores (pelvic fusion outcome scores). The ISF and LPF groups had a comparable Majeed score at the end of the third year of follow-up (excellent rate = 53.3% vs. 58.3%, respectively; p = 0.93). Likewise, ISF and LPF groups had comparable Matta score at the end of the third year of follow-up (excellent rate = 66.7% vs. 70.8%, respectively; p = 0.27). The most commonly reported postoperative complications in the ISF group were screw malposition in 2 cases out of 30 cases (6.6%) and non-union in 2 cases out of 30 cases (6.6%). On the other hand, the most commonly reported postoperative complications in the LPF group were implant prominence in 3 cases out of 24 cases (12.5%) and infection in 2 cases out of 24 cases (8.3%).ConclusionLPF and ISF have comparable safety and efficacy in patients with sacral fractures. ISF is an excellent and safe method of fixation, especially in old age to avoid open surgery-related complications. LPF is preferred in young active patients to benefit from rapid weight bearing after surgery and in cases with ambiguous sacral anatomy as sacral dysmorphism.

Increased Body Mass Index Correlates with Less Favorable Postoperative Outcomes After Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: A Retrospective Cohort Study

Obstructive sleep apnea is associated with high morbidity. Hypoglossal nerve stimulation (HNS) has become a novel (neuro-) surgical treatment strategy for obstructive sleep apnea, demonstrating good success rates. Beyond predefined inclusion and exclusion criteria, no precise data are available, enabling individual preoperative risk assessment. To improve preoperative risk stratification, this study analyzed individual patient factors that affect outcomes of HNS. Fourteen patients treated with unilateral HNS were analyzed retrospectively. Assessed risk factors included: hypertension, diabetes mellitus, depression, smoking, alcohol consumption, body mass index (BMI), and disease duration. Treatment success was defined as a reduction in the postoperative apnea-hypopnea index (AHI) to≤20 events/hour, with a relative reduction of at least 50% compared to baseline. A significant reduction in the postoperative apnea-hypopnea index was observed in all patients (P < 0.0001). BMI correlated significantly with postoperative AHI scores (95% confidence interval, 0.1519-0.8974; P= 0.018). Significant treatment success was observed in 50% of patients. Compared with the "Excellent Responder group," the "Responder group" demonstrated a significantly higher BMI (95% confidence interval, 1.174-6.226; P= 0.0078). Diabetes, hypertension, disease duration, smoking, depression, and alcohol consumption were not significantly associated with AHI reduction. Our findings suggest that BMI may be an independent risk factor for the response to HNS, with patients who had less benefit from therapy having significantly higher BMI than "Excellent Responders." Therefore, carefully selecting patients is crucial in obtaining optimal outcomes with HNS therapy, especially those with a high BMI.

Randomised Prospective Study to Compare Outcomes of Para Umbilical Hernia On-Lay Open Mesh Repair, with and without Drain

Objective: To compare the outcomes of open on-lay mesh hernia repair with and without the use of a drain in PUH cases, with the goal of determining the most favorable post-operative outcome. Methodology: A prospective clinical study was conducted at the Department of General Surgery, Islamabad Medical Complex, NESCOM, a tertiary care hospital in Islamabad, Pakistan from January 2022 to December 2022. Fifty patients were enrolled and divided equally into two treatment groups (Groups A and B), with and without drain placement, respectively. The occurrence of complications such as seroma, hematoma formation, wound dehiscence, mesh infection, and length of hospital stay were compared between the two groups. Results: Postoperative complications were more prevalent in Group A (with drain placement) compared to Group B. Seroma formation was more common in Group A (40% on the 5th day and 16% on the 14th day post-repair) compared to Group B (16% on the 5th day and 4% on the 14th day). Hematoma formation was also higher in Group A (12% on the 5th day) compared to Group B (8% on the 5th day); however, both groups showed a 4% incidence on the 14th day. Infected mesh was more frequent in Group A (8%) compared to Group B (4%), resulting in increased morbidity. Conclusions: In small-sized para-umbilical hernia cases undergoing open on-lay mesh repair, the presence of a drain did not significantly affect the rate of postoperative complications. Seroma formation and infection incidence did not vary significantly between groups. However, patients with drain placement experienced a significantly longer hospital stay post-surgery.

Resection of Intramedullary Hemangioblastoma: Timing of Surgery and Its Impact on Neurological Outcome and Quality of Life.

Background and Objectives: Spinal intramedullary hemangioblastomas (SIMH) are benign vascular lesions that are pathological hallmarks of von Hippel-Lindau disease (vHL) and constitute the third most common intramedullary neoplasm in adults. So far, maximal and safe resection is the first choice of treatment. However, as SIMH show no malignant transformation, it remains unclear whether surgical resection is beneficial for all patients. Materials and Methods: We retrospectively analyzed the surgical outcomes of 27 patients who were treated between 2014 and 2022 at our neurosurgical department and investigated potential risk factors that influence the surgical outcome. Pre- and postoperative neurological status were classified according to the McCormick scale. Furthermore, surgical quality indicators, such as length of hospital stay (LOS; days), 90-day readmissions, nosocomial infections, and potential risk factors that might influence the surgical outcome, such as tumor size and surgical approach, have been analyzed. In addition to that, patients were asked to fill out the EQ-5D-3L questionnaire to assess their quality of life after surgery. Results: Surgery on SIMH patients that display no or minor neurological deficits (McCormick scale I or II) is associated with a favorable postoperative outcome and overall higher quality of life compared to those patients that already suffer from severe neurological deficits (McCormick scale III or IV). Conclusion: Early surgical intervention prior to the development of severe neurological deficits may offer a better neurological outcome and quality of life.