Grade IB Research Articles

MID­term results of the urgent right lung complex reconstructive tracheobronchial resection in a patient with exacerbated central lung cancer (clinical case)

Introduction. Treatment of patients with central non-small-cell lung cancer (NSCLC) complicated by recurrent hemophtysis is an urgent problem in oncology and thoracic surgery. The aim of this study is to demonstrate the possibility of performing radical organ-preserving surgery (right upper lobectomy with resection of the carina) in a patient with central NSCLC complicated by life-threatening pulmonary hemorrhage. Material and methods. A 64-year-old patient was hospitalized in our thoracic surgery department with grade IB hemophtysis for emergency indications. According to the results of the examination and data from rigid bronchoscopy, an infiltrative peribronchial tumor of the right upper lobe bronchus spreading to the right main bronchus, intermediate bronchus and distal trachea was revealed. According to vital indications, the patient underwent video-assisted mediastinal lymphadenectomy (VAMLA) followed by the right upper lobectomy with carinal resection and circular anastomosis between the trachea and the left main bronchus and reimplantation of intermediate bronchus into the right wall of the trachea proximal to the previous tracheobronchial anastomosis. Results. After a complex tracheo-bronchial resection several “non-surgical” early and delayed complications occured including acute respiratory distress syndrome, non-coronary myocardial infarction type II, thromboembolism of small branches of the pulmonary artery, pneumonia in the lower lobe of the left lung and osteomyelitis of the anterior segment of the 4th rib and perichondritis of the right 4th and 5th rib cartilages after adjuvant chemotherapy. We also demonstrate the methods used to treat complications in order to achieve good mid-term surgical results. Conclusion. Complicated central NSCLC is challenging both for surgical and non-surgical treatment. In carefully selected patients with complicated central NSCLC of the right upper lobe bronchus spreading to the main bronchus and trachea, radical organ-preserving surgery can be performed. Modern advances in thoracic surgery and аnaesthesiology, as well as the collaboration of doctors of various specialties in a multidisciplinary hospital, have made it possible to achieve good oncological and functional results 1.5 years after surgery.

Dual-energy computed tomography-based iodine concentration as a predictor of histopathological response to preoperative chemoradiotherapy for pancreatic cancer.

To explore predictors of the histopathological response to preoperative chemoradiotherapy (CRT) in patients with pancreatic cancer (PC) using dual-energy computed tomography-reconstructed images. This retrospective study divided 40 patients who had undergone preoperative CRT (50-60Gy in 25 fractions) followed by surgical resection into two groups: the response group (Grades II, III and IV, evaluated from surgical specimens) and the nonresponse group (Grades Ia and Ib). The computed tomography number [in Hounsfield units (HUs)] and iodine concentration (IC) were measured at the locations of the aorta, PC and pancreatic parenchyma (PP) in the contrast-enhanced 4D dual-energy computed tomography images. Logistic regression analysis was performed to identify predictors of histopathological response. Univariate analysis did not reveal a significant relation between any parameter and patient characteristics or dosimetric parameters of the treatment plan. The HU and IC values in PP and the differences in HU and IC between the PP and PC (ΔHU and ΔIC, respectively) were significant predictors for distinguishing the response (n = 24) and nonresponse (n = 16) groups (P < 0.05). The IC in PP and ΔIC had a higher area under curve values [0.797 (95% confidence interval, 0.659-0.935) and 0.789 (0.650-0.928), respectively] than HU in PP and ΔHU [0.734 (0.580-0.889) and 0.721 (0.562-0.881), respectively]. The IC value could potentially be used for predicting the histopathological response in patients who have undergone preoperative CRT.

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines.

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology.

The clinico-pathological characteristics of surgically treated young women with NSCLC.

Non-small cell lung cancer diagnosed in young patients is rare. Younger patients with lung cancer are mostly female and have a more advanced stage at initial diagnosis. To our knowledge, no studies have compared single-surgical treatment in different age groups among women. Our study aimed to elucidate the clinicopathological characteristics and the best strategies for surgically treating young women with non-small-cell lung cancer. The data were collected retrospectively from the Polish Lung Cancer Study Group database. Women who were surgically treated for non-small-cell lung cancer between 2007 and 2020 were included in the study. The participants (n=11,460) were divided into two subgroups: aged ≤55 and >55 years. Statistically significant differences were found for grades IB, IIA, IIIA, and IIIB (22.8% vs. 24.5%, 5.3% vs. 7.5%, 19.3% vs. 15.8%, 5.8% vs. 3.2%, for younger and older women, respectively, all P<0.001). The univariate analysis showed a higher percentage of 5-year survival in the group of younger women than in older women (0.67 vs. 0.64, P=0.00076). Regarding the stage of advancement, statistically significant differences in survival were found for stages IA1, IA2, and IIIA (0.95 vs. 0.86, P=0.047; 0.88 vs. 0.79, P=0.003; 0.5 vs. 0.42, for younger and older women, respectively, all P=0.01). Postoperative complications were more common in older than younger women (27.6% vs. 23.1%, P<0.001). However, there were no statistically significant differences in the number of hospitalization days since surgery and postoperative 30-day mortality. Younger women treated surgically were characterized by a lower percentage of comorbidities, were treated in a more advanced stage of the disease and had a lower percentage of postoperative complications, which, however, did not affect the hospitalization time. Despite the more advanced stage of the disease, survival in selected stages was much better than in the group of older women.

Congenital hip dysplasia: The importance of early screening and treatment

Congenital Hip Dysplasia (CHD) is characterized by a hip joint dislocation between the femoral head and the acetabulum, with a multifactorial etiology. This disorder can be an isolated condition or the manifestation of a syndromic condition, and it has been estimated with higher rates than registered, with a predominance in female sex and left side; risk factors are now defined. In Italy, the incidence rate is 3-4%, with significant regional differences: higher in Lombardy and lower in Sicily. Because clinical examination alone is insufficient to diagnose CHD, it is supplemented with ultrasonography and X-ray if necessary. Surveillance, static or dynamic splints, or osteotomies are the only treatment options. The goal of this study was to evaluate our experience in terms of management and conservative treatment of all newborns from January 2018 to May 2022: female sex and left hip were major involved, risk factors were not significant in our case, but results from early diagnosis and treatments, in terms of better outcome, were interesting. After a strict 6-month follow-up period, 89.13% of the patients were classified as grade Ia or Ib according to the Graf classification system. Finally, we emphasize the importance of early universal screening and subsequent diagnosis to allow for early treatment of the disorder, at an age when conservative treatments can yield good results.

The SHID wound classification system for diabetic foot ulcer patients: a validity study

This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas University) and Wagner wound classification systems in Indonesia. A prospective cohort study included patients with diabetic foot ulcers at Kitamura wound clinic in Indonesia. A total of 111 diabetic foot ulcer patients were assessed with SHID, TU, and Wagner wound classification systems. Two postgraduate nursing students assessed 111 wounds of bedside patients and observed them for 4 weeks. The predictive validity test indicated that the cut-off score of ≤grade 2 for SHID was 74% and 97%, ≤grade IB for TU was 77% and 92%, then ≤grade 2 for Wagner was 84% and 71% for sensitivity and specificity, respectively. The area under the curve (AUC) in SHID, TU, and Wagner tools was 0.90 (95% CI: 0.828-0.950), 0.85 (95% CI: I0.766-0.910), and 0.86 (95% CI: 0.775-0.917), respectively. The Youden index for SHID, TU, and Wagner was 0.72%, 0.70%, and 0.55%, respectively. The wound classification systems are good tools for identifying diabetic foot ulcers. However, the newly developed SHID tool produced the best AUC and Youden Index values compared to the Wagner tool.

Acute-On-Chronic Liver Failure-Outcome and Its Predictors in A Tertiary Care Hospital

Objective: To determine the characteristics and outcome of acute-on-chronic liver failure patients being managed at PakEmirates Military Hospital Rawalpindi.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Gastroenterology at Pak-Emirates Military Hospital, Rawalpindi, from Sep 2018 to Jan 2021.&#x0D; Methodology: In this study, 1559 patients diagnosed with cirrhosis were studied. Patients with pre-existing chronic kidney disease, chronic obstructive pulmonary disease, cardiac failure, dementia, and stroke were excluded. All the relevant features of each case were recorded in the proforma.&#x0D; Results: Out of 1559 patients, 67 had Acute-on-chronic liver failure. The majority of patients who presented with acute-onchronic liver failure were in grade Ib (55%), followed by grade II (30%). Hepatitis C virus related liver cirrhosis was the commonest underlying liver disease (78.4%). Drugs were the commonest triggering factor (33%), followed by acute viral hepatitis (27%). However, a large number of patients had no identifiable cause (25.4%).&#x0D; Conclusion: Acute-chronic-liver failure is common in patients presenting with acute decompensation of liver cirrhosis. Patients undergoing liver transplantation in the correct window period, have good prognosis.

Classification and Management of Pontecerebellar-Petrosal Bridging Veins

The risks and benefits of coagulating intradural venous elements during a retrosigmoid approach for trigeminal neurovascular decompression has not been accurately established. The objectives of this study were to identify the veins that drain into the superior petrosal sinus, classify them in relation to the suprameatal tubercle, and determine the implication of their coagulation. A retrospective study of 3-dimensional surgical videos of retrosigmoid approaches for trigeminal neurovascular decompression from the Laboratory of Neurosurgical Innovations of Tucumán (LINT) digital archive was carried out. The veins encountered were classified into 3 groups: retromeatal, meatal and premeatal. The neurosurgical postoperative complication scale proposed by Landriel etal. was utilized to assess complications from venous coagulation. A grade 0 was added for patients without complications. The STATA 14 program was utilized for statistical analysis. The pontocerebellar-petrosal veins of 28 patients who underwent trigeminal decompressive surgery were analyzed. In 7 cases these were found in the retromeatal region; 100% were sacrificed. Eleven cases revealed veins within the meatal region; 90.91% were coagulated. Veins in the premeatal region were found in 14 cases; 57.14% were sacrificed. In the postoperative follow-up, 27 patients were grade 0 and 1 patient developed postoperative meningitis (grade Ib complication). No patient suffered vascular complications. The venous elements identified in trigeminal neurovascular decompressive surgery are variable. We propose classifying them into retromeatal, meatal, and premeatal groups. Retromeatal and meatal veins can be safely sacrificed for appropriate visualization of the neurovascular conflict. The premeatal venous elements should be coagulated only in justified cases.

Alteration of Thyroid Hormone among Patients with Ischemic Stroke visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Stroke is broadly classified as cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage. Neuroendocrine profile is altered in acute ischemic stroke and there is a link between hypothyroidism and atherosclerosis which in turn may lead to stroke. The objective of this study was to find out the prevalence of alteration of thyroid hormones in patients with ischemic stroke in a tertiary care center. This descriptive cross-sectional study was conducted from June to December 2019 in a tertiary care center. Ethical approval was taken from Institutional review board of National Academy of Medical Sciences (reference number: IM 175). Patients with a diagnosis of stroke, without evidence of cardioembolic source, history of liver disease, renal failure and thyroid disease and who do not use thyroidal supplementation within 180 days prior the event were included. Convenience sampling was done. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 22. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. The prevalence of altered thyroid levels among 73 patients was 13 (17.8%) (90% Confidence Interval= 10.44-25.16). Among them 11 (15.1%) were hypothyroid and 2 (2.7%) were hyperthyroid. Among severity of hypothyroid cases, subclinical hypothyroidism grade IA was seen in 51 (70%), subclinical hypothyroidism grade IB was seen in 22 (30%). The prevalence of altered thyroid levels among patients undergoing ischemic stroke was similar to the findings of other international studies.

Assessment of the Grades of Vesicoureteral Reflux in Stented Ureters: An Experimental Study

Introduction: The aim of this experimental study is to assess, in a porcine model, the onset and grades of vesicoureteral reflux associated with ureteral stents. Methods: Twenty-four female porcine models were used. A 4.7-Fr ureteral stent was placed in all right ureters and kept in place for 6 weeks. Follow-ups were performed on weeks 1, 3, 6, and 12. Ultrasonography, cystoscopy, and fluoroscopy were used to analyze grade of hydronephrosis, presence and grade of vesicoureteral reflux, bacteriuria, and macroscopic changes of the ureteral orifices. Vesicoureteral reflux was classified using a modification of the International Reflux Study Committee grades. Results: 91.7% animals present vesicoureteral reflux, 89.5% grade IA, 3.5% grade IB, and 7% grade II. There is a significant increase in reflux during follow-ups at 3 and 6 weeks, whereas 6 weeks after removal, 26.3% of the ureters still present vesicoureteral reflux. Hydronephrosis and macroscopic changes of the ureteral orifice increase significantly with stenting, but there is no significant association between them and vesicoureteral reflux; the relationship between bacteriuria and the presence of vesicoureteral reflux is not significant either. Conclusion: Vesicoureteral reflux caused by ureteral stents in an animal model is mostly low grade and mainly affects the distal ureter.

Posterior Focal Curettage and Spine Stability Reconstruction by Temporary Pedicle Screw Fixation in Children With Collapsed Vertebrae due to Eosinophilic Granuloma.

Study Design:Retrospective case series.Objectives:To evaluate the efficacy of growth-preserving posterior spinal column reconstruction surgery in children with collapsed vertebral eosinophilic granuloma (EG).Methods:We retrospectively reviewed 15 confirmed cases of vertebral EG who met the inclusion and exclusion criteria from March 2015 to March 2018 in our hospital. The recovery of diseased vertebrae was assessed.Results:The cases were composed of 11 males and 4 females with a mean age of 74.3 ± 38.8 months. Nine cases presented with thoracic vertebral destruction, 6 cases with lumbar vertebral destruction. Under Garg’s classification, 10, 3 and 2 cases were classified as Grade IIA, IB and IIB lesions, respectively. All patients had mild to moderate night-aggravated back pain and recovered at 1-week after surgery. Three patients had Frankel D neurologic symptoms and recovered at 1-week, 1-week and 4-weeks after surgery, respectively. Follow-up time after surgery ranged from 1.9 years to 4.5 years, with a mean of 2.9 years. The median vertebral height at 12 months after surgery was significantly higher than the preoperative height. Furthermore, the vertebral heights of all diseased vertebrae displayed significant recovery trends at 3, 6 and 12 months after surgical treatment. The percentages of vertebral height recovery to references at 12 months after surgery ranged from 34.7% to 92.5%, with an average of 71.2%.Conclusions:In children with collapsed vertebral EGs, active surgical treatment is necessary to retain the ability to restore height and to reconstruct the spine stability.

Microsurgical reconstruction of the hard palate after resections for malignant tumors

Background. The main aims of hard palate reconstruction include separation of the nasal and oral cavities, restoration of chewing, swallowing, speech, ensuring good aesthetic results, and preparation for dental rehabilitation. The choice of reconstruction method is determined by such factors as the nature and location of the defect, surgeon’s experience in certain reconstruction methods, cancer prognosis, and patient’s preference. The study objective is to analyze the results of microsurgical reconstruction of hard palate defects using different types of flaps. Materials and methods. Forty-one (41) patients underwent microsurgical reconstruction of defects of the hard palate, soft palate, and alveolar process between 2014 and 2020. Defects of the anterior portion of the hard palate (grade I, IIc, IId according to the classification of J.S. Brown; grade IB, II, III according to the classification of D.J. Okay) were formed in 13 cases; all of them involved the alveolar margin of the maxilla to some extent. To repair these defects, we used flaps containing revascularized bone (n = 10; scapular tip flaps in 8 patients and fibular flaps in 2 patients) and fasciocutaneous or musculocutaneous flaps (n = 3; radial fasciocutaneous flaps in 2 patients and musculocutaneous flap from the anterior surface of the thigh in 1 patient). Defects of the posterior portion of the hard palate (grade Ib according to the classification of J.S. Brown; grade Ib according to the classification of D.J. Okay) were formed in 18 patients. To repair these defects, we used radial fasciocutaneous flaps (n = 17) and fibular autologous graft containing skin, muscles, and bone (n = 1). Soft palate resection was performed in 10 patients; all surgeries were combination, since the lateral oropharyngeal wall was included in the block of removed tissues. None of the patients had the opposite side affected. These defects were repaired using radial fasciocutaneous flaps.Results. Six patients (15 %) developed total flap necrosis due to venous thrombosis on days 2, 3, and 6 postoperatively; two patients developed flap necrosis due to arterial thrombosis 2 days postoperatively. Good speech quality was achieved in 33 patients (80 %), while 6 patients (15 %) had satisfactory speech; rhinolalia was observed in 2 patients (5 %). All patients with defects of the posterior hard palate and of the soft palate had excellent aesthetic results. Among participants with defects of the anterior hard palate and alveolar process, 10 patients had excellent aesthetic results, while 5 individuals had good results. Three patients had unsatisfactory results due to scarring in the middle portion of the face.Conclusion. Patients with subtotal defects of the hard palate and defects of its anterior portion (grade I, IIb, IIc according to the classification of J.S. Brown; grade II, III according to the classification of D.J. Okay) require repair of the alveolar margin of the maxilla; flaps containing revascularized bone are preferable in this case. The method of choice is defect repair using musculoskeletal scapular tip flap. In patients with short defects, defects located posteriorly, minimal or no defect of the alveolar margin of the maxilla (grade Ia, IB according to the classification of J.S. Brown; grade Ia, Ib according to the classification of D.J. Okay; grade V according to the classification of M.A. Aramany), soft palate defects, radial fasciocutaneous flaps should be used.

Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

The Use of Audiovisual Media to Improve the Speech Skills of Private School Students

&lt;em&gt;This study aims to improve speaking skills through the use of audiovisual media in class IB SD Negeri Suro, Kalibagor District. Speaking skills observed in this study include linguistic and non-linguistic aspects. In the linguistic aspect, it consists of stress, speech, vocabulary / diction, and sentence structure, while in the non-linguistic aspect it consists of fluency, disclosure of speech material, courage and attitude. This type of research is Classroom Action Research (CAR) which consists of 2 cycles. The subjects of this study were 22 students of SD Negeri Suro class IB. The research design used includes the planning, implementation, observation, and reflection stages. The data collection instruments used were performance tests, teacher and student observation sheets and documentation. The data analysis technique used is descriptive quantitative data analysis. This study shows that the use of audiovisual media can improve the speaking skills of grade IB SD Negeri Suro students in terms of process and outcome. The process improvement is seen from the average results of student activity observations which are included in the good category in the first cycle with a percentage of 45.5% increasing in the second cycle to 68% and are included in the very good category. In terms of results, it is evidenced by the average value of students' speaking skills in pre-action 67.54 increased to 73.05 in cycle I and increased to 75.64 in cycle II. &lt;/em&gt;

THE USE OF AUDIOVISUAL MEDIA TO IMPROVE THE SPEECH SKILLS OF PRIVATE SCHOOL STUDENTS

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;This study aims to improve speaking skills through the use of audiovisual media in class IB SD Negeri Suro, Kalibagor District. Speaking skills observed in this study include linguistic and non-linguistic aspects. In the linguistic aspect, it consists of stress, speech, vocabulary / diction, and sentence structure, while in the non-linguistic aspect it consists of fluency, disclosure of speech material, courage and attitude. This type of research is Classroom Action Research (CAR) which consists of 2 cycles. The subjects of this study were 22 students of SD Negeri Suro class IB. The research design used includes the planning, implementation, observation, and reflection stages. The data collection instruments used were performance tests, teacher and student observation sheets and documentation. The data analysis technique used is descriptive quantitative data analysis. This study shows that the use of audiovisual media can improve the speaking skills of grade IB SD Negeri Suro students in terms of process and outcome. The process improvement is seen from the average results of student activity observations which are included in the good category in the first cycle with a percentage of 45.5% increasing in the second cycle to 68% and are included in the very good category. In terms of results, it is evidenced by the average value of students' speaking skills in pre-action 67.54 increased to 73.05 in cycle I and increased to 75.64 in cycle II. This shows that students' speaking skills increased from cycle I to cycle II.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;

Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

Efficacy analysis of vagus nerve stimulation for the treatment of drug resistant epilepsy: A report of 110 cases

Objective To explore the efficacy of vagus nerve stimulation (VNS) for the treatment of drug resistant epilepsy. Methods The clinical data of 110 patients with drug resistant epilepsy who underwent VNS at Department of Neurosurgery, Provincial Hospital Affiliated to Anhui Medical University (the First Affiliated Hospital of University of Science and Technology of China) from February 2014 to March 2018 were analyzed retrospectively. The frequency and severity of seizures were followed up by outpatient review, and the efficacy was analyzed according to the McHugh seizure outcome classifications. Results The results of McHugh grade of 110 patients were as follows: grade ⅠA in 10 cases, grade ⅠB in 6, grade ⅡA in 25, grade ⅡB in 7, grade ⅢA in 30, grade ⅢB in 8, grade Ⅳ in 1 and grade Ⅴ in 20, and 3 patients were lost to follow-up. There was significant difference in seizure frequency between preoperative and postoperative conditions (P 0.05). In terms of seizure types, there were significant difference in the distribution of the McHugh classifications between patients with seizures of unclassified onset, focal onset and generalized onset (all P<0.05). The frequency of seizures decreased gradually with prolonged VNS stimulation time(P<0.05). Conclusions VNS could significantly reduce the frequency of seizure. VNS has a better effect on seizures with focal onset and generalized onset, while it has a poor effect on seizure types that cannot be classified. With the increase of stimulation time, the therapeutic effect of VNS is gradually improved. However, the age, sex or duration of disease is not related to the effect of VNS. Key words: Epilepsy; Vagus nerve stimulation; Treatment outcome; McHugh seizure outcome classifications

Apatinib enhances chemosensitivity of gastric cancer to paclitaxel and 5-fluorouracil.

Background and aim: Paclitaxel (PTX) plus 5-fluorouracil (5-Fu) has become the standard chemotherapy for advanced gastric cancer (GC). Apatinib, a small-molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, improves outcomes in GC patients as a third-line treatment. However, its impact on the chemosensitivity of GC remains to be determined. Hence, we aimed to assess the efficacy and safety of apatinib combined with chemotherapy in vivo and in vitro.Methods: The MGC803 cell viability was determined by Cell Counting Kit-8 assay, and the interactions between apatinib and conventional cytotoxic agents revealed by combination index values were calculated using Calcusyn 2.0 software. We also used a zebrafish embryo xenograft model to validate the synergistic interactions. Furthermore, 4 patients with late-stage GC were enrolled to explore the efficacy and safety of PTX/Tegafur Gimeracil Oteracil Potassium (S1) (PS) chemotherapy plus apatinib in conversion surgery.Results: Apatinib showed synergistic interactions with both PTX and 5-Fu in vivo. The zebrafish embryo xenograft model also demonstrated that apatinib significantly enhanced the antitumor activity of PTX and 5-Fu. Apatinib plus PS chemotherapy was well tolerated before surgery. Objective response to preoperative SPA treatment was achieved in all 4 patients. No postoperative bleeding events or wound-healing complications were observed. No postperative morbidity occurred and no morbidity was encountered. Pathological examination showed that all patients had grade Ib pathological response.Conclusion: The experimental data suggested that apatinib improves the efficacy of PTX and 5-Fu both in vitro and in vivo. Clinical evidence showed that a combination of PS chemotherapy with apatinib may be an efficient and acceptable safety treatment for late-stage GC, especially in conversion surgery.

A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage.

Background and Purpose The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.