Higher Scores In Group Research Articles

Analysing the Impact of Age, Body Condition, Scrotum Circumference Testicular Size and Hormone Levels in Pre-Pubertal Kundhi Buffalo Bull Calves

: This study investigates and compares the physiological and behavioral characteristics of Kundhi buffalo bull calves focusing on the impact of age and size. Ten bull calves, aged between 14 to 18 months were selected and categorized into two groups: Group A: young (up to 14 months), with 210kg average body weight, and Group B: smaller (up to 18 months) with 305kg average body weight. The body weight of Kundhi buffalo calves linearly increased from the 1st to the 7th fortnight, with significant differences (p<0.05) observed between the two groups. The final body weight was higher in Group B (344.72 kg) when compared to Group A (262.04 kg). Similarly, scrotal circumference, girth, and length exhibited linear increases throughout the experiment with significant differences between the groups (p<0.05). Group B consistently showed larger scrotal circumferences (21.96 cm), girths (66.28 cm), and lengths (51.54 cm) compared to Group A (18.38 cm, 60.36 cm, and 47.44 cm, respectively). While testosterone and estradiol concentrations were non-significant (p>0.05) between the groups, they were higher in Group B (0.1504 ng/ml and 2.4724 pg/ml) than in Group A (0.1082 ng/ml and 2.2724 pg/ml). Behavioral observations, including nuzzling, sniffing, licking, bellowing, protrusion, and mounting, indicated higher scores in Group B. In both groups, mean nuzzling scores were (3.71 and 5.00), sniffing (0.28 and 1.28), licking (3.14 and 4.14), bellowing (0.85 and 2.14), protrusion (0.00 and 0.42), and mounting (0.00 and 1.28) in the "yes" category. These findings offer comprehensive insights into the physiological and behavioral differences influenced by age and size in Kundhi buffalo bull calves.

Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery.

This study aims to evaluate the efficacy and satisfaction of using a multi-angle laser device (MLD) for C-arm fluoroscopy to assist novice learners during lumbar spine surgery. Forty novice learners were randomly assigned to Group A using an MLD-equipped C-arm or Group B using a traditional C-arm. Both groups performed X-ray fluoroscopy on a lumbar spine model in supine and rotated positions. Time, number of shots, and deviation from the target were compared. A questionnaire was used to assess the learning experience. Group A required less time (13.66 vs. 25.63 min), and fewer shots (15.05 vs. 32.50), and had a smaller deviation (22.9% vs. 61.5%) than Group B (all p<0.05). The questionnaire revealed higher scores in Group A for comfort, efficiency, and knowledge mastery (all p<0.05). The MLD significantly improves novice learning of C-arm fluoroscopy during lumbar spine surgery.

Medical device for rehabilitation after proximal femur fracture: usability study

Background: the Proximal Femur Fracture (PFF) is a serious public health concern, and the ABLEFIT Medical Device (MD) may be an added asset in the patient’s process of rehabilitation after PFF. Objectives: to assess usability and ergonomics of the ABLEFIT for patient rehabilitation after PFF. Methodology: a descriptive observational study, using a mixed methodology, with data sourcing through two focus groups and usability questionnaire. Focus groups made up of eight participants each, one group with end users and one with Nurses Specialized in Rehabilitation Nursing (NSRN). All ethical principals were met. The quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) v25 software, in addition to content analysis technique for focus groups. Results: the descriptive analysis of the quantitative data shows a positive appreciation, with higher scores in group A. Overall, participants considered the device to be useful for patient rehabilitation after PFF. Some group B participants perceived the learning process and usability of the medical device as complex. Conclusion: this study allowed to assess usability and improvement of the ABLEFIT for patient rehabilitation after PFF, and to contribute to better quality in Rehabilitation Nursing care services.

Sprouts consumption: A correlational study between Brazilian consumers' perception, motivation to eat new products levels and food choice factors

AbstractEncouraging the consumption of natural foods with a high content of nutrients such as sprouts is a strategy that meets the nutritional guidelines of most countries. Considering that data on sprouts consumption in Brazil are scarce, the present study aimed to evaluate the perception of Brazilian participants about sprouts, correlating these data with the multidimensionality of food choice and motivations for novelties. The perception of 315 participants was evaluated, considering the Food Choice Questionnaire (FCQ), Motivation to Eat New Foods scale, and the projective technique of Word Association (WA). Based on FCQ data, participants were subdivided into two distinct clusters with specific profiles. All factors' scores related to food choice showed significantly higher scores in Group 2. Sensory appeal was their most relevant factor. Both groups were highly motivated to approach new foods. In the WA task, the most mentioned categories were associated with product, health, and environmental aspects.Practical applicationsThe evaluation of consumers' perceptions about sprouts demonstrated that the inclusion of sprouts as part of the diet is feasible and aligns with the demands and motivations of Brazilian participants. As a practical application, it is suggested that strategies be developed to promote the consumption of sprouts based on sensory and nutritional aspects, as well as their relationship with health and the environment.

The Effects of Suburethral Tension Adjustable Sling (Remeex system) for Female Urinary Incontinence between Pure Intrinsic Sphincter Deficiency and Intrinsic Sphincter Deficiency with Overactive Bladder: Initial Experience with Propensity Score Matching

Objective: To compare the therapeutic efficacy after suburethral adjustable sling (Remeex system) for female stress urinary incontinence (SUI) between pure intrinsic s phincter deficiency (ISD) and ISD with overactive bladder (OAB) group. Methods: The study subjects were 86 female patients with ISD who underwent Remeex system to treat female SUI and who were available for 12 months follow-up. We retrospectively studied both patients who underwent Remeex system due to pure ISD (group I) and those who underwent Remeex system due to ISD with OAB (group II). Improvement in objective and subjective symptoms were retrospectively evaluated using a 1hr pad weight test, global response assessment (GRA) and overactive bladder symptom score (OABSS). Results: Group I included 43 patients and group II included 43 patients of mean ages 56.8 ± 7.5 and 57.4 ± 6.6 years, respectively. Use of 1 hr pad weight test showed that incontinence decreased after the procedures in both groups, and that of group I patients was significantly lower than that of group II patients. The mean GRA score was significant a higher score in group I. The OABSS of patients in group II were 8.2 ± 1.1 and 7.2 ± 1.1, respectively, before and at 12 months after operation, did differ significantly. The mean change of OABSS of group II patients was significantly more decreased than that of group I patients. Conclusions: The Remeex system showed a greater patient satisfaction and a higher cure rate in pure ISD than ISD with OAB in female patients with urinary incontinence.

Effect of Multidisciplinary Team Collaborative Nursing Model Combined with Mind Mapping Teaching Method on Postopera-tive Complications and Mental Health of Patients with Advanced Pancreatic Cancer

Background:To analyze the effect of multidisciplinary team (MDT) collaborative nursing model combined with mind mapping teaching method on postoperative complications and mental health of patients with advanced pancreatic cancer (APC).Methods:The clinical data of 100 APC patients treated in Liaoning Cancer Hospital and Institute, Shenyang, China (Dec 2018 – Dec 2020) were retrospectively analyzed. They were randomly and equally split into group J and group Q. The patients of group J were nursed with mind mapping teaching method, while those of group Q were nursed with MDT collaborative nursing model combined with mind mapping teaching method to compare the incidence of complications, quality of life (QOL) and mental health between the two groups after nursing.Results:After nursing, the SAS, SDS and NRS scores decreased in both groups, with the notably lower scores in group Q compared with group J (P < 0.05). After nursing, the QOL scores increased in both groups, with the notably higher scores in group Q compared with group J (P < 0.05). Compared with group J, the nursing satisfaction in group Q was notably higher while the incidence of complications was notably lower (P < 0.05).Conclusion:The MDT collaborative nursing model combined with mind mapping teaching method in postoperative nursing of APC patients can improve negative emotions such as anxiety and depression, enhance the QOL, alleviate pain, reduce the incidence of postoperative complications and improve nursing satisfaction, worthy of application and promotion in clinic.

Prospective comparison of single encounter versus distributed laparoscopic training in novice learners: A controlled trial.

BACKGROUND:The traditional model of teaching surgical skills on “real” patients using graded responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. The purpose of our study was to determine if the number and duration of training sessions influence the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest that distributed training programs might have better outcomes, but the results are inconclusive. We designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained using the distributed method may have enhanced learning outcomes.MATERIALS AND METHODS:100 medical students were assigned in a 1:1 ratio to one of two groups. Group A underwent a single orientation and supervised practice session of 3 h duration. Group B underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive weeks. Participant scores were analyzed before and after the intervention and at 3- and 6-month intervals using repeat measures of ANOVA.RESULTS:Pretest and immediate posttest scores were comparable between the two groups. The 3-month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). The 6-month interval test showed no differences in scores between the two groups (P = 0.178).CONCLUSIONS:Distributed teaching resulted in significantly enhanced scores at 3-month assessment. However, similar scores at 6 months suggest the need for repeated intervention.

Well-Being, Depression, and Anxiety following Oncoplastic Breast Conserving Surgery versus Modified Radical Mastectomy Followed by Late Breast Reconstruction.

Breast cancer requires complex clinical care. Well-being is an intricate concept, encompassing physical, functional, emotional, and social aspects. Background: This study aims to evaluate the relationship between the type of surgery our patients underwent and the timing of the reconstructive surgery with physical, emotional, social, and functional well-being. Furthermore, through our research we tried to identify potential mental health comorbidities in patients with breast cancer, clinical symptoms, and well-being in women with breast cancer, depending on the type of required surgery. Methods: The study included 69 women diagnosed with breast cancer, in stages I to III, divided in two groups: I—patients with oncoplastic breast-conserving surgery and contralateral correction surgery, for symmetry reasons; II—patients who underwent modified radical mastectomy and late breast reconstruction with contralateral symmetrisation. We evaluated socio-demographic aspects, alongside depression, anxiety, stress (DASS 21), and well-being (FACT-B). Data were statistically processed; statistical significance was set at p < 0.05. Results: Clinical elements of depression, anxiety, and stress were noted in both groups, without statistical significance (p > 0.05). Significant differences were found regarding psycho-emotional (p = 0.035) and functional well-being (p = 0.001), with higher scores for group I. The chi-square test indicated statistically significant differences (at p < 0.01) between the groups, regarding the frequency of scores on items B4 and B9 (FACT-B items, related to feminine aesthetics and desirability), with evidently higher scores in group I than in group II. Conclusions: The state of well-being, as well as the items related to femininity and sexuality had higher values in the group of women treated by oncoplastic conservative surgery compared to late reconstruction after modified radical mastectomy.

An Observational Survey of Nail and Skin of Spine Surgeons-Possible Damage by Occupational Ionizing Radiation Exposure.

Introduction Orthopedic surgeons are exposed to ionizing radiation daily. With the increase in the number of minimally invasive surgery performed under X-ray fluoroscopy, radiation exposure to unprotected fingers will increase. Although the effect of high dose radiation exposure is known, the long-term effect of exposure to low doses is unclear. This study aims to investigate damage to the nail and skin on the thumbs of spine surgeons via occupational ionizing radiation exposure. Methods Forty male spine surgeons (group S) and 40 males of the same age group who were not exposed to radiation (controls; group C) were included. Using a scoring system, we evaluated the damage to the fingernail and skin of the bilateral thumb. Scoring was based on fingernail pigmentation (melanonychia), fingernail crack, and periungual dermatitis status. We investigated the number of examinations and operations under radiation exposure in the last 3 months. Results Group S had 17.83 (3-28) years of surgeon experience. In group S, the dominant side scored significantly higher than the non-dominant side; however, there was no dominant vs. non-dominant difference in group C. Only the dominant side had a significantly higher score in group S than in group C. In group S, surgeon experience and the score of the dominant side were significantly correlated; however, for the non-dominant side of group S and both thumbs of group C, no correlation was observed. The kappa coefficients for fingernail pigmentation, fingernail crack, and periungual dermatitis status were 0.458, 0.248, and 0.612, respectively. The average number of examinations and operations under radiation exposure was 11.89 ± 9.04 (0-30) and 26.34 ± 14.67 (1-63), respectively. Conclusions The dominant side in group S had a significantly higher score than the non-dominant side in group S and the dominant side in group C, suggesting the possibility of radiation damage to the dominant side in group S.

The outcome of various amplification strategies in post-lingual sensorineural hearing loss patients

Abstract:Objective: to measure functional and audiologic outcomes in patient with severe to profound post-lingual sensorineural hearing loss using either binaural hearing aids, unilateral cochlear implant or bimodal hearing.Method: This observational cross-sectional study was conducted on 60 adult patients with post-lingual bilateral severe to profound SNHL with age range from 20-50 years divided into 3 equal groups; Group I: 20 patients using binaural regular powerful hearing aids, Group II: 20 patients with unilateral cochlear implant and Group III: 20 patients using bimodal hearing strategy. The functional outcome was measured by using the Categorical Auditory Performances (CAP) scale which is ranged from 0 to 7. The auditory outcome was measured by aided audiometry threshold and clear speech perception test.Results: The CAP score showed higher score in group III as compared to the other groups and the number of participants with CAP score 5 and above was 0 in group I, 6 (30 %) in group II and 12 (60 %) in group III. This was a highly statistically significant difference in mean aided threshold among the 3 groups 42.5, 37.5 and 21.67 respectively. This was a highly statistically significant difference between the three groups in clear speech perception with increased performance in group III in both quiet and variable noisy situations. Conclusion & Recommendations:Bimodal hearing is beneficial when there is a good selection and good optimization of the fitting criteria of the HA. Our study recommends putting guidelines for bimodal candidacy which maximize patient benefits.

Tissue and species identification in minced meat and meat products from Italian commercial markets by DNA microarray and histological approach.

Adequate testing and adulterant detection of food products are required to assure its safety and avoid fraudulent activities. Adulteration/substitution of costlier meat with a cheaper or inferior meat is one of the most common fraudulence in meat industry. Aim of this study was to check the correct labelling of meat and ready to cook bovine meat products, combining the DNA microarray approach to identify the animal species with the histological examination, to check the composition and safety of meat. One hundred and one samples of bovine minced meat (Group 1) and ready to cook meat products (Group 2) were collected from supermarkets in Turin, Italy. DNA microarray revealed that 25.7% of samples were positive for species not declared on the label, swine being the most common. Histology showed the presence of cartilage, bone and glandular tissue. A higher presence of bacteria and inflammatory cells was detected in Group 1. Bacterial cells associated to inflammatory cells were detected with a higher score in Group 2. Sarcocystis spp. were present in 83.3% samples of Group 1 and 49.1% of Group 2. This study confirmed that the mislabelling of meat products is not uncommon. The combination of DNA microarrays and histology can increase the monitoring capacity in bovine meat industry.

Amantadin İnfüzyonunun Travmatik Beyin Hasarında Etkisi

Objective: Traumatic brain injury (TBI) is a significant socioeconomic and public health problem. Amantadine sulfate has been used as a neuroprotective drug. In this study, We aim that amantadine infusion treatment effects positively in patients with a severe head injury on conscious recovery. Materials and Methods: Patients with TBI were classified into two groups: Patients that used amantadine infusion group was Group I (n=40) and patients that not used amantadine infusion group was Group group II (n=40). Age, gender, Glasgow Coma Scale (GCS), education level, intubated or non-intubated when he/she come to Intensive Care Unit (ICU), the recovery time of conscious, discharge time, recovery of CT or MR scan and Coma Recovery Scale-Revised (CRS-R) were retrospectively recorded. Results: Time to recovery in consciousness was statistically significant shorter in group I. There were no statistically significant differences between the educational status of patients. The GCS of patients, when admitted to ICU, was lower in group I. Functional object use and long-term attention were have higher scores in group I when compared to CRS-R.Conclusion: Amantadine infusion affects positively neurological recovery and neurocognitive function for TBI in this study.

The effect of local wound infiltration vs caudal block on wound infection and healing after inguinal herniotomy in pediatrics − a double-blinded randomized study

Purpose The aim was to compare the use of local wound infiltration (LWI) vs caudal block (CB) on wound infection and healing after inguinal herniotomy in pediatrics. Patients and methods A total of 50 patients were assigned randomly into two groups (n=25/group) that received LWI using up to 1 mg/kg bupivacaine 0.25% or CB in group C using 1 mg/kg bupivacaine 0.25%. The authors measured wound infection and healing (primary outcome) using Southampton scoring system and postoperative analgesia (secondary outcome) using Faces Legs Activity Cry Consolability tool scale. Results There was a statistically significant difference regarding Southampton scoring system between the two studied groups, with higher number of patients with higher scores in group L (P=0.008). Comparison between the two groups according to preoperative and postoperative white blood cell count shows statistically significant increase in group C on day 7 postoperatively (P=0.015). There was a statistically significant decrease in pain score scale in group C compared with group L at 15 min (P=0.035), 60 min (P=0.007), and 3 h postoperatively (P=0.049). Analgesic requirement shows a statistically significant increase in group L at 15 and 60 min postoperatively (P=0.022). Postoperative complication was not statistically significant (P=1.000). Conclusion LWI is a safe and satisfactory analgesia option for surgery, and compared with CB, it is not overwhelming. CB provides better and longer analgesia; however, complications are more common. Wound healing was found to be better with CB, but it was clinically insignificant, as all patients healed normally. LWI did not cause wound infection in any of the patients included in the study and showed decrease in white blood cells in group L on day 7 postoperatively.

Masturbation is associated with psychopathological and reproduction health conditions: an online survey among campus male students

In order to investigate the association between masturbation and psychopathological and reproduction relative conditions, an online survey was conducted among campus male students of Zhejiang University, which comprised of basic personal information, and questions for reproduction related health, masturbation frequency, and psychological well-being. Psychological status was evaluated with Middlesex Hospital Questionnaire (MHQ). The psychological and reproduction health related parameters were compared among the groups divided according to masturbation frequency. Finally 143 students were included in analysis. Floating anxiety, somatic, and hysteric scores were significantly associated with masturbation, with higher scores in group with highest masturbation frequency; masturbation is significantly associated with fatigue, soreness and weakness of the lumbar region, memory decline, immunity decline, insomnia dreaminess and gradual increase of frequency of masturbation, and the rates of most of the reproduction related symptoms increased accompanying the increase of the masturbation frequency. MQH scores of obsession, phobic anxiety, and depression were not associated with masturbation. It was concluded that masturbation may adversely affect psychological health as well as reproductive well-being.

Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome.

This study aims to investigate and compare the efficacy of platelet-rich plasma (PRP) injection, corticosteroid injection, and physical therapy in addition to exercise treatment on pain, shoulder functions, and quality of life in patients with subacromial impingement syndrome (SAIS). Ninety patients (37 males, 53 females; mean age 48.99 years; range, 33 to 60 years) who were diagnosed as Stage 2 SAIS were included in the study. Patients were randomized into three groups. PRP injection was administered into the subacromial space of the affected shoulder in group 1, corticosteroid injection was administered in the subacromial joint space in group 2, and 10 sessions of physical therapy were given in group 3 five times weekly including transcutaneous electrical nerve stimulation, ultrasound, and hot packs. Moreover, an exercise program was administered in all groups. Visual Analog Scale (VAS) was used to determine the resting and moving shoulder pain; while the Shoulder Disability Questionnaire, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and the University of California, Los Angeles Shoulder Rating Scale (UCLA SRS) were used to evaluate the functionality of patients. Quality of life was analyzed using a generic Short Form 36 (SF-36). All scores improved in all three groups compared with the period before treatment. Comparison of the groups showed higher scores in group 1 compared to groups 2 and 3 at week eight on QuickDASH, UCLA SRS, VAS at rest and during activity, and SF-36 pain subgroup scores. All three treatment modalities were effective in the treatment of SAIS. However, we suggest that the inexpensive and noninvasive methods of physical therapy and exercise should be the first preferred treatment in SAIS owing to causing no adverse events.

Assessment of long-term articular damage and function in rheumatoid arthritis patients

Aim of the workThis study aimed to assess long-term articular damage and function in rheumatoid arthritis (RA) patients in relation to the type of treatment. Early disease modifying anti-rheumatic drug (DMARD) therapy has not been evaluated in this study. Patients and methodsOne hundred and fifty RA patients (141 females and 9 males) with disease duration more than five years and disease activity score-28 (DAS-28) <3.2 were included in this study. Sixty patients received disease modifying anti-rheumatic drugs (DMARDs) (group A), 60 received DMARDs and corticosteroids (CS) (group B), and 30 patients received CS only (group C). The functional outcome was assessed using the Modified Health Assessment Questionnaire (MHAQ). The articular damage was measured by using Rheumatoid Arthritis Articular Damage (RAAD) Score. The van der Heijde modification of the Sharp erosion score was used to define the plain X-ray of both hands and feet. ResultsThe mean age of the patients was 49.3 ± 11.5 years, and disease duration was 12 ± 7.9 years. There was a significant difference between the RAAD, visual analogue scale and MHAQ scores among the three groups (p = 0.001), with higher score in group C followed by B. By using Multiple regression analysis to examine the relationship between RAAD score and other independent variables there was a significant association of the RAAD score with higher X-ray score (p < 0.001) and with patients taking steroids only (p = 0.001). ConclusionAlthough, use of corticosteroids may help to control the disease activity, but it increases the risk of overall joint damage.

Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases

BackgroundSeveral surgical options for the reconstruction of massive bone defects have been described and include biologic methods with autografts and allografts, and the use of tumor endoprostheses (total femoral replacement, TFR). Several types of modular TFR are available, but nevertheless unpredictable outcomes and high complication rates have been described from most authors. The present study aims to compare results after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients with and without malignant disease.MethodsRetrospective chart review and functional investigation (Musculoskeletal Tumor Society (MSTS) score, Harris Hip Score (HHS), Oxford Knee Score (OKS), SF-12 Health Survey, and failure classification according to Henderson) of TFR cases from 1995 to 2011. Indications for TFR were malignant tumor resection from the femur (n = 9, Group A) or failure of a revision arthroplasty without history of malignant disease (n = 13, Group B).ResultsThirty-six patients were treated during the study period, of whom 22 could be investigated clinically after a mean follow-up of 63 months. Overall failure rate for TFR was 59.1%, leading to 38 surgical revisions. The most common failure mechanisms were Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). Mean MSTS score out of 30 was 13 (range 1–25), with significantly higher scores in Group A (mean 19, range 3–25) than Group B (mean 9, range 1–15).ConclusionTFR is an established procedure to restore femoral integrity. However, complication rates are considerably high, and depend mainly on the age at initial reconstruction.

PENGGUNAAN METODE SQ3R DAN MOTIVASI BELAJAR TERHADAP HASIL BELAJAR MEMBACA PEMAHAMAMAN SISWA KELAS XI SMA NEGERI 12 PEKANBARU

This study is a quasi experimental study aimed to describe the use of methods SQ3R and motivation and student learning outcomes learning materials reading comprehension. Implementation of the research in accordance with the learning procedure starting from planning, core activities and weekend activities. This study is an experimental research that distinguishes SQ3R method and conventional methods as well as motivation and learning outcomes. Research subjects a class XI student of SMAN 12 Pekanbaru. Results motivation and learning outcomes that motivated the data analysis methods SQ3R average of 129.56 and an average of 119.11 conventional methods; (2) Analysis of the average data overall learning outcomes of the students taught using methods SQ3R of 26.56 and 22.33 for the conventional method difference 4.23; (3) Analysis of average data results that are taught using methods SQ3R highest score 30.67 High Group and group the highest score 22.24 Low 8.23 difference in numbers; average data analysis of learning outcomes are taught with methods SQ3R study group Low highest score 26.28 and Conventional High group scores highest score group low 26.28 and the lowest scoring average 18.39 7.89 difference in numbers. So from this analysis can be concluded that the method SQ3R motivation and learning outcomes is higher than the motivation and learning outcomes conventional methods.Keywords: methods SQ3R, motivation and learning outcomes

Perineal Antropylorus Transposition for End-Stage Fecal Incontinence in Humans

Technical feasibility of perineal antropyloric valve transposition to reconstruct a severely damaged incontinent anal sphincter or to replace an excised anorectal sphincter has been reported previously. This study aimed to document the follow-up results of patients who underwent successful perineal antropyloric valve transposition for end-stage fecal incontinence. This study was conducted at a single tertiary care institution. Seventeen patients underwent the procedure. Eight patients had replacement (group 1) and 9 patients had augmentation (group 2) of the anal sphincter. Two patients in group 1 with early graft-related complications were excluded from further analysis, because they had the grafts excised. The primary outcome measures were anatomical integrity and functional status of the graft in the perineum, fecal incontinence scores, and quality-of-life scores (SF-36) over a median follow-up of 18 months. The transposed grafts had a definite tone on digital examination, were well visualized on perineal MRI, showed high-velocity vascular inflow on Doppler ultrasound study, and good vascularity on celiac CT angiography. Anal manometry showed a significant (p = 0.03) rise in the postoperative resting neosphincter pressures with good retention of barium proximal to pyloric valve on distal loopogram. The postoperative St Mark incontinence score improved in both groups and was significantly better in group 2 than in group 1. There was significant improvement in postoperative physical and mental component scores in both groups with higher scores in group 2 than in group 1 on follow-up. A longer follow-up with a larger sample size is required. Antropyloric valve transposition can be used effectively for a selected group of patients with end-stage fecal incontinence. Patients undergoing anal sphincter augmentation have better outcomes in comparison with those having an excised sensate anorectum.

Penehyclidine enhances the efficacy of tropisetron in prevention of PONV following gynecological laparoscopic surgery

Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Because monotherapy with antiemetics is insufficient, combinations of various antiemetics are often recommended by experts. In this study, our purpose was to find out whether penehyclidine could enhance the efficacy of tropisetron in preventing PONV. With hospital ethics committee approval, we investigated 120 women undergoing gynecological laparoscopic surgery receiving prophylactic tropisetron (0.1mg/kg; maximal dose, 5mg) (group T) or tropisetron (0.1mg/kg; maximal dose, 5mg) plus penehyclidine (0.01mg/kg; maximal dose, 1mg) (group TP), or penehyclidine (0.01mg/kg; maximal dose, 1mg) (group P). The incidence of vomiting, the intensity of nausea (assessed by a visual analogue scale [VAS]), antiemetic rescues, and adverse effects were recorded at 2, 6, 12, and 24h after surgery in the gynecological ward by a visiting nurse anesthetist who was unaware of the treatments. Collected data were analyzed using analysis of variance (ANOVA) and the χ(2) test. Continuous variables were expressed as means±SD, and non-continuous variables were expressed as n (%). The overall incidence of vomiting was 28.3% (34/120) in our study. The incidence of vomiting was significantly lower in group TP (4 cases, 10%) than that in group T (12 cases, 30%) and group P (18 cases, 45%). The incidence of vomiting in group TP was also significantly lower than that in group T at 0-2h and 2-6h postoperatively and it was also significantly lower than that in group P at 0-2h, 2-6h, 6-12h, and 12-24h postoperatively. The incidence of vomiting was significantly lower in group T than that in group P at 12-24h postoperatively. The VAS of nausea was significantly lower in group TP than that in group T and group P at 2 and 6 h after surgery. It also showed a significant higher score in group P than that at group T and group TP at 12 and 24 h. Within group P, the VAS of nausea was significantly lower at 2 h postoperatively than that at 24 h. Penehyclidine showed less efficacy in preventing PONV than tropisetron; however, compared with tropisetron or penehyclidine monotherapy, prophylactic medication with tropisetron plus penehyclidine significantly reduced the incidence of vomiting and decreased the intensity of nausea in women undergoing gynecological laparoscopic surgery.