High Incidence Of Complications Research Articles

O USO DO O-ARM® OU DA RADIOSCOPIA EM CIRURGIAS DA COLUNA: REVISÃO SISTEMÁTICA COM META-ANÁLISE

ABSTRACT The great advances in using new devices and imaging systems in surgeries aim to reproduce an ideal and safe scenario for the surgeon, the team, and the patient. New systems and devices are constantly available to demonstrate and facilitate intraoperative navigation, thereby reducing errors and avoiding complications for the patient and staff. This study evaluates and compares using the O-arm® system and radioscopy in the freehand technique in spine surgeries. For this, searches were conducted in PubMed and Embase for randomized and non-randomized studies using the O-arm® system and radioscopy in spine surgery. Twenty-four studies were included and compared regarding procedure time, accuracy of implant positioning, effective radiation dose, safety, and efficacy. In one study, the O-arm® group showed a shorter surgical time when compared to the freehand technique (222.5 min. [SD=38.0] vs. 255.2 min. [SD=40.3], p=0.011, respectively). In two studies, the freehand technique resulted in a lower effective radiation dose for patients. In 12 studies, a higher incidence of complications was observed among patients undergoing surgery with the freehand technique. It was concluded that using the O-arm® is associated with a reduction in malposition of implants and more safety for instrumented procedures. Still, no evidence exists that its use can result in less surgical time. Level of Evidence I; Diagnostic Analysis and Studies, Investigation of a Diagnostic Test.

Position Statement on the Appropriateness and Significance of Adding the Glycated Hemoglobin Test to the National Health Examination

The recent increase in the number of people with diabetes and the high incidence of complications carry a significant socioeconomic burden in addition to the disease burden and impact on personal health. Therefore, the Korean Diabetes Association and the Korean government have been making efforts to prevent the progression from pre-diabetes to diabetes through screening tests and to reduce diabetes complications and associated mortality in diabetic patients. Several studies in Korea have shown that glycated hemoglobin (HbA1c) provides complementary information to fasting plasma glucose (FPG) and improves clinical utility for diabetes screening. We hope that this consensus meeting will serve as an opportunity to identify additional diabetic patients who have not been diagnosed through a combination of FPG and HbA1c during a medical check-up. Our study is aimed to significantly reduce the lead time between diabetes onset and clinical diagnosis and initiation of diabetes treatment.

Frequency of Complications among Trauma Patients Treated by Traditional Bone Setters Presented to Orthopedics Department, Gujranwala Teaching Hospital Gujranwala.

Background: Traditional bone setters (TBS) are widely consulted for trauma care in developing regions, often leading to severe complications due to inadequate medical knowledge. This practice poses significant risks to patient safety and outcomes. Objective: The study aimed to evaluate the frequency and nature of complications encountered by trauma patients treated by traditional bone setters. Methods: This cross-sectional study was conducted in the Department of Orthopedics and Trauma Surgery at Gujranwala Teaching Hospital, Pakistan, from February 1st to April 31st. Ninety-seven patients who received care from TBS and subsequently presented at the Orthopedic outpatient clinic were included. Detailed data on demographics, injury type and site, TBS management techniques, and resulting complications were collected and analyzed using SPSS Version 20. Results: Among the 97 patients, 63 (64.95%) were female and 34 (35.05%) were male, with ages ranging from 3 to 70 years and a mean age of 33. TBS primarily used sticks and bandages for fracture management. The most common complications were malunion (42.27%), non-union (21%), and joint stiffness (17%). Conclusion: The high incidence of complications from TBS treatments significantly strains the Orthopedics department. Proposed solutions include integrating TBS into the healthcare system for improved training and regulation or implementing a complete ban on their malpractices.

CLINICAL AND LABORATORY ASPECTS IN DIAGNOSTICS OF THE FUNCTIONAL STATE OF THE HEPATOBILIARY SYSTEM IN PRETERM INFANTS

Resume. The insufficient information content of existing methods of diagnosis and treatment, the high incidence of complications, and the growing prevalence of digestive diseases in children in Ukraine justify the necessity for in-depth research in order to deepen understanding of the pathophysiological mechanisms underlying organ pathology with the ultimate goal of improving medical care for newborns.
 The aim of this study is to assess clinical and laboratory parameters characterizing the functional state of the hepatobiliary system in preterm infants.
 Participants and methods. The main group included 68 preterm infants of gestational age 32-33/6 weeks who had clinical signs of severe perinatal pathology; the comparison group involved 27 basically healthy infants of gestational age 34-36/6 weeks. A comprehensive examination of newborns with an assessment of the severity of perinatal pathology and a set of generally accepted biochemical blood parameters was performed. The research was conducted in compliance with the basic provisions of GCP (1996), the Council of Europe Convention on Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2008). The research protocol was approved by the Commission on Biomedical Ethics of Bukovinian State Medical University (Protocol No. 5 of 12.09.2015). Statistical processing of the study results was performed using the STATISTICA software (StatSoft Inc., USA, Version 10) MedCalc program (https://www.medcalc. org/index.php). Comparison of quantitative indicators with a normal distribution was performed using the Student's t-test at a statistical significance of p<0.05.
 Results and Discussion. With a burdened somatic history, unfavorable factors of pregnancy and childbirth in the mother, severe forms of diseases in preterm infants in the early neonatal period are accompanied by clinical signs of disorders of the functional state of the hepatobiliary system, in particular, an enlargement of the liver, hepatosplenic syndrome, edema, meteorism, jaundice, hemorrhagic manifestations, such as gastrointestinal bleeding, acholic stools, and hypoglycemia. Laboratory markers of severe functional hepatoniliary disorders include decreased levels of total protein, bilirubin, and glucose; increased levels of urea and cholesterol; reduced enzymatic activity of aspartate aminotransferase and lactate dehydrogenase. A significant decrease in the activity of the enzymes alanine aminotransferase and γ-glutamine transaminase and a decrease in the activity of alkaline phosphatase and Ca2+ level were also observed.
 Conclusions. The obtained results of clinical and laboratory parameters indicate the necessity to study the main pathophysiological syndromes of hepatobiliary system dysfunction in perinatal pathology, considering morphological and functional characteristics in preterm infants.

Microbiological spectrum of SSI pathogens in patients with chronic infectious spondylitis requiring revision surgery: results of continuous monocentric 5-year monitoring

Objective. To analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgery.Material and Methods. The study included patient data from 2018 to 2022. The primary cohort included 569 consecutively operated patients with chronic infectious spondylitis of nonspecific (n1 = 214) and tuberculous (n2 = 355) etiology. The analyzed sample was formed taking into according to inclusion and exclusion criteria. Thus, in 99 patients who required revision surgical interventions due to the development of SSI, a continuous microbiological monitoring of pathogens was performed, including the assessment of drug resistance and the timing of the development of infectious complications. Periodization of the time of SSI development was performed according to the accepted classification of Prinz et al. (2020), the assessment of drug resistance spectrum was performed according to the EUCAST recommendations (2020) and taking into account the approved methodological recommendations.Results. In the general structure of surgical interventions for chronic infectious spondylitis, the share of revision interventions due to the development of SSI was 17.4 %. The highest incidence of complications was noted in the late postoperative period (χ2 = 9.237; p = 0.009). Bacterial detection from the material of vertebral localization was noted in 43 cases (48.3 %), pathogen strains were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients. Culture negative SSI was detected in 10 cases (10.1 %) in the late period. Infectious complications in the setting of chronic non-specific spondylitis were detected more frequently than in spondylitis of tuberculous etiology (χ2 = 21.345; p < 0.001). Gram-positive multidrug-resistant and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, and Gram-positive strains without drug resistance in that of early and delayed SSI (χ2 = 17.516; p = 0.0032).Conclusion. Drug-resistant Gram-positive bacteria predominate in the structure of SSI with a significantly higher frequency of complication development. Nonspecific etiology of spondylitis is associated with a significantly higher incidence of SSI. In the absence of a positive result of bacteriological examination of the material of vertebral localization, it is advisable to collect blood, decubital ulcer secretion and urine sampling.

Comparison of microvascular decompression, percutaneous radiofrequency rhizotomy, and stereotactic radiosurgery in the treatment of trigeminal neuralgia: A long term quasi-experimental study.

Microvascular decompression (MVD), radiofrequency rhizotomy (RFR), and stereotactic radiosurgery (SRS) are surgical techniques frequently used in the treatment of idiopathic trigeminal neuralgia (TN), although the results reported for each of these are diverse. This study aimed to compare long-term pain control obtained by MVD, SRS, and RFR in patients with idiopathic TN. To compare the results obtained by MVD, SRS, and RFR we chose a quasi-experimental, ambispective design with control groups but no pretest. A total of 52 participants (MVD n = 33, RFR n = 10, SRS n = 9) were included. Using standardized outcome measures, pain intensity, pain relief, quality of life, and satisfaction with treatment were assessed by an independent investigator. The TREND statement for reporting non-randomized evaluations was applied. Clinical outcomes were evaluated at the initial postoperative period and at 6 months, 1, 2, 3, 4, and 5 years postoperatively. MVD has shown better results in pain scales compared to ablative procedures. Significant differences between groups were found regarding pain intensity and pain relief at the initial postoperative period (p < 0.001) and 6 months (p = 0.022), 1 year (p < 0.001), 2 years (p = 0.002), and 3 years (p = 0.004) after the intervention. Those differences exceeded the thresholds of the minimal clinically important difference. A higher percentage of patients free of pain was observed in the group of patients treated by MVD, with significant differences at the initial postoperative period (p < 0.001) and 6 months (p = 0.02), 1 year (p = 0.001), and 2 years (p = 0.04) after the procedure. Also, a higher risk of pain recurrence was observed in the RFR and SRS groups (HR 3.15, 95% CI 1.33-7.46; p = 0.009; and HR 4.26, 95% CI 1.77-10.2; p = 0.001, respectively) compared to the MVD group. No significant differences were found in terms of quality of life and satisfaction with treatment. A higher incidence of complications was observed in the MVD group. Concerning pain control and risk of pain recurrence, MVD is superior to RFR and SRS, but not in terms of quality of life, satisfaction with treatment, and safety profile.

Role of specific nutritional biomarkers in predicting post-operative complications among patients undergoing elective abdominal surgery.

Nutritional biomarkers like serum prealbumin, transferrin, retinol-binding protein (RBP), C-reactive protein (CRP), leptin, and insulin-like growth factor 1 (IGF1) have the inherent ability to diagnose undernutrition objectively before it is clinically manifested. The primary objective of the study was to evaluate the diagnostic efficacy of the specific nutritional biomarkers in predicting post-operative complications. A prospective cohort study was conducted in the department of surgery and included all patients aged 18 years and above who underwent elective abdominal surgery. Demographic details and clinical and surgical details were documented from the case records. Nutritional biomarker assay was done at admission. The post-operative complications occurring until discharge were graded using the Clavien-Dindo classification. The diagnostic accuracy of the specific nutritional biomarkers in predicting post-operative complications was assessed. A total of 320 patients were included in the study. Of these, 126 (39.38%) developed post-operative complications. Major complications accounted for 19.05% of the complications, while 80.95% were minor complications. Patients with blood prealbumin level less than 17.287 mg/dL had a higher incidence of complications (p < 0.001). Serum transferrin levels less than 168.04 mg/dL and IGF1 levels less than < 44.51 ng/ml showed increased incidence of complications (p < 0.001). The AUC was found to be the highest for serum IGF1 with 0.7782. Sensitivity was equally high for IGF1 and serum transferrin, with 76.98% for the former and 76.19% for the latter. Specific nutritional biomarkers, like serum prealbumin and transferrin, were efficient in predicting postoperative complications of patients before undergoing elective abdominal surgeries even after adjusting for confounders. This can facilitate preoperative corrective measures to lower the overall postoperative complications.

Asymptomatic Brugada patients: long-term prognosis from a large prospective study

Abstract Background One of the greatest challenges concerning the Brugada syndrome is how to stratify and manage asymptomatic patients, who represent the majority of patients with Brugada ECG pattern (BrECG). Purpose Aim of our study was to evaluate the long-term prognosis of a large population of asymptomatic Brugada patients. Methods One thousand one hundred and forty-nine asymptomatic Brugada patients were collected. Patients were treated as follows: in the 539 subjects with spontaneous type 1 BrECG documented on basal ECG or at 12-lead 24-hour Holter monitoring (12L-Holter) an electrophysiological study (EPS) was proposed and ICD implantation was proposed on the basis of the EPS results; in the 610 subjects with drug-induced-only type 1, clinical follow-up with multiple ECGs and 12L-Holter was suggested to search for spontaneous type 1 BrECG. Results Over a median follow-up of 6 (4-9) years there were 17 arrhythmic events (1.5%). Sixteen events occurred in the 539 patients with spontaneous type 1 (3%; 0.4% person-years) and only 1 in the 610 patients with drug-induced type 1 BrECG (0.16%; 0.03% person-years, p 0.001). Patients with spontaneous type 1 had a 15-time higher risk of arrhythmic events than patients with drug- induced type 1 BrECG. Patients with spontaneous type 1 BrECG and positive EPS had a 3-time higher risk of arrhythmic events than patients with negative EPS (6.8% vs 1.6%, p 0.035). An ICD was implanted in 163 patients: 8 (5%) received an appropriate intervention, while 23% experienced device-related complications, including 1 death. Conclusions Asymptomatic patients with spontaneous type 1 BrECG have an event rate of 3% at a median follow-up of 6 years. In this group, EPS represents a useful risk stratification procedure, as a positive EPS identifies patients with a 3-time higher event rate as compared to subjects with negative EPS. A negative EPS identifies a population at low although not zero-risk. Asymptomatic patients with drug-induced only Brugada ECG pattern are a group at very low arrhythmic risk. ICD implantation is burdened by a high incidence of complications, therefore alternative therapeutic strategies are needed.

Clinical outcomes of percutaneous coronary intervention of chronic total occlusion vs. non-chronic total occlusion: a multicentre registry

Abstract Background Revascularization of Chronic Total Occlusions (CTO) has gained popularity in recent decades. However, there is still debate about the benefits of treating a chronic total occlusion, resulting in a class IIa indication in the ESC Guidelines. Especially data regarding bleedings is scarce which could be expected due to the use of multiple and large-bore access and the use of prolonged and strong dual antiplatelet therapy after percutaneous coronary intervention (PCI). Providing more insight in the benefits and risks of CTO treatment in the context of PCI revascularization could be performed on a more evidence-based assessment. Purpose This study aims to provide additional data about outcomes and complications of patients undergoing revascularization of a CTO. Methods Patients from an ongoing, multicentre registry (‘Zuid-Oost Nederland Hart Registratie’ (ZON-HR)), which has started in November 2020, are included, in which patient- and angiography characteristics and 30-day and 1-year outcomes are collected. MACCE was defined as a composite endpoint of cardiovascular death, myocardial infarction, ischemic cerebrovascular accidents and stent thrombosis. Results A total of 3996 patients with complete 30-day follow-up were included in the registry, of which 185 patients underwent a PCI of a CTO and 3811 patients underwent a PCI of a non-CTO lesion between November 2020 and June 2022. Baseline characteristics are described in Table 1. The mean age of the entire population was 67.9 (± 12.1) years and predominantly male (72.7%). Analysis showed a significantly higher incidence of bleedings in patients treated with CTO (7.6% vs. 3.4%, p &amp;lt; 0.01) and especially access bleedings (5.9% vs. 1.9%, p &amp;lt; 0.01). In patients with access bleedings double access-site punction was more frequently applied for CTO PCI (80% vs. 25%, p &amp;lt; 0.01). Patients with CTO PCI showed more coronary dissection/perforation with the need for covered stent treatment (2.7% vs. 0.6%, p &amp;lt; 0.01) as well. No significant difference for MACCE within 30 days was present. Additionally, multivariate analysis were performed for baseline variables showing no association with the occurrence of access bleedings and peripheral artery vessel disease and the indication of PCI. Ancillary analyses were performed with patients with 1-year follow-up (n = 1356; CTO = 64 vs. non-CTO = 1292), showing no significant differences in MACCE and bleedings. Conclusion(s) This registry shows that CTO PCI results in higher incidence of complications and access bleedings. Access bleedings are possibly related to the frequent use of double access-site punction in patients with CTO PCI which should be investigated further, as well as the role of DAPT after PCI.

Complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects–a retrospective study of 199 cases

BackgroundThe clinical treatment of long bone defets in the extremities caused by trauma, infection, tumours, and nonunion has been a challenge for orthopaedic surgeons. Bone transport techniques have become the only way to treat such bone defects. However, inevitable difficulties and complications related to bone transport techniques have been reported in many studies.AimThe purpose of this study was to investigate the risk factors for complications and the effectiveness of the Ilizarov bone transport technique in the treatment of tibial bone defects.MethodsThe study was conducted in 199 patients who underwent treatment with the Ilizarov bone transport technique at our institution from May 2012 to September 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, a risk factor analysis was performed for the top three major complications. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical follow-up.ResultsA total of 199 patients underwent follow-up for 12–40 months, with an average of 23.5 months, and all achieved bone healing. A total of 310 complications occurred, with an average of 1.04 minor complications and 0.48 major complications per patient. The top three complications were pin tract infection in 48 cases (61.3%), axial deviation in 86 cases (43.2%), and delayed union in 50 cases (25.13%). Multivariate analysis showed that the bone defect length (P = 0.02, OR = 5.489), the number of previous surgeries (P = 0.003, OR = 2.204), and the external fixation index (P = 0.01, OR = 1.202) were significantly correlated with pin tract infection. Bone defects of the middle 1/3 (P < 0.001, OR = 23.769), the bone defect length (P < 0.001, OR = 2.776), and the external fixation index (P < 0.001, OR = 1.154) were significantly correlated with axial deviation. The bone defect length (P = 0.003, OR = 1.242), soft tissue defects (P = 0.013, OR = 0.312) and bone defects of the distal 1/3 (P = 0.023, OR = 4.257) were significantly correlated with delayed healing. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.48% and a rate of excellent functional results of 87.94%.ConclusionThe Ilizarov bone transfer technique is an effective method for treating tibial bone defects, and shortening the treatment period can reduce the incidence of complications. Older patients and those with longer bone defects, a higher external fixation index, more previous operations, and defects of the middle and distal 1/3 had a higher incidence of complications.

Abstract 13112: Cardiovascular Complications During Delivery Hospitalizations in Patients With Pulmonary Hypertension: A Nationwide Analysis

Introduction: Pregnancy in patients with pulmonary hypertension (PH) is associated with a high risk of medical complications. We aimed to study the patient characteristics and association between PH and delivery complications. Hypothesis: PH is associated with poor outcomes in pregnant patients. Methods: We utilized the National Inpatient Sample (NIS) database 2011-2020 to identify adult patients (≥18 years) with PH undergoing delivery hospitalizations. The primary outcomes were in-hospital medical and obstetric complications. Multivariate regression was performed to study the association of PH with these complications. Results: A total of 37,482,207 delivery hospitalizations were identified out of which 9,593 patients had PH. Pregnant patients with PH had a higher incidence of complications at delivery like preeclampsia/eclampsia, cardiac arrhythmias, pulmonary edema amongst others as well as a higher incidence of in-hospital mortality compared to those without PH (0.51% vs 0.007%). In adjusted analyses, PH was independently associated with a higher risk of pulmonary edema (Odds ratio (OR) 18.65 (95% confidence interval (CI) 13.71-25.38), p&lt;0.001), peripartum cardiomyopathy (PPCM) (OR 14.06 (9.15-21.60), p&lt;0.001), venous thromboembolism (VTE) (OR 12.25 (7.80-19.24), p&lt;0.001), cardiac arrhythmias (OR 11.75 (10.11-13.67), p&lt;0.001), acute kidney injury (AKI) (OR 7.53 (5.36-10.58), p&lt;0.001), preeclampsia/eclampsia (OR 4.61 (4.04-5.25), p&lt;0.001), and acute coronary syndrome (ACS) (OR 2.83 (1.17-6.85), p=0.02), compared with pregnant patients without PH. Further, stroke (OR 127.33 (78.49-206.57), p&lt;0.001), AKI (OR 51.25 (34.40-76.36), p&lt;0.001), cardiac arrhythmias (OR 24.80 (19.43-31.65), p&lt;0.001), PPCM (OR 6.47 (3.23-12.97), p&lt;0.001), pulmonary edema (OR 4.27 (2.18-8.37), p&lt;0.001), VTE (OR 2.75 (1.07-7.10), p=0.036), and preeclampsia/eclampsia (OR 1.87 (1.35-2.60), p&lt;0.001) were associated with a high risk of in-hospital mortality in pregnant patients with PH as compared to those without PH. Conclusions: Delivery hospitalizations in patients with PH are associated with worse outcomes. Prenatal counseling and multidisciplinary care are essential to help mitigate unfavorable outcomes in this cohort.

Infective endocarditis of the aortic valve in an 85-year-old man due to translocation of the intestinal flora

Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.

Influence of Inflammatory Bowel Disease on Patients Undergoing Primary Total Joint Arthroplasty: A Systematic Review and Meta-analysis of Cohort Studies

Background: Inflammatory bowel disease (IBD) is recognized as a global disease. Although IBD is commonly diagnosed in the young male population, it also occurs in patients aged &gt;60 years. With the advent of an aging society, it is expected that an increasing number of patients with IBD will undergo total joint arthroplasty (TJA). Purpose: To assess the impact of IBD on the risk of complications and revision as well as the length of stay (LOS) and treatment costs after TJA. Study Design: Systematic review; Level of evidence, 4. Methods: Utilizing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles were searched in the PubMed/MEDLINE, Embase, and Cochrane Library databases from the date of inception to August 31, 2022, using the following search terms: (1) “Inflammatory Bowel Diseases”[MeSH] and (2) “Arthroplasty, Replacement”[MeSH]. The study quality was scored according to the Newcastle-Ottawa Scale. A fixed-effects or random-effects model was used to calculate odds ratios or mean differences with 95% confidence intervals. Results: Of 232 studies initially retrieved, 8 retrospective cohort studies consisting of 33,758 patients with IBD and 386,238 patients without IBD were included. Patients with IBD had a higher incidence of complications ( P &lt; .05), readmission and revision ( P &lt; .05), experienced a longer LOS ( P &lt; .01), and paid higher treatment costs after TJA compared with patients without IBD . Conclusion: The results of our review demonstrated that IBD increased the risk of postoperative complications, prolonged the LOS, and increased treatment costs.

Comparative Analysis of Surgical Approaches for Distal Biceps Tendon Rupture: Single-Incision Technique versus Double-Incision Technique.

Background: This study aimed to compare the outcomes of the single-incision technique with a distal biceps repair system versus the modified double-incision technique, specifically the Morrey-modified approach, Krackow sutures, and drill holes, for the management of acute and chronic distal biceps tendon rupture. The study was conducted at the Orthopedic-Traumatology Clinic II of SCJUPBT Timisoara, Romania, between 2014 and 2022. Methods: A total of sixty-nine patients with acute distal biceps tendon rupture and five patients with chronic distal tendon rupture were included in the study. Forty-eight cases underwent the single-incision technique with the distal biceps repair system, while twenty-four patients were treated with the modified double-incision technique. Results: Both surgical techniques demonstrated favorable outcomes in terms of successful tendon repair and functional restoration. However, the single-incision technique exhibited slightly superior results in terms of patient satisfaction, range of motion, and postoperative rehabilitation. The modified double-incision technique showed comparable outcomes but had a higher incidence of complications, particularly related to wound healing. Conclusion: The single-incision technique with the distal biceps repair system and the modified double-incision technique, including the Morrey-modified approach, Krackow sutures, and drill holes, are effective surgical approaches for the management of distal biceps tendon rupture. The single-incision technique yielded better functional outcomes and patient satisfaction, while the modified double-incision technique had a higher risk of complications. Further research with larger sample sizes and longer follow-up periods is necessary to validate these findings and determine the most appropriate surgical approach for distal biceps tendon rupture.

Gut microbiota aggravates neutrophil extracellular traps-induced pancreatic injury in hypertriglyceridemic pancreatitis

Hypertriglyceridemic pancreatitis (HTGP) is featured by higher incidence of complications and poor clinical outcomes. Gut microbiota dysbiosis is associated with pancreatic injury in HTGP and the mechanism remains unclear. Here, we observe lower diversity of gut microbiota and absence of beneficial bacteria in HTGP patients. In a fecal microbiota transplantation mouse model, the colonization of gut microbiota from HTGP patients recruits neutrophils and increases neutrophil extracellular traps (NETs) formation that exacerbates pancreatic injury and systemic inflammation. We find that decreased abundance of Bacteroides uniformis in gut microbiota impairs taurine production and increases IL-17 release in colon that triggers NETs formation. Moreover, Bacteroides uniformis or taurine inhibits the activation of NF-κB and IL-17 signaling pathways in neutrophils which harness NETs and alleviate pancreatic injury. Our findings establish roles of endogenous Bacteroides uniformis-derived metabolic and inflammatory products on suppressing NETs release, which provides potential insights of ameliorating HTGP through gut microbiota modulation.

Risk factors for intensive care unit admission following correction surgery for adult spinal deformity

ObjectiveThe literature currently available on the characteristics of patients who require intensive care unit (ICU) admission after correction surgery for adult spinal deformity is lacking; this study aimed to identify risk factors for postoperative ICU admission following correction surgery for adult spinal deformity.MethodsA retrospective review of patients who underwent primary posterior-based spinal fusion from 2015 to 2023 was performed. According to the ward they returned to, patients were further divided into an ICU group and a non-ICU group. Univariate and multivariate analyses were performed to evaluate preoperative and perioperative parameters to identify independent risk factors for postoperative ICU admission in adult spinal deformity patients.ResultsA total of 274 patients were included, including 115 males (41.97%) and 159 females (58.03%). The mean age of the patients was 32.00 ± 11.16 years (19–77 years). Following adjusted analysis, the preoperative and perioperative factors that were independently associated with ICU admission were age, body mass index ≥ 28 kg/m2, neuromuscular spinal deformity, respiratory disease, grade III-IV American Society of Anesthesiologists (ASA) classification, a scoliosis Cobb angle ≥ 90°, a kyphosis Cobb angle ≥ 90°, and ≥ 12 fused segments. Compared with the non-ICU group, the ICU group had a higher incidence of complications, a longer hospital stay, and higher medical costs (P < 0.05).ConclusionThis study identified independent risk factors associated with postoperative ICU admission in adult spinal deformity patients; and explored relative measures to decrease or avoid the risk of postoperative ICU admission. Surgeons could use these data to develop and plan appropriate perioperative care processes in advance and provide consultation for family members before surgery.

제 2형 당뇨병 환자의 약물 순응도 영향요인

Diabetes continues to increase due to changes in lifestyle habits such as obesity, irregular diet, and decreased physical activity along with the aging population. Moreover, diabetes is difficult to cure and has a high incidence of complications and mortality, so it is very important to increase the drug adherence to maintain normal blood sugar. therefore, this study is a cross-sectional and descriptive survay conducted to identify factor affecting drug adherence in patients with type 2 diabetes.&#x0D; This study used the Korea Medical Panel data (β-version 1.0) in 2018, and among them, 1,069 people who were taking drugs after diagnosis of type 2 diabetes. The dependent variable of the study was the presence or absence of drug adherence, and the independent variable included demographic, physical and social characteristics and drug use characteristics. Data analysis was performed using Chi-Square and Logistic Regression using SPSS/wWin 22.0. The study result that 95.3% of patients with type 2 diabetes had a 1.97 (95% CI=1.06~3.67) times higher drug adherence factors than those without spouses of demographic factors. As for the physical and social characteristics factors, the group without decision-making disabilities had a drug adherence ratio of 2.25 (95% CI=1.16~4.24) for those with decision-making disabilities. Finally, compared to the group that did not occur in the drug side effects of drug use characteristics, the group satisfied with the drug was 4.44 times higher (95% CI=2.34-8.45) and the drug adherence ratio of the moderate/ unsatisfied subjects was 17.70 (95% CI=5.72-54.76). In conclusion, in order to increase drug adherence in type 2 diabetes patients, it is necessary to increase drug satisfaction through active intervention by health and medical staff through immediate monitoring of drug side effects, as well as education and intervention.

The Relationship between the Burden of Acromegaly, Associated Comorbidities, Complications and Disease Status.

Uncontrolled acromegaly causes increased morbidity and mortality. The analysis of acromegaly comorbidities and complications is important when establishing a standard of care for the entire population of acromegaly patients. The aim of this study was to determine the frequency of comorbidities and complications of acromegaly and their dependence on the activity of the disease. A retrospective analysis of medical records from 124 patients with acromegaly was carried out, including 39 who were cured, 73 treated with somatostatin analogs and 12 newly diagnosed patients. The incidence of comorbidities and complications was very high, and those most frequently observed were arterial hypertension, multinodular goiter, lipid disorders, hypopituitarism and degenerative changes. At least one complication of acromegaly was observed in 92% of patients undergoing successful neurosurgery and in all pharmacologically treated patients. By contrast, two or more complications were observed in 77% of cured patients and in pharmacologically controlled and uncontrolled patients, 82% and 91%, respectively. Conclusions: Acromegaly is associated with a high prevalence of complications. Active acromegaly is associated with a higher incidence of complications than in treated groups. Untreated patients have more complications than treated patients. Successfully cured patients have significantly fewer complications than pharmacologically controlled patients and patients with active acromegaly.

Canine ex vivo tarsal arthrodesis: fixation by using a new bone tissue glue.

Arthrodesis, performed as a salvage surgical procedure to treat intractable joint conditions in dogs and cats, is associated with a high incidence of complications intra and postoperative, proving the need for improved and new techniques in arthrodesis surgery. Adding a new resorbable bone glue to the arthrodesis could potentially add fixation strength and lower complications. The objectives of this experimental ex vivo biomechanical study were therefore to develop a biomechanical test model of partial tarsal arthrodesis and to determine whether the new resorbable bone glue (phosphoserine modified cement) produced measurable fixation strength in canine calcaneoquartal arthrodesis, without orthopedic implants. Four biomechanical test models with a total of 35 canine tarsal joints were used. Soft tissues were dissected to 4 different test models with variable contributions from soft tissues. The calcaneoquartal joint was prepared as in vivo arthrodesis and the glue was applied to joint surfaces as a liquid/putty (0.4 cc). After curing for 24 h, a shear force was applied to the joint (1 mm per minute) and the failure strength was recorded. Calcaneoquartal joints, where all soft tissues had been completely resected and fixated with glue (1-1.5 cm2 joint surface), withstood 2-5 mm of displacement and an average of 100 ± 58 N/cm2 of shear force (Model 1). Similar adhesive fixation strengths were obtained in Model 2 and 3 with increasing contributions from soft tissues (80 ± 44 and 63 ± 23 N/cm2, p = 0.39, ANOVA). The developed biomechanical model was sensitive enough to measure differences in fixation strengths between different glue formulations. The average fixation strength (60-100 N/cm2) should be strong enough to support short-term load bearing in medium sized canines (20 kg). The developed cadaver biomechanical test model is of potential use for other arthrodesis studies. The new resorbable glue can potentially contribute to stability at arthrodesis surgery, acting as a complement to today's standard fixation, metal implants.

Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients.

Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative (p < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.