Incidence Of Serious Complications Research Articles

Plasma knife sphenopalatine artery cauterization via lateral nasal wall incision for posterior epistaxis

Background Endoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis. Aims/Objectives To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis. Material and methods A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups. Results ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP. Conclusions and significance Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time.

IMPACT OF ADVANCED HEMODYNAMIC MONITORING ON MYOCARDIAL REVASCULARIZATION SURGERY IN HIGH-RISK PATIENTS

Coronary artery bypass grafting is a critical procedure for patients with advanced coronary disease, especially those classified as high risk due to comorbidities such as heart failure, hypertension and diabetes. Advanced hemodynamic monitoring has proved essential in this context, allowing continuous and accurate surveillance of cardiac and vascular parameters, which can reduce intra- and post-operative complications. This abstract aims to assess the impact of advanced hemodynamic monitoring during coronary artery bypass graft surgery in high-risk patients. The aim is to explore the advantages of this type of monitoring, the technologies used and the benefits in terms of clinical outcomes and reduction of complications. This is a literature review with a qualitative approach, carried out in the PubMed, SciELO, LILACS, BVS and Google Scholar databases. In order to optimize the search, descriptors such as Hemodynamic Monitoring, Cardiac Surgery, High Risk Patients and Fluid Management were used. For time delimitation, the research considered publications between the years 2019 and 2022, a period that reflects the latest advances in hemodynamic monitoring technologies in high-risk cardiac surgeries. Advanced hemodynamic monitoring includes the use of devices such as the pulmonary artery catheter and non-invasive bioimpedance systems, which provide real-time data on cardiac output, blood pressure, oxygen saturation and systemic vascular resistance. In high-risk patients, these devices allow for precise adjustments in the administration of fluids and vasoactive drugs, promoting better hemodynamic stability. Studies indicate that this approach reduces the incidence of serious complications, such as cardiogenic shock and arrhythmias, optimizing post-operative recovery. Therefore, advanced hemodynamic monitoring is a crucial tool in CABG surgeries, especially for high-risk patients. Its implementation improves intraoperative management, reducing the risk of complications and promoting better clinical outcomes. Therefore, its use should be considered an integral part of strategies for complex cardiac surgeries.

Experimental Study on Penetration of Smaller Inferior Vena Cava after Conical Filter Placement: Results in a Swine Model

Inferior vena cava (IVC) penetration is a prevalent complication following the placement of conical filters. However, there is a paucity of studies examining the penetration in smaller IVC. The objective of this study was to assess the time of penetration, the incidence of serious complications associated with penetration, and the process of IVC wall repair in the smaller IVC following the placement of a conical filter. Twenty pigs were randomly assigned to two groups and received either Celect or Denali filters. Weekly follow-up imaging using computed tomography venography (CTV) of the IVC was conducted to monitor the position of the IVC filter struts until at least one strut was observed to be penetrating the vessel wall. At necropsy, a comprehensive gross and histological examination was performed on the IVC and adjacent anatomical structures in all animals. The puncture and cavography procedures were successfully conducted on all animals, and no significant differences were found in the mean diameter of the IVC between the Celect and Denali groups ( 15.89 ± 1.27 mm vs. 16.39 ± 1.39 mm, P ＜ 0.001). All filters were implanted without complications. CTV detected IVC penetration within nine weeks, confirmed during necropsy. The Celect group had a significantly earlier time of IVC penetration compared to the Denali group ( 2.43 ± 0.52 weeks vs. 6.81 ± 1.32 weeks, P ＜ 0.001). No evidence of filter tilt, fracture, migration, caval thromboses, retroperitoneal bleeding, wall hematoma, tearing of the IVC wall, or peripheral tissue and organ damage was observed during the CTV and subsequent necropsy. Additionally, histological analysis showed that the Celect group had a lower percentage area of collagen fiber compared to the Denali group (33.92% vs. 49.04%, P ＜ 0.001). The fiber proliferation was positively correlated linearly with the indwelling time of filter (r = 0.97, P ＜ 0.001) . Penetration can occur within a relatively brief period following the placement of the conical filter into the smaller IVC. Nevertheless, no short-term severe complications were observed in connection with the penetration. The proliferation of fibers in the IVC wall exhibited a positive linear correlation with the duration of filter indwelling.

Impact of propofol versus desflurane anesthesia on postoperative hepatic and renal functions in infants with living-related liver transplantation: a randomized controlled trial

BackgroundThe effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia–reperfusion injury (HIRI).MethodsSeventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI.ResultsThere were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161–777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58–366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) μmol/L, P < 0.001 (95% CI: 3.0–8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) μmol/L, P = 0.02 (95% CI: 0.0–5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038).ConclusionsPropofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

Major Complications of Deep Venous Stenting.

Deep venous stent placement has developed into a primary treatment modality for venous obstruction in recent decades. Reported rates of complications are low in the literature and are based mainly on case reports and single-centre cohorts. Interventionalists performing these procedures must be aware of the occurrence of complications associated with stent placement to counsel patients adequately and promote avoidance through optimal procedural approach. This study aims to determine the incidence of serious complications associated with iliocaval and iliofemoral stent placement in a cohort of patients from 3 major tertiary deep venous referral centres. Data were collated from January 2014 to September 2023. The following major complications were included in the analysis: death, major bleeding requiring transfusion, massive pulmonary embolism, any complication which required endovascular or open surgical intervention, vessel rupture, acute kidney injury requiring dialysis, stent crushing, fracture, migration, involution or erosion. One thousand eight hundred fourteen (1814) patients were treated for acute or chronic deep venous pathology during the 9-year study period. Sixty-one patients (3.3%) experienced a major stent-related complication. The most frequently reported complication was stent crushing (n = 18, 29.5%), followed by stent fracture (n = 10, 16.4%) and erosion of the stent through the vessel wall (n = 8, 13.1%). Death was a rare event (0.2%). Deep venous stent placement is a safe procedure with low rates of major complications. It is incumbent upon operators to be aware of the risks associated with these procedures, however, rare, so that they may obtain fully informed consent from patients.

Challenging the Controversy Surrounding Percutaneous Brachial Artery Access Related Complications: A Systematic Review and Meta-Analysis.

Endovascular therapy has become increasingly preferred in the diagnosis and treatment of various conditions. The choice of arterial access usually depends on the type of procedure being performed with most via the common femoral artery and increasingly via the radial artery. Percutaneous access via the brachial artery has however been approached with caution due to the perceived increased risk for development of complications. Percutaneous brachial artery access (pBAA) has insufficient evidence when compared to femoral and radial access, with no large-scale studies available. The objective of this study is to review the literature and report the clinical and radiological complications associated with pBAA. EMBASE, EMCARE, CINAHL and Medline were searched for existing data on the complications associated with pBAA. Systematic review and meta-analysis were carried out on the data of 31 studies. The results of this systematic review and meta-analysis indicates that the probability of post procedural haematoma was 4.76%, haemorrhage 1.43%, perforation 1.11% pseudoaneurysm 1.06%, spasm 0.9%, thrombus 0.55%, neuropathy 0.53%, occlusion 0.51%, ischaemia 0.37% and infection 0.24 %. Non-target vessel puncture, stenosis and stroke had a 0% incidence among the assessed population. This study provides evidence to support clinical decision making when it comes to the utility of pBAA in endovascular diagnosis or therapy. The results demonstrate that pBAA is relatively safe with a low incidence of serious complications and thereby provide the clinician with the option of an alternate access point when planning treatment.

Effect of Recipient Age on Perioperative Complications after Pediatric Liver Transplantation: A Single-Center Retrospective Study.

It has not been clear how recipient age affects the incidence of serious complications after pediatric living donor liver transplantation (LDLT). We investigated the records of 42 pediatric patients receiving LDLT, dividing our sample into two groups: the infant group (aged < 1 year) and the non-infant group (aged ≥ 1 year and ≤15 years). The primary outcome was postoperative complications assessed using the Clavien-Dindo classification. Multivariate analysis using the Cox regression model was applied to adjust for confounding factors in assessing the incidence of Clavien-Dindo grade ≥ III (C-D ≥ III) complications. The incidence of C-D ≥ III complications was higher in the non-infant group (46.2%) than in the infant group (12.5%) (odds ratio 6.00, 95% confidence interval [CI] 1.13-31.88, p=0.03). In multivariate analysis using the Cox regression model, the Graft-to-Recipient Weight Ratio (GRWR) was independently associated with the incidence of C-D ≥ III complications (hazard ratio [HR] 0.62, 95%CI 0.40-0.95, p=0.03), but being an infant was not (HR 0.84, 95%CI 0.35-1.98, p=0.68). In conclusion, the incidence of C-D ≥ III complications was higher in the non-infant group than in the infant group, but this was largely a function of GRWR: multivariate analysis revealed that GRWR was independently associated with complications.

Application of external fixator combined with Kirschner wire fixation for oblique and comminuted distal humeral metaphyseal-diaphyseal junction fractures in children

To analyze the effectiveness of external fixator combined with Kirschner wire (EF-KW) fixation in the treatment of oblique and comminuted distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children. A clinical data of 22 children with DHMDJ fractures who met the selection criteria between April 2021 and December 2023 was retrospectively analyzed. All patients were treated with EF-KW fixation. There were 14 boys and 8 girls with an average age of 6.8 years (range, 1.5-12.0 years). The time from injury to operation was 14-38 hours (mean, 24.2 hours). There were 18 cases of comminuted fractures and 4 cases of oblique fractures; and 1 case of median nerve injury and 1 case of radial nerve injury before operation. The occurrence of postoperative complications was recorded. At last follow-up, the function of the affected elbow joint was evaluated according to the Mayo elbow joint function score, and the Baumann's angle (BA) and humero-capitellar angle (HCA) of the affected and healthy sides were recorded and compared. All fractures were successfully treated with closed reduction and no complications such as nerve injury occurred. Superficial infection occurred in 4 cases after operation and healed after symptomatic treatment. The incisions of other patients healed by first intention. All patients were followed up 9-24 months (mean, 13.8 months). At last follow-up, according to the Mayo elbow joint function score, the elbow joint function was rated as excellent in 15 cases, good in 6 cases, and fair in 1 case, with an excellent and good rate of 95.5%. The neurologic injury before operation recovered gradually. X-ray films reexamination showed that all fractures healed, and the healing time of fractures ranged from 29 to 61 days, with an average of 35.6 days. At last follow-up, there was no significant difference in BA and HCA between the healthy side and the affected side ( P>0.05). During follow-up, 1 case developed mild cubitus varus, while the other patients had no serious complications. EF-KW fixation for oblique and comminuted DHMDJ fractures in children has the advantages of less trauma, simple operation, easy reduction, good stability after reduction, low incidence of serious complications, and good elbow functional recovery.

MRI-guided in-bore biopsy of the prostate – defining the optimal number of cores needed

BackgroundNumerous studies have shown that magnetic resonance imaging (MRI)-targeted biopsy approaches are superior to traditional systematic transrectal ultrasound guided biopsy (TRUS-Bx). The optimal number of biopsy cores to be obtained per lesion identified on multiparametric MRI (mpMRI) images, however, remains a matter of debate. The aim of this study was to evaluate the incremental value of additional biopsy cores in an MRI-targeted “in-bore”-biopsy (MRI-Bx) setting.Patients and methodsTwo hundred and forty-five patients, who underwent MRI-Bx between June 2014 and September 2021, were included in this retrospective single-center analysis. All lesions were biopsied with at least five biopsy cores and cumulative detection rates for any cancer (PCa) as well as detection rates of clinically significant cancers (csPCa) were calculated for each sequentially labeled biopsy core. The cumulative per-core detection rates are presented as whole numbers and as proportion of the maximum detection rate reached, when all biopsy cores were considered. CsPCa was defined as Gleason Score (GS) ≥ 7 (3 + 4).ResultsOne hundred and thirty-two of 245 Patients (53.9%) were diagnosed with prostate cancer and csPCa was found in 64 (26.1%) patients. The first biopsy core revealed csPCa/ PCa in 76.6% (49/64)/ 81.8% (108/132) of cases. The second, third and fourth core found csPCa/ PCa not detected by previous cores in 10.9% (7/64)/ 8.3% (11/132), 7.8% (5/64)/ 5.3% (7/132) and 3.1% (2/64)/ 3% (4/132) of cases, respectively. Obtaining one or more cores beyond the fourth biopsy core resulted in an increase in detection rate of 1.6% (1/64)/ 1.5% (2/132).ConclusionWe found that obtaining five cores per lesion maximized detection rates. If, however, future research should establish a clear link between the incidence of serious complications and the number of biopsy cores obtained, a three-core biopsy might suffice as our results suggest that about 95% of all csPCa are detected by the first three cores.

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

BackgroundAs the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients.MethodsA retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes.ResultsAmong 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications.ConclusionImplementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

Comparison of methods of non-mechanical pressure measurement in the cuff of an endotracheal tube

Bronchoscopy is a diagnostic and follow-up procedure. Despite the fact that this manipulation itself is minimally invasive, it can be a difficult test for both the patient and the doctor. Therefore, this manipulation definitely requires anesthesia and sedation. This study compared dexmedetomidine and propofol sedation methods during diagnostic bronchoscopy to assess their safety, effectiveness, and satisfaction. The results show a high level of safety of both methods, although some significant differences affecting the choice of sedation method were found. 32 patients participated in the study, divided into two groups depending on the used method of sedation: propofol or dexmedetomidine. Pulse oximetry, heart rate, capnography parameters were measured, the number and severity of iatrogenic lesions of the trachea, as well as the satisfaction of care and doctors were assessed. In some groups, there was a high level of safety of sedation. Dexmedetomidine sedation was associated with fewer cough episodes and greater satisfaction, but had a longer induction time with propofol. A low incidence of serious complications was observed in both groups. Dexmedetomidine can be considered a safe and effective sedation option for diagnostic bronchoscopy, offering additional benefits such as reduced cough episodes and increased patient satisfaction. The choice of the sedation method is based on the individual characteristics of the patient and the available resources of the hospital.

Dosing Strategy for Osteobiologics Used in ACDF Surgery: Influence on Fusion Rates and Associated Complications. A Systematic Literature Review.

Systematic review. To assess the available evidence related to dose-dependent effectiveness (i.e., bone fusion) and morbidity of osteobiologics used in anterior cervical discectomy and fusion (ACDF). Studies with more than 9 adult patients with degenerated/herniated cervical discs operated for one-to four-levels ACDF reporting used osteobiologics doses, fusion rates at six months or later, and related comorbidities were included. PubMed, EMBASE, ClinicalTrials, and Cochrane were searched through September 2021. Data extracted in spread sheet and risk of bias assessed using MINORS and Rob-2. Sixteen studies were selected and sub-grouped into BMP and non-BMP osteobiologics. For the 10 BMP studies, doses varied from 0.26 to 2.1mg in 649 patients with fusion rates of 95.3 to 100% at 12months. For other osteobiologics, each of six studies reported one type of osteobiologic in certain dose/concentration/volume in a total of 580 patients with fusion rates of 6.8 to 96.9% at 12months. Risk of bias was low in three of the 13 non-randomized (18.75%) and in all the three randomized studies (100%). Taking into account the inconsistent reporting within available literature, for BMP usage in ACDF, doses lower than 0.7mg per level can achieve equal successful fusion rates as higher doses, and there is no complication-free dose proved yet. It seems that the lower the dose the lower the incidence of serious complications. As for non-BMP osteobiologics the studies are very limited for each osteobiologic and thus conclusions must be drawn individually and with caution.

Development of a transition program for emerging adults with type 1 diabetes: A quality improvement initiative

BackgroundEmerging adults with type 1 diabetes (T1D) struggle with glycemic management that can be exacerbated by a disorganized transition process. Substantial gaps in care have been noted during this transition period and have been shown to lead to suboptimal health care utilization, worsening glycemic management, increased incidence of serious complications, and mental health challenges. A formal transition program can help prevent gaps in care, improve disease self-management skills, decrease disease burden, and reduce diabetes complications. PurposeThere is an increased focus within the pediatric community to formally prepare young adults with T1D as they transition to the adult health care setting. The purpose of the quality improvement initiative was to develop a transition program for adolescents with T1D in a pediatric endocrinology clinic within an academic medical center. Methods/interventionsThe Institute for Healthcare Improvement Model for Improvement was used to guide this project. Got Transition's® Six Core Elements of Health Care Transition were adapted to the unique needs of the pediatric endocrinology setting by incorporating diabetes-specific transition guidelines recommended by the American Diabetes Association (ADA). A new program was designed to target patients between the ages of 16–18 offering structured transition visits focused on enhancing knowledge and skills related to the management of T1D and improving the transfer of care process between pediatric and adult providers. Key elements of the program were integrated into the electronic health record. A focus group with clinical partners was used to evaluate the acceptability and practicality of the program. ResultsTransition activity within the clinic increased from 12/32–28/32 on the Current Assessment of Healthcare Transition Activities tool. Four themes were identified from clinical partner feedback supporting the acceptability and practicality of program design. ConclusionsThe integration of the Got Transition® framework and the ADA recommendations supports clinicians in meeting the unique needs of adolescents with T1D. Incorporating the transition activities into the electronic health record facilitated integration into the workflow of the clinic providers. This initiative can serve as a model to expand transition activities across pediatric specialty care settings.

Laser ablation on vascular diseases: mechanisms and influencing factors.

Vascular diseases, such as venous insufficiency and coronary artery diseases, have been threatening the health of people. Efficient treatment with proper postoperative care is required to relieve the pain of the patients. Traditionally, venous insufficiency is treated with ligation and stripping, an open surgery whose complication rate cannot be ignored. Coronary artery disease is often treated with balloon angioplasty during which undilatable lesions may be encountered, limiting the efficacy of this approach. With advances in laser photonics and percutaneous coronary intervention procedure, laser ablation is emerging as an alternative and adjunctive therapy for these diseases. Endovenous laser ablation has the advantages of high success rate, low complication risk, and fast postoperative recovery. Laser ablation in arteries can handle uncrossable or undilatable lesions with a low incidence of serious complications. In this review, previously published research concerning vascular diseases and their therapies are analyzed in order to provide a clear explanation of the mechanisms and merits of laser ablation. For endovenous laser ablation, the main mechanisms are steam bubbles, heat conduction, and heat pipe, and three main influencing factors are wavelength, fiber types, and laser energy density. For excimer laser coronary atherectomy, the main mechanisms are photochemical, photothermal, and photomechanical effects, and three main influencing factors are catheter, medium, and laser parameters.

Regression of Neovascularization after Panretinal Photocoagulation Combined with Anti-VEGF Injection for Proliferative Diabetic Retinopathy-A Review.

Proliferative diabetic retinopathy (PDR) poses a significant therapeutic problem that often results in severe visual loss. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. Conversely, intravitreal anti-VEGF therapy has served as an alternative treatment for PDR. This review aimed to evaluate the effects of PRP combined with anti-VEGF therapy on the regression of neovascularization (NV), including functional outcomes and incidence of complications. The MEDLINE database was searched for articles evaluating regression of NV using a combination of the following terms: "proliferative diabetic retinopathy", "anti-VEGF", "panretinal photocoagulation", and "combined treatment". The search yielded a total of 22 articles. The analysis of their results indicated PRP combined with ant-VEGF therapy as superior over PRP alone in the management of PDR. Combination treatment yields better and faster regression of NV and a lower incidence of serious complications, such as vitreous hemorrhage and the need for pars plana vitrectomy. Nevertheless, complete regression of NV is not achieved in a significant proportion of patients. Further research is needed to establish the most effective schedule for intravitreal injections as an adjunct to PRP. The current literature shows that in some cases, cessation of anti-VEGF injection in combination treatment for PDR can lead to relapse of NV.

Surgical treatment of Behcet's disease with severe aortic regurgitation.

Behcet's disease (BD) is a multisystem inflammatory disease that is characterized by oral aphthosis, genital aphthosis, ocular lesions, and cutaneous lesions. Although BD rarely affects the cardiovascular system, its symptoms can be shown as aortic regurgitation (AR), which requires surgical intervention. Due to the special pathogenesis of BD, a low preoperative diagnosis rate and a high incidence of serious complications, such as perivalvular leakage, valve detachment, and pseudoaneurysm after prosthetic valve replacement, surgical treatment of BD with severe AR has a poor prognosis. In recent years, new surgical strategies have been developed to improve treatment efficacy for this disease. This article reviews and summarizes the evolution of surgical techniques for BD with AR and aims to provide a reference for optimizing surgical strategies, improving perioperative management, and assisting prognosis in patients suffering from BD with severe AR.

Acute kidney injury after living‐related liver transplantation in infants with biliary atresia: A retrospective study

AbstractAlthough acute kidney injury (AKI) is a frequent postoperative complication after liver transplantation, renal function following living‐related liver transplantation (LRLT) in infants remains understudied. The aim of this study was to identify the prevalence of AKI and the impact of AKI on outcomes in infant recipients with biliary atresia. We retrospectively reviewed infants who underwent LRLT surgery between January 2018 and January 2021. The primary outcome was the risk of postoperative AKI occurrence in the first 7 postoperative days. A multivariate regression analysis model was used to investigate risk factors for AKI, and the incidence and impacts of AKI on outcomes were analyzed. A total of 98 patients were included in the analysis. AKI occurred in 59 patients (60.2%) within 7 days after surgery. Logistic regression analysis revealed that preoperative transfusion (p &lt; 0.05) and lower serum creatinine (SCr) (p &lt; 0.05) were independent risk factors for AKI. The incidence of serious complications was significantly higher in the AKI group than in the non‐AKI group (p &lt; 0.05). The postoperative mechanical ventilation time (p &lt; 0.05) and hospital stay (p = 0.019) were significantly longer in the AKI group. There was no evidence of chronic kidney disease (CKD) in any surviving infants within 1 year after surgery. In conclusion, AKI is common in infant LRLT (60.2%), and preoperative transfusion and lower SCr levels were independently associated with AKI. AKI may be associated with the incidence of serious complications, prolonged use of ventilators, and hospital stays. No CKD occurred within 1 year.

Comparison of Transradial Access and Transfemoral Access for Diagnostic Cerebral Angiography in the Elderly Population

Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age). We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis. Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P= 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P= 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P= 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group. TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.

Comparison of safety and effectiveness between robotic and laparoscopic major hepatectomy: a systematic review and meta-analysis.

Robotic platform has been increasingly applied in major hepatectomy. However, the role or advantage of robotic approach comparing with laparoscopic approach in major hepatectomy remains controversial. This meta-analysis compares perioperative outcomes of robotic major hepatectomy (RMH) to laparoscopic major hepatectomy (LMH) for hepatic neoplasms. PubMed, Web of Science, EMBASE, and Cochrane Library were searched to identify comparative studies compared RMH versus LMH for hepatic neoplasms. The search timeframe was set before May 2023. Main outcomes were mortality, overall morbidities, serious complications, and conversion to open surgery. Secondary outcomes were operative time, intraoperative blood loss, blood transfusion, postoperative length of hospital stay, R0 resection, reoperation, and readmission. Studies were evaluated for quality by Cochrane risk of bias tool or Newcastle-Ottawa scale. Data were pooled as odds ratio (OR) or mean difference (MD). This study was registered at PROSPERO (CRD42023410951). Twelve retrospective cohort studies concerning total 1657 patients (796 RMH, 861 LMH) were included. Meta-analyses showed no significant differences in mortality (OR=1.23, 95% CI=0.50-2.98, P =0.65), overall postoperative complications (OR=0.83, 95% CI=0.65-1.06, P =0.14), operative time (MD=6.47, 95% CI=-14.72 to 27.65, P =0.55), blood transfusion (OR=0.77, 95% CI=0.55-1.08, P =0.13), R0 resection (OR=1.45, 95% CI=0.91-2.31, P =0.12), reoperation (OR=0.76, 95% CI=0.31-1.88, P =0.56), and readmission (OR=0.63, 95% CI=0.28-1.44, P =0.27) between RMH and LMH. Incidence of serious complications (OR=0.60, 95% CI=0.40-0.90, P =0.01), conversion to open surgery (OR=0.41, 95% CI=0.27-0.63, P <0.0001), blood loss (MD=-91.42, 95% CI=-142.18 to -40.66, P =0.0004), and postoperative hospital stay (MD=-0.64, 95% CI=-0.78 to -0.49, P <0.00001) were reduced for RMH versus LMH. RMH is associated with comparable short-term surgical outcomes and oncologic adequacy compared to LMH when performed by experienced surgeons at large centres. RMH may result in reduced major morbidities, conversion rate, blood loss, and hospital stay, but these results were volatile. Further randomized studies should address the potential advantages of RMH over LMH.

Effect of Synbiotic Supplementation on Maternal and Neonatal Outcomes in Pregnant Women With Pre-eclampsia: Study Protocol for a Triple Blind Randomized Controlled Clinical Trial

Objectives: Background: Preeclampsia is one of the main causes of premature birth, growth restriction, and intrauterine death of fetus. Probiotics has the potential to modulate inflammatory and oxidative stress biomarkers that implicated in the pathophysiology of preeclampsia. The aim of the present study is to establish the impact of synbiotic supplements, comprising of probiotic and prebiotic fructooligosaccharide, in comparison to placebo, on the maternal and neonatal outcome outcomes in women afflicted with mild preeclampsia. Methods: This is a study protocol of a randomized, controlled, phase 3, triple-blind, randomized clinical trial. The classification is based on the gestational age at the time of diagnosis of mild preeclampsia (early-onset or late-onset preeclampsia). Participants will be 128 pregnant women with mild pre-eclampsia (systolic blood pressure between 140-160 mm Hg or diastolic blood pressure between 90-110 mm Hg, along with other preeclampsia symptoms). Participants will divide into two intervention and control groups using a 1:1 random allocation ratio randomly. They will receive one oral capsule (the concentration of 109 CFU) or placebo daily from admission until delivery. Primary outcomes included mean systolic and diastolic blood pressure, mean gestational age from diagnosis to delivery, and mean birth weight. Also, secondary outcomes included proteinuria, serum creatinine level, the incidence of severe PE, the use of antihypertensive drugs, the rate of natural delivery, incidence of serious complications, maternal blood factors such as platelet count, and serum levels of liver enzymes such as ALT, AST, bilirubin, and LDH. Discussion: The present trial can importantly contribute to the selection of an appropriate Synbiotic supplement as safe pharmaceutical adjuvants in the treatment of pregnant women with mild preeclampsia and prevention of maternal and neonatal complications. Trial Registration: IRCT20110606006709N20. Registered on August 13, 2022.