Intergroup Differences In Terms Research Articles

Comparative Outcome between Intracervical Catheterization and Vaginal Misoprostol in the Induction of Labour in Intrauterine Fetal Death

Background & Objective: Induction of labour (ILO) is a standard obstetric approach to terminate the pregnancy. But it is always a challenge to many an obstetrician and is more so when the cervix is unfavourable. The intrauterine fetal death (IUFD) itself does not constitute an indication for cesarean section and surgery should be reserved for specific conditions, since it increases maternal morbidity without any fetal advantage. The present study was undertaken to make a comparative evaluation of the outcome of intracervical Foley’s catheter insertion and vaginal misoprostol in the induction of labour in pregnant women with IUFD. Methods: This study was a comparative cross-sectional study conducted in the Department of Obstetrics and Gynecology, Sir Salimullah Medical College & Mitford Hospital over a period of one year between January to December 2013. A total 68 single-tone pregnant women with gestational age > 24 weeks, intact membrane and IUFD confirmed by sonography were consecutively included in the study. However, cases with temperature > 38˚C, placenta previa, chorioamnionitis, vaginal bleeding were excluded from the study. The recruited patients were randomly assigned to intracervical catheterization (ICC) and vaginal misoprostol (VMP) groups. While the independent variable was induction of labour, the outcome variables were time to induction, interval from induction to full-dilatation and thinning of the cervix (effacement) and time needed from induction to delivery. Results: More than one-quarter (27.9%) of the patients were 20 or < 20 years. The patients were predominantly primipara (63.2%). Around two-thirds of the patients in either study groups received 10 – 20 units of oxytocin with no significant intergroup difference in terms of oxytocin needed (p = 0.793). The difference between the two groups in terms of pethidine needed to get rid of the labour pain was not statistically significant (p = 0.278). Time to induction in majority of the patients of both groups was 13 or < 13 hours and there was no significant difference between the groups in terms of time to induction (p = 0.380). About one-third (32.4%) of VMP group required < 15 hours from induction to full-dilatation (effacement) of cervix as opposed to only 11.8% of the ICC group (p = 0.014). Over half (52.9%) of the VMP group delivered their dead fetus in < 18 hours as compared to 41.2% of the ICC group (p = 0.331). Conclusion: The study concluded that vaginal misoprostol is more effective and safe for cervical ripening and labour induction than Foley’s catheter in pregnant women with IUFD. Type and amount of analgesia needed and oxytocin required between VMP and ICC groups do not differ significantly. Ibrahim Card Med J 2022; 12 (1): 25-29

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

BackgroundThis study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture.ResultsA total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty.ConclusionBoth surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.

Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea.

Acute appendicitis is the most common cause of non-obstetric surgical disease in pregnant women. The diagnosis and treatment of appendicitis during pregnancy are very important because it can cause life-threatening morbidity to the fetus and mother. We evaluated the clinical characteristics of acute appendicitis in pregnant women. We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis at our hospital from January 2013 through December 2022. We compared non-pregnant women of reproductive age with pregnant women. We classified the pregnant women according to gestational age. A total of 828 patients were reproductive-aged women between 15 and 44 years old. There were 759 non-pregnant patients and 69 pregnant patients. ASA (American Society of Anesthesiologists) physical status classes were significantly higher and hospital stays were significantly longer in the pregnant group. There was no significant intergroup difference in terms of the proportions of complicated appendicitis, extended surgery, or complications. When the enrolled pregnant women were divided into three subgroups according to gestational age, the mean operation time was longest in the third-trimester subgroup. There were no differences among the subgroups in terms of the proportions of complicated appendicitis, extended surgery, or complications, nor were there differences among the subgroups in terms of laboratory findings. Preterm labor and stillbirth occurred in two pregnant women with complicated appendicitis in the second trimester. Immediate surgical treatment should be strongly considered in pregnant women with appendicitis. Efforts for more accurate diagnosis are needed for pregnant women with appendicitis.

Assessment of maternal serum SERPINC1, E-selectin, P-selectin, and RBP4 levels in pregnancies with early- and late-onset preeclampsia.

To investigate whether the SERPINC1, E-selectin, P-selectin, and RBP4 levels in first trimester maternal serum was associated with the presence of preeclampsia (PE). This cross-sectional study was conducted on 26 women with early-onset preeclampsia (EO-PE), 27 women with late-onset preeclampsia (LO-PE), and 27 women with uncomplicated pregnancies. Levels of serum SERPINC1, E-selectin, P-selectin, and RBP4 were measured with the use of an enzyme-linked immunosorbent assay (ELISA) kit. E-Selectin levels in patients with EO-PE were higher than those with LO-PE and control patients (pE-L =0.025; pE-C =0.000; p < 0.05). There was no significant intergroup difference in terms of P-selectin and RBP4 levels (p > 0.05). SERPINC1 levels were lower in the patients in the with EO-PE group than in those in the LO-PE and the control groups (pE-L =0.000; pE-C =0.000; p < 0.05). In the PE group, there was a negative, moderate (41.7%) correlation between E-selectin level and SERPINC1 (p=0.002; p < 0.05). The receiver operating characteristic (ROC) curve showed that the best cut-off values for E-selectin were 23.14 ng/ml > with 100% sensitivity and 100% specificity. The ROC curve showed that the best cut-off values for SERPINC1 were ≤87.76 ng/ml with 98.1% sensitivity and 96.3% specificity. Of the endothelial damage parameters, E-selectin and SERPINC1 are especially associated with EO-PE. Furthermore, they can be used as potential early diagnosis markers in the prediction of PE.

Determining the Role of Immunoglobulin Levels in Children with Febrile Seizures.

Febrile seizures are the most common form of convulsive disorder in childhood. The mechanisms underlying the pathogenesis of febrile seizure remain unclear. The aim of this study was to assess the immunoglobulin (IG) sub-group levels in children with febrile seizures. The patients with a diagnosis of febrile seizure with an age range of 1-7 years who attended the clinic were included in the study. Neurologically normal and age- and sex-matched children with no history of febrile seizures were considered as controls. A total of 64 patients and 100 control subjects participated in this study. There were no significant inter-group differences in terms of sex and age of the participants (p >.05). There was no statistical difference between case and control groups for serum lymphocyte count, IgA, IgG, IgM, IgE levels, and anti-HB response (p >.05). Our study demonstrated that there is no difference in humoral immunity between children with febrile seizures and control subjects with the same age range.

A study of functional outcome in patients undergoing arthroscopic reconstruction of anterior cruciate ligament injury using hamstring tendon graft with interference screws

The Anterior Cruciate Ligament is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting the rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion and easier rehabilitation. Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Materials and Methods: Patients admitted to CG hospital and Bapuji hospital in Davangere, Karnataka between 2019 October to 2021 October were taken into the study after taking informed consent. Results: This study consists of 25 cases of Anterior Cruciate Ligament injury. All cases were performed arthroscopically. ACL rupture was common in second and third decade. In our study, male preponderance was found with 23 (92%) and female preponderance of 2 (8%). Side affected was 13 (52%) right side and 12 (48%) left side. Mode of injury in the present study includes various sources such as sports, RTA, fall. Results were evaluated by using International Knee Documentation committee (IKDC) and Lysholm knee scoring scale. In present study we have 22 patients with Excellent results, 2 cases as Good, 1 case as Fair and 0 cases as Poor. No case needed re-surgery. In the present study there were no cases of superficial infection. Conclusion: Arthroscopic reconstruction of ACL using Semitendinous and Gracilis tendon graft (Hamstring tendon) with Interference screws can be considered the best mode of treatment for ACL rupture.

Sex-related differences in the effect of rotational thrombectomy for thrombus-containing lower limbs ischemic lesions

BackgroundTo assess the immediate effect and factors affecting the efficacy of rotational thrombectomy (RT) in patients with thrombus-containing lower-limb ischaemic lesions.MethodsPatients were retrospectively divided into two groups: RT and RT+ CDT (Catheter-directed thrombolysis). The RT group included patients in whom intraoperative thrombus aspiration was successful, while the RT + CDT group included patients in whom intraoperative thrombus aspiration was less effective and remedial CDT treatment was used. The primary outcome was the immediate effect of RT on thrombus-containing lower-limb ischaemic lesions.ResultsFrom May 2015 to July 2021, 170 patients (113 men, 57 women; mean age, 74.0 years) with thrombus-containing lower-limb ischaemic lesions were treated in our centre. Of these patients, 113 received RT only, while 57 received RT + CDT. There were no significant intergroup differences in terms of age, disease duration, or comorbidities, but a higher proportion of male patients and higher preoperative plasma D-dimer levels (1.23 vs. 0.84; p = .017) was observed in the RT + CDT group. There were no significant intergroup differences in terms of diagnosis, lesion characteristics, lesion location, or lesion length. Multivariate logistic regression analysis revealed that male sex (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.098–6.410; p = .030) and poor distal runoff (OR, 2.94; 95% CI, 1.439–5.988; p = .003) were associated with higher rates of additional CDT. Male patients also had a significantly longer onset time, more thrombotic occlusions, and a greater frequency of in-stent restenosis.ConclusionsRT alone or with CDT is a feasible primary treatment option for thrombus debulking. Sex significantly influences the effect of RT on thrombus-containing lower-limb ischaemic lesions.

Titanium-base abutments may have similar long-term peri-implant effects as non-bonded one-piece abutments.

Design A single-centre (private practice), prospective, longitudinal, split-mouth, single-blind, randomised controlled clinical trial reported peri-implant parameters of individualised abutments bonded to titanium (Ti) bases during a five-year follow-up. The study complied with the ethical principles of the Helsinki Declaration and the CONSORT (Consolidated Standards of Reporting Trials) guidelines. It was approved by the Medical Ethical Committee of the University of Freiburg (013/1630) and registered in the German Clinical Trials Register (DRKS00006163).Case selection The included subjects had to be over 17 years of age, have an American Society of Anaesthesiologists score of 1, be a non-smoker, have a full-mouth plaque index (PI) below 20%, full-mouth bleeding index (BI) 20%, and planned with at least two dental implants but not adjacent to each other. Participants were excluded if they required simultaneous augmentation, were pregnant or breastfeeding, or had a history of periodontitis. Marginal bone loss (MBL) was the main clinical outcome, while local bleeding on probing (BoP), probing pocket depth (PPD), plaque Index (PI), local recession (REC), and relative attachment level (RAL) were also evaluated. The study timeline consisted of a screening (visit 1) and implant surgery (visit 2). Stage two was three months after implant surgery (visit 3), impression was two weeks after stage two (visit 4), followed up by baseline with a standardised radiograph (visit 5), one-year follow-up with radiographic and clinical parameters (visit 6), two-year follow-up (visit 7), three-year follow-up (visit 8), four-year follow-up (visit 9) and five-year follow-up (visit 10). In total, 24 subjects received two bone-level implants (Conelog, Camlog Biotechnologies, Basel, Switzerland) in the same arch and region up to 1 mm subcrestally. Their implant-abutment connection was an internal 7.5 degree conical connection platform-switch. Each subject received two abutments (one control and one test) as per the split-mouth design. The control abutments consisted of individualised, one-piece, computer-aided design/computer-aided manufacturing (CAD/CAM) titanium abutments, whereas the test abutments were CAD/CAM titanium abutments bonded to Ti-bases. The decision which implant was restored and in which way was made by a coin flip. The surgeon, patient and prosthodontist were blinded regarding the treatment allocation.Data analysis Descriptive measures and quantitative parameters were obtained from means, standard deviations, minimum and maximum values and 95% confidence intervals. The means of clinical parameters (six sites per implant) were MBL, BoP, PPD, PI, REC, and RAL. Paired t-tests were used for intragroup comparisons at different intervals as well as for intergroup comparisons within each time point. All data collected were considered until participants dropped out (that is, intention-to-treat principle). The significance level alpha was set to 0.05. The post-hoc power calculation of the MBL intergroup comparison dammed this trial as underpowered (power = 34%).Results All implants were osseointegrated after the healing stage and no implants were lost during the trial. Two subjects dropped out (one after the two-year follow-up and the other at the last appointment). Regarding MBL, no significant intergroup differences were found between the abutment groups. Nonetheless, significant intragroup differences were found at several visits (visit 6 to visit 10) compared to the baseline MBL (visit 5), indicating continuous bone level alterations. Concerning the BoP, no significant differences were identified. In terms of PPD, significant intergroup differences were found at visits 9 (p = 0.006) and 10 (p = 0.024), favouring Ti-base abutments. There were significantly intergroup differences in terms of REC (p = 0.014) at visit 10, with higher values in the one-piece abutment group. No differences were found in terms of PI.Conclusions A preliminary conclusion of this underpowered trial was that Ti-base abutments have a similar long-term effect to one-piece abutments on human peri-implant tissues.

Analiza stanu zdrowia psychicznego i problemów ze snem wśród personelu pielęgniarskiego i położniczego w dobie pandemii COVID-19

Introduction: Nursing and midwifery staff members are at high risk of mental disorders. Depression, anxiety, and insomnia are commonly reported symptoms among healthcare professionals during the COVID-19 pandemic. Chronic insomnia leads to lower quality of life, worse professional performance, and deterioration of cognitive function. Moreover, it increases the risk of metabolic and cardiovascular diseases. Material and methods: The study included 235 nurses (n =133) and midwives (n =102). The diagnostic methods included a descriptive and demographic questionnaire, The General Health Questionnaire (GHQ-28), The Pittsburgh Sleep Quality Index (PSQI), and The Insomnia Severity Index (ISI). The study was conducted using an online survey. Results: There are no statistically significant intergroup differences in terms of mental state, sleep quality and the insomnia level in the groups of nurses and midwives. 9% of subjects used psychological support and revealed lower assessment of their mental health, poorer sleep quality and the higher insomnia rate. The stable mental health of nurses and midwives positively correlated with the sleep quality and negatively with the insomnia level. 63% of study participants assessed their sleep quality as low. The symptoms of clinical insomnia were present in 35% of subjects. Conclusions: Insomnia is a serious health problem for nursing and midwifery staff during the COVID-19 pandemic. The implementation of preventive programmes focused on medical workers’ mental health should be a priority in prevention of long-term consequences of sleep problems and insomnia

Antegrade versus retrograde nailing of proximal femur fractures: A cortical diameter based study

BackgroundRetrograde nailing of proximal femoral shaft fractures is controversial. The purpose of this study was to compare patients with proximal femur fractures undergoing antegrade versus retrograde intramedullary nailing (AIMN vs RIMN) and determine the safety and efficacy of RIMN. MethodsA retrospective review was performed on 54 patients undergoing femoral IMN for proximal femoral shaft fractures at an urban level one trauma institution between January 2016 and July 2021.Fracture distance from the lesser trochanter (LT) was recorded and used to calculate the number of cortical diameters (NCD) from the LT. Proximal femur fractures were defined as < 3 NCD. AIMN and RIMN fixation was utilized in 31 (57.4%) and 23 (42.6%) patients, respectively. Outcomes measures included pre-/postoperative true translational and angular displacement (TTD and TAD), operative time, estimated blood loss (EBL), union rate, time to union, complications, and reoperations. ResultsAIMN and RIMN groups were similar in terms of age, sex, BMI, tobacco use, diabetes, ASA classification >2, AO/OTA classification, preoperative TTD or TAD, open fractures, or ballistic fractures. The AIMN group, had a shorter measured distance from the LT (47.0 vs. 66.1 mm, p = 0.04) but the difference in NCD was not significant (1.4 vs. 2.0, p = 0.07). Among patients with isolated IMN procedures, the RIMN group had shorter operative times (142.3 vs. 178.5 min, p = 0.01) and less EBL (100 vs. 250 mL, p = 0.008). There was no observed intergroup difference in terms of postoperative TTD/TAD, union rate, time to union, complications, or reoperations. ConclusionRIMN is a viable treatment option for proximal femoral shaft fractures that results in less operative time, less blood loss, and no detectable differences in union, reoperations, or complications. Level of evidenceLevel III, Retrospective cohort study.

The effectiveness of mindful self-compassion treatment on sleep quality, rumination and self-compassion in people with cardiovascular disease

Introduction: Cardiovascular diseases are the most common cause of death in the world and psychological components play an important role in cardiovascular diseases. Aim: The present study aimed to determine the effectiveness of mindful self-compassion treatment to sleep quality, rumination and self-compassion in people with cardiovascular diseases. Method: The study method was a clinical trial with a control group. The statistical population included all patients who had sought professional help in Imam Ali and Imam Reza hospitals in Kermanshah from October-December 2020. Using purposive sampling method, 20 people were randomly assigned to the two groups. The experimental group received 8 sessions of mindful self-compassion treatment and the control group received a CD and a relaxation training manual. Participants completed a demographic data collection form and questionnaires on Sleep Quality, Ruminant Response Style and Self-Compassion. The data were analyzed using SPSS-22, the descriptive statistics and the repeated measures ANOVA. Results: The results showed that there was a significant difference between the two groups in terms of sleep quality based on time (P≤0.001) and intergroup differences (P&lt;0.05). Also, based on time, time and group interaction, and intergroup differences in terms of rumination and self-compassion, there is a significant difference between the two groups (P≤0.001). Conclusion: Based on the results of this study this treatment affects the psychological and physical symptoms of heart patients. Therefore, it is suggested that this treatment be used to improve sleep quality, rumination and self-compassion in cardiovascular patients.

Factors reducing psychological satisfaction after the Nuss procedure in pediatric patients.

We examined patient satisfaction with postoperative chest appearance after Nuss procedure and analyzed the factors for postoperative low satisfaction. We retrospectively reviewed data of 133 patients who underwent the Nuss procedure from 2000 to 2016. Their medical records, X-rays, and computed tomography scans were evaluated. Haller index and concave rate were used as objective indices of the deformity. The questionnaires were used to evaluate satisfaction with the chest appearance by a linear scale including five markers (1: dissatisfaction, 5: satisfaction). The patients were divided into two groups: the low satisfaction (score=1, 2) and the high satisfaction (score=3-5). The median age during the Nuss procedure was 7.6 (interquartile range, 5.8-12.8)years. Out of 133, 65 patients replied, and the mean postoperative satisfaction score was 3.8 ± 0.2. Out of the 65 respondents, 16 patients (24.6%) were classified as low satisfaction group. Haller index and concave rate were significantly higher and the previous instances of chest operation history were more frequent in the low satisfaction group than in the high satisfaction group, although there was no significant intergroup difference in terms of the postoperative concave rate. Severe deformity and previous chest operation history were considered to be factors for low satisfaction.

Investigation of serum and adipose tissue levels of asprosin in patients with severe obesity undergoing sleeve gastrectomy.

This study aimed to reveal the relationship between obesity and asprosin (fibrillin-1) in patients undergoing bariatric surgery and to investigate the role of asprosin in obesity etiopathogenesis. The study included 37 patients who underwent laparoscopic sleeve gastrectomy for severe obesity and 37 patients who underwent laparoscopic cholecystectomy for cholelithiasis in the study and control groups, respectively. Blood samples were collected from the patients in the preoperative period to measure biochemical parameters. Blood samples were collected at 6 months postoperatively from the patients in the study group to compare their pre- and postoperative serum asprosin levels. A significant intergroup difference in terms of mean asprosin levels in adipose tissue was noted (p=0.001). A comparison of preoperative and postoperative 6-month serum asprosin levels in the study group showed significant differences (p=0.021). The area under the curve of asprosin tissue levels was 78.1%, and the cutoff value was 217.34 ng/g of protein, with a sensitivity and specificity of 73.0%. Tissue levels of asprosin were found to increase the risk of obesity by a factor of 1.018 (odds ratio; 95% CI: 1.008-1.027). Serum asprosin levels decreased significantly at 6 months after bariatric surgery. Adipose tissue of patients with obesity showed high asprosin levels and immunoreactivity. In conclusion, asprosin levels in adipose tissue were considered a potential independent risk factor in obesity etiopathogenesis.

Predictors of the need for rib resection in minimally invasive retroperitoneal approach for oblique lateral interbody fusion at upper lumbar spine (L1-2 and L2-3)

BackgroundThis study aimed to identify factors that can predict the need for rib resection in a minimally invasive, oblique retroperitoneal approach for upper lumbar interbody fusion (OLIF at L1-3) using modern tubular retractors. MethodsEighty-six patients, who underwent L1-2 and/or L2-3 OLIF at a single institution, were included. Decision for rib resection was made through intraoperative fluoroscopic view (true lateral view of the desired level). Patients were divided into two groups according to rib resection (rib resection and non-rib resection groups). Baseline demographics, surgical and radiographic data, including coronal/sagittal spinopelvic parameters and perioperative complications, were compared between the groups. Logistic regression analysis was performed to identify the factors predicting the need for rib resection. ResultsThe study cohort comprised 31 patients in the rib resection group and 55 patients in the non-rib resection group. There was no significant inter-group difference in terms of the baseline demographics. A total of 79% patients undergoing the two-level (both L1-2 and L2-3) procedures were rib-resected, while 81.6% of the patients undergoing the L2-3 level alone were not rib-resected. Endplate injuries occurred more commonly in the non-rib resection group (3% vs. 14%). Pleural laceration was observed in 6% of the patients in the rib resection group. The mean T10-L2 kyphosis was larger in the rib resection group than in the non-rib resection group (14.9° vs. 6.6°, P = 0.031). Multivariate logistic regression analysis identified the following independent predictors of the need for rib resection: an L1-2 inclusive procedure; T10-L2 kyphosis > 15.9°; and the apex of the coronal curve located above L2. Conclusion: The need for rib resection should be expected when performing L1-2 inclusive procedure. Even in the L2-3 alone case, aggressive decision-making for intraoperative rib resection might be required for an appropriate tubular retractor position, especially for patients with thoracolumbar kyphosis and apex vertebra of the major coronal curve located above L2.

Battlefield Acupuncture Use for Perioperative Anesthesia in Veterans Affairs Surgical Patients: A Single-Center Randomized Controlled Trial.

Introduction: The risks from opioid use are well known in and mandate nonpharmacological modalities for the management of postoperative pain. The aim of this study was to investigate the effectiveness of battlefield acupuncture (BFA) as an adjunct therapy for postoperative pain in U.S. veteran patients undergoing major surgery under general anesthesia. Methods: Patients undergoing major surgery performed under general anesthesia from June 2017 to June 2018 were enrolled in the study. Patients were randomly assigned to receive either BFA or sham acupuncture. Outcomes such as pain intensity measured by visual analog scale score, opioid consumption, and the incidence of analgesia-related adverse effects were compared between the study groups. Results: A total of 72 subjects were included in this study (36 subjects in each study group). The median 24-h opioid postoperative consumption measured in morphine milligram equivalent (MME) was lower in the BFA group compared to the sham acupuncture group (18.3 [±12.2] MME vs. 38.6 [±15.9] MME, p < 0.001). Pain intensity reported by patients at 6, 12, 18, and 24 h postoperatively was lower in the BFA group compared to the sham acupuncture group. The incidence of postsurgical nausea and vomiting was lower in patients receiving BFA compared to patients receiving sham acupuncture. There were no intergroup differences in terms of postoperative anxiety or hospital length of stay. Conclusion: The results from this study reveal the potential clinical benefits of using BFA for reducing pain intensity and opioid requirements in surgical patients.

Minimally Invasive versus Conventional Lumbar Interbody Fusion at L5–S1: A Retrospective Comparative Study

Objective: This study aimed to evaluate the radiologic and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and conventional posterior lumbar interbody fusion (PLIF) at the L5–S1.Methods: We retrospectively reviewed patients who underwent posterior lumbar fusion (MIS-TLIF and PLIF) at only the L5–S1 and were followed up for more than 12 months. Age, sex, body mass index (BMI), bone mineral density (BMD), diagnosis, comorbid conditions, fusion rate, perioperative results, and pre- and postoperative radiographic parameters at the L5–S1 level, pelvic parameters and degree of spondylolisthesis, and clinical results were analyzed.Results: A total of 102 patients (46 male, 56 female) with a mean age of 57.1 years were evaluated. Fifty and fifty-two patients underwent MIS-TLIF and PLIF surgeries, respectively. Radiologic parameters increased from their preoperative measures at the last follow-up study; similarly, there were no intergroup differences. The fusion rates in the MIS-TLIF and PLIF groups were 86% and 82.7%, respectively. The subsidence rates in the MIS-TLIF and PLIF groups were 6% and 3.8%, respectively. There was no intergroup difference in terms of fusion rate and subsidence. Clinical outcomes also gradually improved after surgery in both groups without intergroup differences.Conclusion: In L5–S1 posterior spinal surgery, there was no significant difference between MIS-TLIF and conventional PLIF. Considering the operation time and estimated blood loss, MIS-TLIF is more effective than PLIF surgery in terms of postoperative health care and economics.

Short versus Longer Implants in Sites without the Need for Bone Augmentation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: The present systematic review and meta-analysis aims to analyse the clinical performance of short compared to longer implants inserted in sites without the need for bone augmentation. Methods: The protocol of the present PRISMA-driven meta-analysis was registered on PROSPERO (CRD42021264781). Electronic and manual searches were performed up to January 2022. All Randomized Controlled Trials (RCTs) comparing short (≤6 mm) to longer (≥8.5 mm) implants placed in non-atrophic and non-augmented sites were included. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomized clinical trials (RoB 2) and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was performed on implant survival rate, marginal bone level change (MBLc), and technical and biological complications at the available follow-up time points. The power of the meta-analytic findings was determined by trial sequential analysis (TSA). Results: From 1485 initial records, 13 articles were finally included. No significant difference was found in the survival rate between short and long implant at any follow-up (moderate quality of evidence). Significantly more bone loss for long implants at 1 and 5 years from implant placement and more technical complications with short implants at 10 years were found. No other significant inter-group differences in terms of MBLc and biological complications were detected. Conclusions: Moderate evidence exists suggesting that short implants perform as well as longer ones in the rehabilitation of edentulous sites without the need for bone augmentation. Further long-term, well-designed RCTs, however, are still needed to provide specific evidence-based clinical recommendations for an extended use of short implants in non-atrophic sites.

EVALUATION OF PAIN, ANXIETY AND HEMODYNAMIC PARAMETERS IN THE GROUPS LİSTENING AND NOT LISTENING TO MUSIC IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

This study was conducted to determine the effect of music listened to during compulsory bed rest after coronary angiography on pain, anxiety and hemodynamic parameters experienced by patients. 80 patients were randomized into the music and control groups. The patients in the music group were allowed to listen to music (Sufi, relaxing, sounds of nature) preferred by them for 20-30 minutes half an hour after admission to the service for follow-up after angiography. No music was listened for the control group. The pain, anxiety, and hemodynamic parameters of the patients were measured before, immediately after, one hour after listening to music, and at discharge. Descriptive statistics, Student t, Mann Whitney U, Repeat Measurament, Fridman and Chi-square tests were used to evaluate the data. There was no statistically significant intergroup difference in terms of average scores of pain and anxiety and hemodynamic parameters at the baseline (p&gt;0.05). The difference between the average scores of pain and anxiety between groups in all measurements after listening to music was found to be significant (p&lt;0.05). The mean anxiety and pain scores of the patients in the study group were lower. In the study group, systolic and diastolic blood pressure, heart rate, respiratory rate decreased, and oxygen saturation increased in all measurements after listening to music (p&lt;0.05).

Effect of Fresh Gas Flow Rate on Thiol/Disulphide Hemostasis and Ischemia-modified Albumin in Laparoscopic Cholecystectomy.

To investigate the effects of low-flow and high-flow anesthesia techniques, administered with sevoflurane during laparoscopic cholecystectomy, on thiol/disulphide homeostasis and serum ischemia-modified albumin (IMA) levels. Double-blind, randomised study. Department of Anesthesiology and Reanimation, Health Science University, Bursa Yuksek Ihtisas Training and Education hospital, Bursa, Turkey from January to October 2020. Patients over the age of 18 years, scheduled for elective laparoscopic cholecystectomy, were included in the study. The patients were divided into two groups: Group 1 (low-flow, 1 L/min) and Group 2 (high-flow, 2 L/min). The blood samples for thiol/disulphide homeostasis and serum IMA levels were collected as follows: 5 minutes before induction of anesthesia (T0), 5 minutes after induction of anesthesia (T1) and postoperative 24th hour (T2). The final analysis included 104 patients. The two groups did not differ significantly in terms of any of the demographic characteristics (p >0.05). There were also no inter-group differences in terms of thiol/disulphide homeostasis parameters or serum IMA levels at T0, T1, or T2. However, in both groups, there were statistically significant changes in serum disulphide and IMA levels from T0 to T1 and T0 to T2 (p=0.000, and p=0.005, respectively). There was no difference between low-flow and high-flow anesthesia during laparoscopic cholecystectomy in terms of hemodynamics or thiol/disulphide homeostasis. Key Words: Low-flow anesthesia, High-flow anesthesia, Thiol/disulphide homeostasis, İschemia-modified albumin (IMA), Laparoscopic cholecystectomy.

Pulmonary artery pathologies in Alagille syndrome: a meta-analysis

Alagille syndrome, caused by mutations in the gene encoding Jagged1 (JAG1), a ligand in the Notch signaling pathway, is an autosomal dominant disorder with developmental abnormalities affecting the liver, heart, eyes, face and skeleton. The aim of the present study is try to disclose the clinical features, management and outcomes of pulmonary artery stenosis associated with Alagille syndrome. By comprehensive literature retrieval, 38 articles involving 401 patients were recruited for this study. The pertinent variables closely related to pulmonary artery stenosis in patients with Alagille syndrome were comprehensively analyzed by following the PRISMA guidelines. The management of pulmonary artery pathologies, especially a severe type of pulmonary artery stenosis in Alagille syndrome, is a concerned matter. Publications of literature retrieval of recent 3 decades were the study material of this article. The pulmonary artery pathologies, especially the severe type of pulmonary artery stenosis in Alagille syndrome, warrant surgical or interventional treatments. After the procedures, the right ventricular to left ventricular pressure ratio was reduced by 25%. There were no intergroup differences in terms of recovery, reintervention and mortality rates between interventionally and surgically treated patients. Transcatheter treatment is preferable due to less trauma. Surgical treatment of pulmonary artery stenosis can be performed currently with intracardiac defect repair.