Intervention Surgery Research Articles

Abstract 4119303: The New Strait-Jacket Designed for Endovascular Therapy Reduces the First Reperfusion Time of Emergency Thrombectomy for Stroke

Introduction: Conscious sedation during cerebrovascular interventional surgery can shorten the time of vascular recanalization and bring significant benefits to patients, but patients are often difficult to cooperate, which affects the operation of interventional surgery. This study aims to develop a novel cerebral vascular intervention strait-jacket and explore its safety and effectiveness in emergency cerebral vascular intervention surgery. Methods: Using the convenient sampling method, patients with acute large artery occlusion stroke who underwent emergency mechanical thrombectomy in Zhongnan Hospital of Wuhan University from September 2018 to March 2021 were selected as the research objects. The control group was treated with conventional restraint belt, and the experimental group was treated with new cerebrovascular interventional surgery strait-jacket. The first reperfusion time, total operation time, modified Rankin score (mRS) at 30 days, intraoperative limb prolapse rate, average surgical cost, and safety indicators were compared between the two groups. The t test, Mann-Whitney U test or Fisher exact test were used for comparison between groups according to the data type. A p<0.05 indicated statistical significance. Results: The new type of cerebrovascular interventional surgical strait-jacket developed in this study are shown in Figure 1, which have been patented and transformed into products. A total of 140 patients were included for mechanical thrombectomy, randomly divided into an experimental group (n=69) and a control group (n=71). Using the new strait-jacket significantly shortened the first reperfusion time (43.5±13.7 vs 50.7±15.7, P=0.039) and the total operation time (81.1±12.6 vs 93.2±21.1, P=0.027). There was a significant decrease in limb dislodgement rate (0% vs 35.2%, P<0.001) and a noticeable reduction in average surgical cost (76315±12400 vs 81462±14142 P=0.040) by using the strait-jacket. In terms of safety performance, using the strait-jacket significantly lower rates of skin redness than the control group (8.7% vs 42.3%, P<0.001). Conclusion: The new type of cerebrovascular interventional surgical strait-jacket is safe, which can effectively shorten the operation time, reduce the rate of intraoperative limb prolapse and the average operation cost, and can bring good social benefits.

Variation in the management and treatment of children with giant coronary artery aneurysm following Kawasaki disease.

Giant coronary artery aneurysms are rare but potentially fatal complications of Kawasaki disease. The lack of evidence-based recommendations on their management and treatment cause guidelines and practices to differ. We aimed to assess these variations. An anonymous online survey regarding surveillance, imaging, pharmacological management, and interventional practices was distributed among 134 physicians attending to Kawasaki disease patients worldwide. A p-value of <0.05 was deemed significant. The majority (60%) of respondents were general paediatric cardiologists, and 29% interventional specialists. The average years in practice was 15 ± 9.6. Physicians from Asia had the most experience with giant coronary artery aneurysms. American practitioners preferred combining anticoagulants with aspirin. Beta-blockers and statins were more likely used in teenagers versus younger children. Cardiac catheterisation was most (52%) chosen for coronary surveillance in patients with echocardiogram anomalies, followed by Coronary CT-angiography. The indications for coronary intervention were split among respondents, regardless of geographic region or experience. The preferred treatment of coronary stenosis was percutaneous intervention (69%) versus bypass surgery. For thrombosis, thrombolytics (50%) were preferred over percutaneous (39%) and surgical (11%) interventions. Most (92%) preferred intervening in young children in a paediatric facility but were split between a paediatric and adult facility for older children. Most chose combined management by adult and paediatric specialists for either age-scenarios (70, 82%). As identified by our study, the lack of large studies and evidence-based recommendations cause uncertainty and ambivalence towards certain treatments. International collaborative efforts are needed to provide more robust evidence in the management of these patients.

A Nation-Wide Evaluation of Suboptimal Lipid-Lowering Treatment Patterns Among Patients Undergoing Intervention for Acute Coronary Syndrome in Hungary.

Background/Objectives: A significant gap exists between guideline recommendations and everyday practice. Stringent treatment is needed for vulnerable patients with acute coronary syndrome (ACS). Methods: Data on the lipid-lowering therapy (LLT), including the adherence, persistence, and mortality of patients undergoing percutaneous coronary intervention or bypass surgery in Hungary in 2018 were followed up and analyzed based on the National Health Insurance Fund database until the end of 2020. Results: A total of 12,997 patients underwent revascularization for ACS in 2018, whose discharge therapy included any LLT, a high- or moderate-intensity statin, or ezetimibe at a proportion of 91%, 75%, 12%, and 4%, respectively. By the end of the observation period, the frequency of ezetimibe administration increased to 11%. Persistence decreased, reaching 50% for all therapeutic regimens by month 16. Patients on moderate statin doses had a significantly higher mortality rate at the end of follow-up than those receiving high-intensity statin with (20% vs. 9%, p < 0.0001) or without (20% vs. 14%, p = 0.00029) ezetimibe. Those taking less potent statin doses had higher rates of comorbidities; for example, a minimum of three comorbidities were present in 39% of patients taking medium statin doses and 23% among those on high-intensity statin therapy (p < 0.0001). Conclusions: LLT persistence decreased during follow-up. The administration of a higher-intensity lipid-lowering regimen was associated with better persistence and adherence, along with more favorable mortality rates. Multimorbidity was associated with the use of lower statin doses. The results suggest that more attention is needed in terms of lipid control of females, elderly people, and individuals with several comorbidities, and emphasis should be placed on improving persistence and increasing the frequency of combined LLT prescriptions.

Multimodal human-computer interaction in interventional radiology and surgery: a systematic literature review.

As technology advances, more research dedicated to medical interactive systems emphasizes the integration of touchless and multimodal interaction (MMI). Particularly in surgical and interventional settings, this approach is advantageous because it maintains sterility and promotes a natural interaction. Past reviews have focused on investigating MMI in terms of technology and interaction with robots. However, none has put particular emphasis on analyzing these kind of interactions for surgical and interventional scenarios. Two databases were included in the query to search for relevant publications within the past 10 years. After identification, two screening steps followed which included eligibility criteria. A forward/backward search was added to identify more relevant publications. The analysis incorporated the clustering of references in terms of addressed medical field, input and output modalities, and challenges regarding the development and evaluation. A sample of 31 references was obtained (16 journal articles, 15 conference papers). MMI was predominantly developed for laparoscopy and radiology and interaction with image viewers. The majority implemented two input modalities, with voice-hand interaction being the most common combination-voice for discrete and hand for continuous navigation tasks. The application of gaze, body, and facial control is minimal, primarily because of ergonomic concerns. Feedback was included in 81% publications, of which visual cues were most often applied. This work systematically reviews MMI for surgical and interventional scenarios over the past decade. In future research endeavors, we propose an enhanced focus on conducting in-depth analyses of the considered use cases and the application of standardized evaluation methods. Moreover, insights from various sectors, including but not limited to the gaming sector, should be exploited.

Lipoprotein (a), coronary artery disease risk, and MACE in individuals without standard modifiable risk factors in the UK Biobank

Abstract Background A significant proportion of patients with coronary artery disease (CAD) lack standard modifiable risk factors (SMuRFs; smoking, hypercholesterolaemia, diabetes and hypertension), for example with recent analyses demonstrating that around 25% of patients with ST-elevation myocardial infarction are SMuRF-less(1). With continued focus on primary prevention in cardiovascular disease, the SMuRF-less subset is likely to increase over time. A body of evidence has implicated lipoprotein (a) in CAD, but no such studies have investigated this association in a purely SMuRF-less population. Purpose To investigate the role of lipoprotein (a) in predicting CAD risk and major adverse cardiovascular events (MACE) in a large, SMuRF-less cohort. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37-73 years at entry between 2006-2010. SMuRFs were defined as 1) smoking (current or historical), 2) hypercholesterolaemia – lipid lowering medication on enrolment or total cholesterol &amp;gt;5.5mmol/L or LDL-C &amp;gt;3.5mmol/L, 3) previous diagnosis of diabetes mellitus, or HbA1c &amp;gt;48mmol/mol, 4) previous diagnosis of hypertension. MACE was defined as a composite of coronary artery disease – previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery –, stroke, or all-cause mortality. Results Of the total UK Biobank cohort, 46,139 participants were identified as SMuRF-less together with a valid lipoprotein (a) level. Median follow-up duration was 12yrs. In univariate analyses (Table 1), there was no significant difference in lipoprotein (a) concentrations between individuals with and without MACE (16.9 vs. 17.1nmol/L respectively, p = 0.913). The overall event rate was low, with just 3% MACE (1381 events) overall. Older age, male gender, apolipoprotein A, apolipoprotein B, HbA1c level, HDL cholesterol level and body mass index were all associated with MACE. In regard to all-cause mortality alone, there was no association with lipoprotein (a) level, although the other aforementioned parameters were all significantly associated with this outcome. Similarly, lipoprotein (a) was not a significant predictor of stroke. However, there was a large difference in lipoprotein (a) levels between patients with and without CAD (27.2 vs. 17.1nmol/L respectively, p = 0.004). In Kaplan-Meier analysis, lipoprotein (a) level above the 77th percentile (60.3nmol/L) was significantly associated with CAD (p=0.032). In Cox regression models, despite the low event rate, lipoprotein (a) was a significant predictor of CAD (HR 1.00-1.01, p=0.01), and importantly the only potentially modifiable parameter (N = 39,433, 111 events, Table 2). Conclusion Lipoprotein (a) independently predicts CAD in those without SMuRFs, highlighting the importance of checking this parameter in such patients, particularly given the novel antisense technologies in development which may lower lipoprotein (a)(2).Univariate analysesCox regression for CAD

Introducing online narrated video animations to facilitate patients' understanding of cardiac procedures in a high-volume tertiary centre

Abstract Introduction Discussions about the benefits and risks of invasive procedures, including their alternatives, are an integral part of certain patient consultations in Cardiology. However, patients absorb only a fraction of the information shared during a single encounter, often due to time constraints, leading to an incomplete understanding. Video animation tools were designed to better facilitate communication and consolidate patient (and family members) understanding in advance of their procedure. Purpose We are a high-volume tertiary cardiac centre, and we aimed to assess real-world patient feedback having introduced an online cardiac video animation tool into our organisation. Methods In July 2022, we obtained unlimited patient access to a digital tool that offers short, multi-language narrated video animations covering the breadth of cardiac procedures (cardiac intervention, electrophysiology, structural and cardiac surgery). It is accessible on any device, including a desktop, laptop, or mobile phone. Specifically, we purchased password protected access to 31 video animations in three local languages. Web-links and QR codes for each video animation were designed. These were shared with patients and family members during different stages of the patients’ journey through the hospital. We sampled qualitative feedback from a cohort of patients attending pre-assessment clinic, measured on our electronic patient record via a 3-point Likert scale. Results As illustrated in Figure 1, we adapted our patient pathway to integrate use of this resource in the patient journey by 1) notifying patients during their out-patient cardiologist consultation; 2) emailing video links integrated within an e-consent process; 3) introducing video links as QR codes in patient letters; 4) reminding patients during their nurse-led pre-assessment clinic; 5) via hospital poster advertisements; 6) and on the front page of the hospital website. Since its introduction 18 months ago, 20,607 animation views have occurred, with 90% watched to completion. The three most popular animations were "angiogram/angioplasty" (4135), atrial fibrillation ablation (1415), and TAVI (1243). From July 2022 to December 2023, 1,878 patients have attended our nurse led pre-assessment clinic, and we sampled qualitative feedback from about 20% (342 patients). As demonstrated in Figure 2, 84% of patients felt the procedural video animations were quite helpful/very helpful. The remaining 16% found it "not helpful", with anecdotal reasons being "inability to access the technology", "feeling already adequately informed", or "not wanting to know". Conclusion In our high-volume tertiary centre, online narrated video animations discussing cardiac procedures were successfully implemented into our patient pathway and deemed helpful by the majority of our patients.Fig1.Process map of the patient journeyFig2.Patients’ feedback regarding video

Structure design and ergonomic assessment of a passive exoskeleton supporting the lead apron for interventional surgery

Structure design and ergonomic assessment of a passive exoskeleton supporting the lead apron for interventional surgery

A WeChat platform program (WCPP) for full-process management of patients with cardiac valve interventional surgery based on psycho-cardiology: protocol of a mixed-method study

BackgroundValvular heart disease is the third most common cardiovascular disease; it significantly diminishes patients’ quality of life and imposes burdens on individuals, families, and healthcare systems. In recent years, psycho-cardiology has emerged as a prominent field in which to explore the link between mental illness and heart disease. This mixed-method study aims to assess the effectiveness of the WCPP, which includes hospital-to-home transitional care, remote intelligent monitoring, and decision aids, in improving the physical and mental health of patients.MethodsA mixed-method study was conducted at a cardiac valve interventional surgery (CVIS) center in Southwest China. A total of 154 CVIS patients participated, with the intervention group receiving the WCPP and the control group following the traditional CVIS management program. Both groups were followed up at 1, 3, 6, and 12 months. The primary outcome is measured via the Chinese version of the 36-item Short Form Health Survey (SF-36). The Secondary outcomes included the 6-min walk test (6MWT), modified Barthel index (MBI), major adverse cardiovascular events (MACE), patient satisfaction, and length of hospital stay (LOS). Additionally, qualitative research will assess the psychological state and experiences of the patients.DiscussionOur study is one of the few involving patients with CVIS and the first to apply psycho-cardiology through a full-process management platform. The study population is predominantly from Southwest China and includes a diverse range of demographic and socioeconomic backgrounds. Upon completion, this study will provide valuable insights into the use of a remote, full-process management platform for CVIS patients.Trial registrationChinese Clinical Trial Registry ChiCTR2400081052. Registered on 21 February 2024. The trial complies with the SPIRIT and CONSORT guidelines.

Black-Phosphorus-Reinforced Injectable Conductive Biodegradable Hydrogel for the Delivery of ADSC-Derived Exosomes to Repair Myocardial Infarction.

Myocardial infarction (MI) remains one of the leading causes of death globally, necessitating innovative therapeutic strategies for effective repair. Conventional treatment methods such as pharmacotherapy, interventional surgery, and cardiac transplantation, while capable of reducing short-term mortality rates, still face significant challenges in post-MI repair including the restoration of intercellular biological and electrical signaling. This study presents a novel exosome-loaded conductive hydrogel designed to enhance myocardial repair by concurrently improving biological and electrical signals. Adipose-derived stem cell (ADSC) exosomes, encapsulated within a hyaluronic acid-dopamine (HA-DA) hydrogel, were employed to promote angiogenesis and inhibit inflammation. Incorporating black phosphorus (BP) into the hydrogel improved its electrical conductivity, thereby restoring electrical signal transmission in the infarcted myocardium and preventing arrhythmias. In vitro and in vivo experiments demonstrated that the exosome-loaded conductive hydrogel significantly enhanced cardiac function recovery by accelerating angiogenesis, reducing inflammation, and increasing electrical activity between myocardial cells. The hydrogel exhibited excellent biocompatibility, biodegradability, and sustained release of exosomes, ensuring prolonged therapeutic effects. This integrated approach resulted in notable improvements in the left ventricular ejection fraction, reduced fibrosis, and increased neovascularization. The combination of bioactive exosomes and a conductive hydrogel presents a promising therapeutic strategy for myocardial infarction repair.

Health Education Nursing Based on BCW Theory Improve Negative Psychology, Sleep and Quality of Life in Elderly Patients After Cardiac Interventional Surgery: A Retrospective Study

Objective: Guided by Behavior Change Wheel (BCW) theory, a rehabilitation nursing intervention program for patients after percutaneous coronary intervention (PCI) was constructed. This study aimed to explore the impact of this intervention program on the negative emotions, sleep quality, and quality of life of patients after PCI. Methods: Patients with coronary heart disease after PCI who visited the cardiology department in our hospital from September 2022 to February 2024 were selected as the research subjects. The patients were divided into two groups according to the order of the operation time: 57 cases in the conventional group and 56 in the BCW group. The systolic blood pressure, diastolic blood pressure, and resting heart rate (RHR) of the two groups before the administration (T1) and at the end of 3 month administration (T2) were evaluated. The Self-Rating Anxiety Scale (SAS), self-rating depression scale, Pittsburgh sleep quality index, and quality of life scale were used in measuring the anxiety, depression, sleep quality, and quality of life levels of the two groups of patients at two-time points. Results: A total of 113 cases were included: 57 cases in the conventional group and 56 in the BCW group. The BCW group had larger improvements in RHR and blood pressure than the conventional group (p &lt; 0.05). The SAS and Self-rating Depression Scale (SDS) scores of the BCW group were significantly lower than those in the conventional group (p &lt; 0.05). After nursing based on the BCW model was implemented, the Pittsburgh Sleep Quality Index (PSQI) scores of the patients in the BCW group were lower than those in the conventional group (p &lt; 0.001). After 3 months of administration, the SF-36 total score and other dimensional scores in the BCW group were higher than those in the conventional group (p &lt; 0.05), and no significant difference was observed between the groups before administration (p &gt; 0.05). Conclusion: Intervention programs based on BCW theory may help to reduce patients' depression and anxiety levels, potentially exerting positive effects that improve RHR and cardiac function in patients after coronary intervention and improving patients' sleep and life quality.

Adipocyte-Targeted Nanotechnology and Cell-Based Therapy for Obesity Treatment.

Obesity is a critical risk factor for the development of metabolic diseases and is often associated with dysfunctional adipocytes. Prevalent treatments such as lifestyle intervention, pharmacotherapy, and bariatric surgery are often accompanied by adverse side effects and poor patient compliance. Nanotechnology and cell-based therapy offer innovative approaches for targeted obesity treatments, as they can directly target adipocytes, regulate lipid metabolism, and minimize off-target effects. Here, we provide an overview of the intricate relationship between adipocytes and obesity, highlighting the potential of nanotechnology and cell-based therapy in obesity treatment. Additionally, we discuss the advancements of adipose-derived mesenchymal stem cells (ADMSCs) in obesity progression, including the latest challenges and considerations for developing adipose-targeted treatments for obesity. The objective is to provide a perspective on the design and development of nanotechnology and cell-based therapy for treating obesity and related comorbidities.

Ferroptosis and its Potential Determinant Role in Myocardial Susceptibility to Ischemia/Reperfusion Injury in Diabetes.

Myocardial ischemia/reperfusion injury (MIRI) is a major cause of cardiac death particularly in patients with diabetes. When the coronary artery is partially or completely blocked, restoration of blood perfusion can normally be achieved within a certain time due to the development of advanced techniques such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) surgery. However, cardiac tissue injury may aggravate progressively even after the ischemic myocardium is restored to normal perfusion. MIRI is often associated with various forms of cell death, including apoptosis, autophagy, programmed necrosis, pyroptosis, and ferroptosis, among others. Ferroptosis is known as iron-dependent cell death that is distinct from other programmed modes of cell death. Ferroptosis is under constitutive control by glutathione peroxidase 4 (GPX4), and the reduction of GPX4 may result in ferroptosis even if iron homeostasis is physiologically maintained. The essences of ferroptosis are substantial iron accumulation and lipid peroxidation that trigger cell death. Under impaired antioxidant system, cellular reactive oxygen species (ROS) accumulation leads to lipid peroxidation which consequently results in ferroptosis. Ferroptosis shares a few common features with several types of cell death and interplays with various forms of cell death such as autophagy and apoptosis in the development of cardiovascular diseases. More and more recent studies have demonstrated that ferroptosis plays an important role in MIRI. However, few studies have addressed the relative importance of ferroptosis in MIRI relative to other forms of cell deaths. In this review, we summarized the basic aspects and advances regarding the molecular pathogenesis of ferroptosis, evaluated its role in MIRI, and propose that the levels of ferroptosis may function as a major determinant of myocardial susceptibility to ischemia/reperfusion injury (IRI) in general and of the enhanced vulnerability to MIRI specifically in diabetes.

Addressing disparities in the long-term mortality risk in individuals with non-ST segment myocardial infarction (NSTEMI) by diabetes mellitus status: a nationwide cohort study.

The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI). We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics death reporting. We compared outcomes and quality of care by diabetes status. Individuals with diabetes were older (median age 74 vs 73 years), were more often of Asian ethnicity (13% vs 4%) and underwent revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery) (38% vs 40%) less frequently than those without diabetes. The mortality risk for those with diabetes compared with those without was significantly higher at 30 days (HR 1.19, 95% CI 1.15, 1.23), 1 year (HR 1.28, 95% CI 1.26, 1.31), 5 years (HR 1.36, 95% CI 1.34, 1.38) and 10 years (HR 1.39, 95% CI 1.36, 1.42). In individuals with diabetes, higher quality inpatient care, assessed by opportunity-based quality indicator (OBQI) score category ('poor', 'fair', 'good' or 'excellent'), was associated with lower mortality rates compared with poor care (good: HR 0.74, 95% CI 0.73, 0.76; excellent: HR 0.69, 95% CI 0.68, 0.71). In addition, compared with poor care, excellent care in the diabetes group was associated with the lowest mortality rates in the diet-treated and insulin-treated subgroups (diet-treated: HR 0.64, 95% CI 0.61, 0.68; insulin-treated: HR 0.69, CI 0.66, 0.72). Individuals with diabetes experience disparities during inpatient care following NSTEMI. They have a higher risk of long-term mortality than those without diabetes, and higher quality inpatient care may lead to better long-term survival.

Study on Bionic Design and Tissue Manipulation of Breast Interventional Robot.

Minimally invasive interventional surgery is commonly used for diagnosing and treating breast cancer, but the high fluidity and deformability of breast tissue reduce intervention accuracy. This study proposes a bionic breast interventional robot that mimics the scorpion's predation process, actively manipulating tissue deformation to control target displacement and enhance accuracy. The robot's structure is designed using a modular method, and its kinematics and workspace are analyzed and solved. To address the nonlinear breast tissue deformation problem, a hierarchical tissue method is proposed to simplify the three-dimensional problem into a two-dimensional one. A two-dimensional tissue deformation solver is established based on the minimum energy method for quick resolution. The problem is treated as quasi-static, deriving the displacement relationship between external manipulation points and internal tissue targets. The method of active manipulation of tissue deformation is simulated using MATLAB (2019-b) software to verify the feasibility of the method. Results show maximum errors of 1.7 mm for prostheses and 2.5 mm for in vitro tissues in the X and Y directions. This method improves intervention accuracy in breast surgery and offers a new solution for breast cancer diagnosis and treatment.

Robot-assisted Laparoscopic Ureteral Reimplantation in Pre-toilet Trained Children With Vesicoureteral Reflux

ObjectivesTo evaluate the outcomes of pre-toilet trained children undergoing RALUR for the treatment of primary VUR at our institution and compare these to an older cohort. Materials and MethodsThis retrospective study analyzed data from a single institution's registry, comparing outcomes between pre-toilet trained and toilet trained children who underwent RALUR for primary VUR. Preoperative parameters, surgical details, and postoperative outcomes were evaluated. ResultsThe study included 158 patients, with 24 in the pre-toilet trained group and 134 in the toilet trained group. Both cohorts exhibited similar demographics and preoperative characteristics. Operative times, complication rates, and surgical outcomes were comparable between the groups, despite the pre-toilet trained group presenting with more severe VUR grades. Incidence of febrile UTI after surgery and need for further intervention did not significantly differ between the cohorts. ConclusionThe current study demonstrates the feasibility, success, and safety of RALUR in pre-toilet trained compared to toilet-trained children and thus support the stance that it is a viable alternative to open surgery.

A Novel Transverse Ultrasound-Guided Approach for Puncturing the Cervical Dorsal Root Ganglion at the Level of Articular Pillar for Radiofrequency Treatment.

Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly involves the use of cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. Here, we proposed a novel transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment. A retrospective analysis of the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated with Hubei Medical University from January 2021 to March 2024 was performed. During surgery, motor electrical stimulation was used to induce movement in the nerve-innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. The numerical rating scale (NRS) was used for preoperative and postoperative pain assessment, clinical treatment effectiveness was evaluated, surgical duration and the associated complications were also recorded. Thirty patients exhibited clear cervical DRG images under ultrasound guidance, and the punctures were successful in all patients. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3-0.8 mv in all patients. No serious complications occurred during the procedure. The transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment is effective, convenient, and safe.

Risk Factors of Unsatisfactory Outcomes Requiring Additional Intervention Following Oblique Lateral Interbody Fusion.

Oblique lateral interbody fusion (OLIF) is a minimally invasive procedure for stabilizing the spine and indirectly decompressing the neural elements. There is sparse data on unsatisfactory outcomes that require additional interventions (surgery or intervention) after OLIF. This study aimed to identify the causes, and risk factors of these reintervention. This was a single-center retrospective study of the patients who underwent the OLIF procedure from June 2016 to March 2023. Several clinical and radiographic parameters were studied. We also analyzed associations between several potential risk factors and the reintervention following OLIF. A total of 231 patients were included. Over an average of 2.5 years of follow-up, 28 patients (12.1%) required a reintervention. Adjacent segment disease (ASD) was the most common cause of reintervention. The risk factors associated with reintervention were previous surgery (adjusted odds ratio [aOR], 4.44; 95% confidence interval [CI], 1.21-16.33; p=0.02) and high preoperative Oswestry Disability Index (ODI) scores (aOR, 1.04; 95% CI, 1.00-1.08; p=0.03). Although increasing the duration of follow-up was not statistically significant, the 95% CI was consistent with an increased risk of reintervention with longer follow-up (OR, 1.18; 95% CI, 0.94-1.50). This study showed that patients with prior lumbar surgery and high preoperative ODI scores were more likely to require additional intervention after the OLIF procedure. In addition, an increasing duration of follow-up was associated with an increased risk of reintervention. The most common reason for reintervention was ASD after OLIF.

Are Palliative Interventions Worth the Risk in Advanced Gastric Cancer? A Systematic Review.

Background: Less than 25% of gastric cancers (GC) are discovered early, leading to limited treatment options and poor outcomes (27.8% mortality, 3.7% 5-year survival). Screening programs have improved cure rates, yet post-diagnosis treatment guidelines remain unclear (systemic chemotherapy versus surgery). The optimal type of palliative surgery (palliative gastrectomy (PG), surgical bypass (SB), endoscopic stenting (ES)) for long-term outcomes is also debated. Methods: A literature review was conducted using PubMed, MEDLINE, and EMBASE databases along with Google Scholar with the search terms "gastric cancer" and "palliative surgery" for studies post-1985. From the initial 1018 articles, multiple screenings narrowed it to 92 articles meeting criteria such as "metastatic, stage IV GC", and intervention (surgery or chemotherapy). Data regarding survival and other long-term outcomes were recorded. Results: Overall, there was significant variation between studies but there were similarities of the conclusions reached. ES provided quick symptom relief, while PG showed improved overall survival (OS) only with adjuvant chemotherapy in a selective population. PG had higher mortality rates compared to SB, with ES having a reported 0% mortality, but OS improved with chemotherapy across both SB and PG. Conclusions: Less frail patients may experience an improvement in OS with palliative resection under limited circumstances. However, operative intervention without systemic chemotherapy is unlikely to demonstrate a survival benefit. Further research is needed to explore any correlations.

Impact of Diabetic Condition on the Remodeling of In Situ Tissue-Engineered Heart Valves.

Most in situ tissue-engineered heart valve (TEHV) evaluation studies are conducted in a healthy physical environment, which cannot accurately reflect the specific characteristics of patients. In this study, we established a diabetic rabbit model and implanted decellularized extracellular matrix (dECM) into the abdominal aorta of rabbits through interventional surgery with a follow-up period of 8 weeks. The results indicated that dECM implants in diabetic rabbits exhibited poorer endothelialization and more severe fibrosis compared to those in healthy animals. Furthermore, mechanistic studies revealed that high glucose induced endothelial cell (EC) apoptosis and impeded their proliferation and migration, accompanied by an increase in reactive oxygen species (ROS) concentration and a decrease in the nitric oxide (NO) level. High glucose also led to elevated ROS levels and an increased expression of inflammatory factors and transforming growth factor β1 (TGF-β1) in macrophages, contributing to fibrosis. These findings suggest that oxidative-stress-mediated mechanisms are likely the primary pathways affecting heart valve repair and regeneration under diabetic conditions. Therefore, future design and evaluation of TEHVs may concern more patient-specific circumstances.

MA-VoxelMorph: Multi-scale attention-based VoxelMorph for nonrigid registration of thoracoabdominal CT images

This paper aims to develop a nonrigid registration method of preoperative and intraoperative thoracoabdominal CT images in computer-assisted interventional surgeries for accurate tumor localization and tissue visualization enhancement. However, fine structure registration of complex thoracoabdominal organs and large deformation registration caused by respiratory motion is challenging. To deal with this problem, we propose a 3D multi-scale attention VoxelMorph (MA-VoxelMorph) registration network. To alleviate the large deformation problem, a multi-scale axial attention mechanism is utilized by using a residual dilated pyramid pooling for multi-scale feature extraction, and position-aware axial attention for long-distance dependencies between pixels capture. To further improve the large deformation and fine structure registration results, a multi-scale context channel attention mechanism is employed utilizing content information via adjacent encoding layers. Our method was evaluated on four public lung datasets (DIR-Lab dataset, Creatis dataset, Learn2Reg dataset, OASIS dataset) and a local dataset. Results proved that the proposed method achieved better registration performance than current state-of-the-art methods, especially in handling the registration of large deformations and fine structures. It also proved to be fast in 3D image registration, using about 1.5 s, and faster than most methods. Qualitative and quantitative assessments proved that the proposed MA-VoxelMorph has the potential to realize precise and fast tumor localization in clinical interventional surgeries.