Major Procedures Research Articles

Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea

Abstract Objectives Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival. Methods A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed. Results The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes. Key messages • This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission. • Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.

Extraction of old His bundle pacing leads and coronary sinus leads - an analysis of 3897 lead extraction procedures including 27 His and 253 coronary sinus lead removals

Abstract Background The lumen-less the Medtronic 3830 lead is most popular for His bundle pacing (HBP) and experience with such lead extraction are very limited especially for leads older than 4 years. Methods Analysis of 3898 transvenous lead extraction (TLE) procedures (including 27 HBP and 253 LVP lead extraction) was performed. Results The HBP was used usually in the CRT-D system (72.4%) and EF and NYHA class were better than patients with LVP extracted leads. Age of extracted HBP or LVP lead did not differ significantly (54.5 vs 50.2 months). Extraction of "old" HBP leads extraction was longer than in case of "young HBP leads (8,6 and 3.8 min). Mechanical dilatation was necessary in 63 and 100% extracted HBP leads. Unexpected procedure difficulties appeared (14,3%) and utility of second line / advanced tools had been utilised (28,6%) only when "old" HBP lead were extracted. Difficulties in extracting HBP leads were comparable to those encountered in the extraction of LVP leads of similar age. There was no extracted 3830 extracted lead break and no major complication, necessity of rescue cardiac surgery and procedure related death when HBP and LVP leads were extracted. The length of the FU period for those still alive patients was shorter for patients with removed leads for HBP as this technique was introduced significantly later than LVP. However, the 1-month mortality rate of patients with LVP lead removed is higher than in the HBP and control groups. Conclusions 1. HBP most frequently is utilised in the CRT-D system for resynchronisation of failing heart (72.4%) 2. Extraction of HBP leads is performed most frequently due to non-infective indications (59,3%) and most often because of lead dysfunction (33,3%). 3. Extraction of "old" (>40 mth) HBP leads is twice longer than younger ones (3.8 and 8,6 min) and mechanical dilatation is necessary frequently. 4. Extraction of "old" (>40 mth) HBP leads is more difficult than younger ones due to appearance unexpected procedure difficulties (14,3%) and necessity utility of second line / advanced tools (28,6%) but it does not entail the risk of major complications and procedure related death. 5. Difficulties in extracting HBP leads comparable to those encountered in the extraction of LVP leads of similar age. 6. Survival after HBP and LVP lead extraction was comparable, but shorter than after removal of other leads.

Use of extracorporeal membrane oxygenation during a decompressive hemicraniectomy for severe traumatic brain injury: illustrative case.

Decompressive hemicraniectomy (DHC) can be a life-saving treatment for patients with severe traumatic brain injury (TBI) with a focal mass lesion who develop refractory elevated intracranial pressure (ICP). Nonetheless, successful completion of this procedure requires maintaining hemodynamic and respiratory stability. Extracorporeal membrane oxygenation (ECMO) use in patients with respiratory or cardiac failure is well described in the literature and has become routinely used in patients with refractory hypoxia unresponsive to traditional mechanical ventilation strategies, but few cases of its use have been reported in the neurosurgical literature. Herein, the authors describe a unique case in which a man presented after an unwitnessed fall that caused severe TBI without a focal mass lesion. The patient subsequently developed medically refractory elevated ICP secondary to traumatic cerebral edema. He required DHC, but the procedure could only be completed safely with the utilization of intraoperative ECMO. As more is learned about the techniques and pitfalls of ECMO, its indications are rapidly expanding. The case presented describes the safe use of ECMO during a major neurosurgical procedure, showing that the technique can be completed safely and offering a therapeutic option for effectively addressing refractory hypoxia and hypercarbia in patients with severe TBI who require urgent or emergency neurosurgical procedures. https://thejns.org/doi/10.3171/CASE24264.

Prior central venous catheter placement and age are associated with earlier intervention after permanent hemodialysis access creation.

Arteriovenous fistulas (AVFs) and grafts are essential for long-term hemodialysis access in patients with end-stage renal disease. However, complications and access failure often necessitate re-intervention. In this study, we aim to delineate the factors associated with earlier failure of permanent hemodialysis access warranting revision procedures. This retrospective study aimed to identify factors associated with increased revision rates in AVFs and arteriovenous grafts, using multivariate survival analysis. A cohort of 136 patients who underwent initial arteriovenous access creation between 2005 and 2022 was analyzed. Patient characteristics, including age, comorbidities, access type, and vascular anatomy, were extracted, and hazard ratios (HR) were calculated to identify independent predictors of needing revision. A total of 119 patients were included in the final cohort, with a mean age of 55.2 years. Over 40% of patients had a previous central venous catheter placement, while 15% had a previous AVF. The majority of procedures were performed on the left side (74%), and brachiocephalic fistulas were most commonly created (41%). Univariate and multivariate Cox regression revealed that age (adjusted HR = 1.02, p = 0.01) and prior central venous catheter placement (adjusted HR = 1.77, p = 0.01) were independent predictors of earlier revision, while other variables such as sex, hypertension, and diabetes did not show significant associations. Patients with prior central venous catheter placement had a 77% increased risk of revision, even when adjusted for confounders. Understanding predictors of successful long-term access outcomes can guide decision-making regarding access type and alternative strategies. In our cohort, increased age and prior central venous catheter placement are associated with a shorter time to failure of permanent hemodialysis access and an increased risk of needing revision.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.

Incidence and risk factors of postoperative delirium in lumbar spinal fusion patients: A National Database analysis

Postoperative delirium (POD) is a frequent complication observed in patients following spinal surgeries. The incidence of POD is particularly concerning for major procedures like lumbar spinal fusion, leading to a range of detrimental outcomes. However, existing research on the prevalence and risk factors associated with POD after lumbar spinal fusion is limited, especially when relying on data from large-scale national databases. This study employed a comprehensive analysis of the National Inpatient Sample (NIS) database, encompassing data from 2010 to 2019. The study population included patients who underwent primary lumbar spinal fusion surgery. We compared patients who did not experience POD with those who developed POD postoperatively, analyzing demographic characteristics, pre-existing comorbidities, and perioperative complications. Analysis of the NIS database identified a total of 493,481 patients who underwent lumbar spinal fusion. The overall incidence of POD following the procedure was 1.07%. Patients who experienced delirium postoperatively exhibited significantly longer hospital stays, incurred higher healthcare costs, and faced a heightened risk of in-hospital mortality (p < 0.001). Additionally, POD following lumbar spinal fusion was associated with various medical complications, including acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infections. Several independent predictors were identified as being significantly associated with postoperative delirium, including advanced age (≥65 years old), pre-existing neurological disorders, a history of alcohol or drug abuse, depression, psychotic disorders, fluid and electrolyte imbalances, diabetes, weight loss, deficiency anemia, coagulopathy, congestive heart failure, pulmonary circulation disorders, peripheral vascular disease, chronic renal insufficiency, and receiving treatment at a teaching hospital. Notably, neurological disorders demonstrated the strongest correlation with the development of postoperative delirium. Overall, our analysis revealed a relatively low prevalence of POD following lumbar spinal fusion surgery. Nevertheless, it is critical to investigate and understand the independent predictors of POD to effectively prevent and mitigate its negative impact on patient outcomes.

PREVALENCE AND DETERMINANTS OF HYSTERECTOMY IN THE GYNECOLOGY UNIT OF AYUB TEACHING HOSPITAL, ABBOTTABAD

Hysterectomy is one of the most common obstetric surgery performed on women. It provides symptomatic relief, reduces morbidity and enhances the quality of life but can also lead to complications like mental stress, infertility, fractures and cardiovascular insults. To the best of our knowledge, no studies have provided information regarding the prevalence and risk factors of hysterectomies in Pakistani females. Objective: The goal of this study is to investigate the prevalence and socio-demographic determinants of hysterectomy in a teaching hospital in Pakistan, Methods: This descriptive cross-sectional study was done in the Gynecology C unit of Ayub Teaching Hospital, Abbottabad from 25th July 2024 to 10th Oct, 2024 after taking approval from ethical committee. 246 patients who underwent major gynaecological procedures were included in this study. Basic demographics, type of procedure and indication for hysterectomy were noted after obtaining consent from the patient. Results: The overall prevalence of hysterectomy was around 36.9% in our study. Heavy menstrual bleeding (43.95%) was found to be the leading cause of hysterectomy followed by fibroid uterus and adenomyosis in 25.27% and 16.48% cases respectively. Additionally, age group 45-49 (OR: 1.04, 95% CI: 0.5-2.1), urban residence (OR: 1.08, 95% CI: 0.64-1.8), more gravida (OR: 2.08, 95% CI: 0.88-4.92) and higher socioeconomic levels (OR: 1.28, 95% CI: 0.62-2.64) were found to increase odds of hysterectomy, whereas having a job (OR: 0.83, 95% CI: 0.47-1.44) and getting college education (OR: 0.83, 95% CI: 0.4- 1.7) were found to decrease the risk of hysterectomy. Conclusion: The prevalence of hysterectomy was found to be higher than in other countries. Urban residence, multigravida, higher socioeconomic levels and older age groups tend to increase the odds of hysterectomy.

Precision detection and identification method for apparent damage in timber components of historic buildings based on portable LiDAR equipment

For the purpose of preservation and restoration of historic timber buildings, it is critical that damage to timber components must be detected and identified accurately since proper detection and identification lay the foundation for scientific utilization and preservation of cultural heritage. Portable smart devices with integrated LiDAR sensor technology have significantly advanced, enabling them to be major pedestals for damage detection. An iPhone Pro based technique is therefore suggested for the precise detection and diagnosis of apparent damage to the timber components. The study consists of three major procedures. First, an apparent data collection of the timber components was conducted. A high-resolution triangular mesh model was utilized for precision detection and identification. Point cloud and texture data were the main constituents of this data collection. Second, a technique for image processing and apparent damage analysis was proposed for crack detection in historic timber buildings. This approach can be used to identify, recognize,and assess damage to timber components such as cracks, rotting, and knots. Finally, actual measurements of the timber components in Datong, Shanxi Province, at the Great Temple Corner, proved the effectiveness of the iPhone 12 Pro as a substitute approach to the conventional inspection equipment. The findings indicate that the iPhone 12 Pro, which has a built-in LiDAR sensor, performs exceptionally well in terms of effectiveness, accuracy, and graphical interpretation when identifying apparent damage to historic timber components. Moreover, it has the potential to substitute traditional measurement, 3D scanning, and other detection and identification techniques. Even though damage detection and identification of historical timber buildings has reached a mature stage in terms of portable, refined, and digital transformation, such technique can serve as a compatible addition as a safe, affordable, and paradigm shifting technical solution for detection and identification of historic building components.

Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

Background: This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. Methods: A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia. Space requirements were compared to general surgery cases (laparoscopic appendectomy) and general orthopaedic surgery cases (cephalomedullary nail [CMN]). Necessary operative equipment was measured (ft2) to calculate requirements for each procedure. Results: Large hand cases such as digit replantation necessitated the most OR space (125 ft2), followed by general orthopaedic cases (CMN; 118 ft2), medium-sized hand cases (CRPP phalanx; 107 ft2), general surgery laparoscopic appendectomy (68 ft2), small hand cases (CTR; 85 ft2) and minor procedures (49 ft2). Conclusions: Hand procedures can be divided into major procedures requiring significant OR space (125 ft2), medium procedures in standard OR suites (107 ft2), procedures in small ORs with anaesthesia (81 ft2) or office-based setting without anaesthesia (49 ft2). These findings help define space utilisation for hand procedures and may have practical implications related to efficiency, cost and patient safety in the hospital and outpatient setting. Level of Evidence: Level IV (Economic and Decision Analyses).

Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019

IntroductionThe incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019. Materials and MethodsWe examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission. ResultsWe identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63–0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48–2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34–2.58, P < 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16–2.48, P = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78–3.74, P < 0.001), open radical nephrectomy (OR 2.06, CI 1.42–2.99, P < 0.001) and open radical prostatectomy (OR 2.12, CI 1.44–3.12, P < 0.001). Female urologists had significantly lower odds of performing each oncologic procedure. ConclusionsIn this analysis of early career urologist case logs, the proportion of urologists performing a radical cystectomy, radical nephrectomy, and open prostatectomy declined between 2003 and 2019. Oncology specialization or fellowship training, however, significantly increased the odds of performing the procedures. Specifically, oncology fellowship alone was associated with over 2 times the odds of performing major open oncologic procedures. These findings reflect ongoing specialization among early career urologists, such that an oncology fellowship or practice focus has likely become necessary for access to open urologic procedures and to become a high-volume urologic oncology surgeon.

Risk of Venous Thromboembolism in Adolescents Undergoing Pelvic Osteotomy: Insights From a Propensity-matched Retrospective Cohort Study.

Pelvic osteotomies are surgical procedures that are commonly performed in adolescents and young adults to improve stability or correct various deformities. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), are dreaded complications of any major procedure including pelvic osteotomies. Unlike adults, the incidence of DVT and need for prophylactic measures are not well understood in the adolescents. The purpose of this study is to understand the need for VTE prophylaxis in adolescents and determine if their risk profile aligns with adults, who have more established VTE prophylactic guidelines in place for these surgeries. This retrospective cohort study utilized data from the TriNetX Research Network, which includes records from over 80 healthcare organizations and more than 120 million patients. De-identified patient data from January 1, 2003, to March 1, 2024, were extracted using relevant ICD-9 and ICD-10 procedural codes. The study included 2 cohorts: patients aged 13 to 17 years (adolescents) and patients 18 years and older (adults) who underwent pelvic osteotomies. To control for confounding variables, propensity score matching was employed based on sex and relevant comorbidities, including diabetes mellitus, tobacco use, and overweight/obesity. Statistical significance was set at P<0.01. A total of 2374 patients successfully matched in each cohort. Within 90 days following surgical intervention, adult patients had overall risks of 4.5%, 1.9%, and 5.9%, whereas adolescent patients had overall risks of 1.3%, 0.5%, and 1.4% for DVT (RR: 3.419), PE (RR: 4.182), and either DVT or PE (RR: 4.118), respectively. This study examines the rate of VTE in a large cohort of adolescents undergoing pelvic osteotomies. Although we found the rates to be lower in adolescents compared with adults, the high absolute risk in adolescents-above 1%, the threshold established in the literature for considering prophylaxis-underscores the need for tailored risk stratification strategies and targeted thromboprophylaxis protocols for this population. Level III: case-control study or retrospective cohort study.

Surgical Specialty Outcome Differences for Major Spinal Procedures in Low-Acuity Patients.

Retrospective Cohort Study. There is an ongoing debate as to the influence of specialty training on spine surgery. Alomari et al. indicated the influence of specialty on ACDF procedures. However, deeper analysis into other spine procedures and lower-acuity procedures has yet to occur. In this study, we aim to determine if the outcomes of the low American Society of Anesthesiologists (ASA) classification (ASA 1&2) patients undergoing spine surgery vary based on whether the operating surgeon was an orthopedic surgeon or a neurosurgeon. The NSQIP databases from 2015 to 2021 were queried based on the CPT code for nine common spine procedures. Indicators of surgical course and successful outcomes were documented and compared between specialties. Neurosurgeons had minimally shorter operative times in the ASA 1&2 combined classification (ASA-C) group for cervical, lumbar, and combined spinal procedural groups. Neurosurgeons had a slightly lower percentage of perioperative transfusions in select ASA-C classes. Orthopedic surgeons had shorter lengths of stay for the cervical groups in ASA-C and ASA-1 classes (ASA-1). However, many specialty differences found in spine patients become less pronounced when considering only ASA-1 patients. Finally, postoperative complication outcomes and re-admission were similar between orthopedic and neurological surgeons in all cases. These results, while statistically significant, are very likely clinically insignificant. They demonstrate that both orthopedic surgeons and neurosurgeons perform spinal surgery exceedingly safely with similarly low complication rates. This lays the groundwork for future exploration and benchmarking of performance in spine surgeries across neurosurgery and orthopedics.

Retrospective analysis of hemophilia B in Turkey: identifying main characteristics and treatment options

BackgroundHemophilia B (HB), an X-linked recessive inherited bleeding disorder, exhibits a high prevalence among males. ObjectivesTo present the first national cohort of persons with HB to define the demographics, clinical characteristics, and treatment patterns in Turkey. MethodsThis multicenter, retrospective study included 433 alive persons with HB registered in 35 centers between 1961 and 2018. Analyses were performed by age subgroups (0-17 years, 18-64 years, and ≥65 years), disease severity by factor levels (severe, <1 IU/dL; moderate, 1-5 IU/dL; mild, >5 IU/dL). Additionally, patients were stratified based on the initiation year of follow-up at the relevant study center, creating 2 periods: 1993-2006 (referred to as period A) and 2007-2018 (referred to as period B). ResultsPredominantly male (98.6%), the median age at data entry was 22.1 years (n = 429). The majority (49.0%) had moderate HB, followed by severe (30.0%) and mild (15.7%) disease. Of the 377 patients with complete treatment details, 209 (55.4%) were under prophylaxis from their diagnosis onwards, while 79 patients (21.0%) only received on-demand treatment. Additionally, 89 patients (23.6%) initially underwent on-demand treatment and later were switched to prophylaxis. Knees were the primary site of bleeding and the most frequently intervened joints. Most of the major (47.5%) and minor (53.3%) orthopedic procedures were carried out in persons with severe HB, while half of radioactive synovectomy procedures were performed on persons with moderate HB. ConclusionThis paper describes the demographics, clinical characteristics, and treatments patterns of a large cohort of alive persons with HB on a national scale.

HYPERBILIRUBINEMIA: A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS PART IN PREDICTING APPENDICULAR PERFORATION

Introduction:Acuteappendicitis is the commonest cause of Acute Surgical abdomen.Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Aims&amp;Objectives:The objectives of the study were-To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis. Materials&amp;Methods:The study was conducted in the Department of General Surgery, HKEs Basaveshwar Teaching and General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi during the period of August 2022 to August 2023. A one year cross sectional study. Results:A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation admitted in the Department of General surgery, HKEs Basaveshwar Teaching &amp; General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi were studied. Discussion:Acute appendicitis is the most common cause of acute abdomen in young adults. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training.PPAbout 8% of people in Westerncountries have appendicitis at some time in their lifetime. Conclusion: The present study suggests-Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out tobe a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making.

Central venus cannulation during cardiac surgery as a possible new additional risk factor for late post-operative atrial fibrillation insurgence.

Postoperative atrial fibrillation (POAF) is the most frequent cardiac arrhythmia following cardiac operations. It has been associated with an increased risk of postoperative cerebrovascular complications, morbidity and mortality. The aim of this study is to evaluate if the type of venous cannulation to institute the cardiopulmonary bypass (CPB) during major cardiac surgery procedures can influence the rate of POAF and late FA onset. We collected data from 2087 consecutive patients who have been operated at our Institution from January 2016 to December 2018. To obtain two homogenous groups we performed a propensity match analyzes: Group 1 for whom the blood drain of the CPB has been granted via peripheral cannulation (PC) through the right common femoral vein and Group 2 with patients who underwent central cannulation (CC) with insertion of a drainage cannula in the right atrium or in the superior and inferior vein cava. POAF has been observed as statistically similar between the two groups. At 1250-day follow-up, While the incidence of POAF was 2.9% and 8.7% in the PC and CC groups, respectively (p = .04). our data seems to show that the two groups do not differ in terms of POAF, while the CC group may have a significantly higher rate of atrial fibrillation in the follow-up period.

The role of subcutaneous drain in laparotomy patients

Background: In surgical incision wounds, hematoma, serous fluid, and dead space increase the risk of infection because they provide a surface for microbial growth. Subcutaneous drain reduces dead space in the subcutaneous tissue plane, which prevents fluid from accumulating and seroma from forming by removing infectious content, residual effusion, and blood from the wound. This study attempts to determine the efficacy of subcutaneous drain in laparotomy in the management of surgical site infection (SSI). Methods: This prospective study was conducted at the Department of Surgery in various hospitals in Cumilla, Bangladesh. This study includes 150 adult patients aged between 18 to 70 years. A closed subcutaneous suction drain was inserted before the skin was closed in 75 patients at random (drain group), whereas the rest of the 75 patients' subcutaneous suction drains were not kept (no-drain group). Results: The association between comorbidities and SSI in both the drain and no-drain groups were significant, p value &lt;0.001 respectively. SSI was mainly in the group with fewer surgery hours (72.4%). Patients with SSI also have longer hospital stays on average. Conclusions: Patients with SSI have increased morbidity, and those undergoing major procedures are more likely to experience SSI afterwards. The presence of a subcutaneous closed suction drain contributes to reducing SSI.

Analyzing the emergence of surgical robotics in Africa: a scoping review of pioneering procedures, platforms utilized, and outcome meta-analysis.

Surgical practice globally has undergone significant advancements with the advent of robotic systems. In Africa, a similar trend is emerging with the introduction of robots into various surgical specialties in certain countries. The need to review the robotic procedures performed, platforms utilized, and analyze outcomes such as conversion, morbidity, and mortality associated with robotic surgery in Africa, necessitated this study. This is the first study examining the status and outcomes of robotic surgery in Africa. A thorough scoping search was performed in PubMed, Google Scholar, Web of Science, and African Journals Online. Of the 1,266 studies identified, 16 studies across 3 countries met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% confidence interval (CI) of conversion, morbidity, and mortality. Surgical robots are reportedly in use in South Africa, Egypt, and Tunisia. Across four specialties, 1,328 procedures were performed using da Vinci (Intuitive Surgical), Versius (CMR Surgical), and Senhance (Asensus Surgical) surgical robotic platforms. Urological procedures (90.1%) were the major procedures performed, with robotic prostatectomy (49.3%) being the most common procedure. The pooled rate of conversion and prevalence of morbidity from the meta-analysis was 0.21% (95% CI, 0%-0.54%) and 21.15% (95% CI, 7.45%-34.85%), respectively. There was no reported case of mortality. The outcomes highlight successful implementation and the potential for wider adoption. Based on our findings, we advocate for multidisciplinary and multinational collaboration, investment in surgical training programs, and policy initiatives aimed at addressing barriers to the widespread adoption of robotic surgery in Africa.

Tools for assessing the quality of life of hysterectomized women: A systematic review.

Since hysterectomy surgery is a major and invasive procedure, it can affect the quality of life of women in many ways. This study aimed to review and critique the psychometric properties of tools used to measure the quality of life of hysterectomized women. An advanced search was conducted in international (PubMed, Web of Science, Scopus, PsycINFO, Embase) as well as national databases (SID and Magiran) to retrieve articles published from 2000 to 2024, using keywords related to hysterectomy and quality of life. Then, the psychometric properties of the tools found in these articles were evaluated by COSMIN checklist. The psychometric properties of tools were analyzed using the COSMIN checklist. Among the 20 general and specific tools examined, content validity had not been evaluated in 15 tools, construct validity had not been evaluated in four tools, criterion validity had not been evaluated in eight tools, internal consistency had not been evaluated in five tools, responsiveness had not been evaluated in 16 tools, and interpretability had not been assessed in 18 tools, and measurement error had not been evaluated in any of the tools. The results showed that none of the evaluated tools have all the criteria of Cosmin's checklist. Of course, construct validity and reliability had been assessed in most of the tools. Meanwhile, there was no tool to measure the quality of life of hysterectomized women specifically. Therefore, it seems that developing a tool with acceptable psychometric properties is necessary to measure the quality of life of hysterectomized women specifically.

Design and construction of GaInSn experimental facility for studies of mixed-convection MHD flows

A multifunctional liquid metal loop named MaTHE-XJTU (Magneto-Thermo-Hydrodynamic Experiments-Xi'an Jiaotong University) that utilizes eutectic alloy GaInSn as a working fluid has been designed and constructed. The function of the MaTHE-XJTU facility is to study the magnetohydrodynamic (MHD) flow and mixed convection characteristics under the coupling effect. The main operating parameters of the loop are: the maximum magnetic field intensity is 3T, the effective magnetic field region is 300 mm × 800 mm × 1000 mm, the maximum flow rate of electromagnetic pump (EM pump) is 8 m3/h, the maximum pressure head of EM pump is 0.5 MPa. The paper describes the major components and basic operation procedures of the loop, the related flow diagnostics method, and near-future experiments. This loop could provide a high-parameter experimental platform (Ha∼104, Gr∼109, Re∼104) for investigations that improve the present understanding of magnetohydrodynamic and heat transfer performance in liquid metal blankets.

Real-World Evidence comparing Early and Late Pancreatic Stent Placement to Prevent Post-ERCP Pancreatitis

Background: Pancreatic stenting effectively lowers the occurrence of post-ERCP pancreatitis (PEP) and reduces its severity. However, limited research has been conducted to determine the optimal timing for pancreatic stent placement. Our objective was to evaluate whether early pancreatic stent placement (EPSP) is more effective than late pancreatic stent placement (LPSP) in preventing PEP among patients with naive papilla. Methods：We conducted a retrospective cohort study that analyzed 590 patients with difficult biliary cannulation using the pancreatic guidewire technique, who were grouped into EPSP and LPSP. In the EPSP group, a pancreatic stent was placed immediately before/after endoscopic retrograde cholangiography (ERC) or endoscopic sphincterotomy (EST). Conversely, in the LPSP group, a pancreatic stent was placed after partial/all completion of major endoscopic procedures. Results：From Nov. 2017 to May 2023, a total of 385 patients were divided into EPSP and 205 into LPSP. EPSP was associated with a decreased PEP occurrence compared to LPSP (2.9% vs. 7.3%; P=0.012). Similarly, hyperamylasemia was lower in the EPSP group (19.7% vs. 27.8%; P=0.026). Furthermore, sensitivity analysis using multivariable analysis and propensity score–matched (PSM) analysis also validated these findings. Conclusion：Early pancreatic stent placement reduced the incidence of PEP and hyperamylasemia compared to late pancreatic stent placement. Our findings favor pancreatic stenting immediately before/after ERC or EST.