Minimal Trauma Research Articles

Epidermolysis Bullosa and Associated Therapy: a Literature Review

Background: Epidermolysis Bullosa is associated with poor dermal-epidermal cohesion, leading to the formation of blisters, erosions and scars on the skin and mucous membranes in response to minimal mechanical trauma. It is clinically and genetically heterogeneous, comprising phenotypes with different levels of severity. A definitive cure does not appear to be forthcoming, with symptomatic treatment being the most commonly used approach. However, various studies and clinical trials have been carried out with the aim of testing different theories and finding an effective method for improving the quality of life of people with this condition and mitigating its negative effects. Objectives: The aim of this study is to gather complete and up-to-date information on the main therapeutic strategies used and/or under development for Epidermolysis Bullosa. Material and Methods: A literature review was carried out, searching the Pubmed, Google Scholar and Scielo databases for the keywords "epidermolysis bullosa", "treatment" and "pharmacotherapy", selecting articles using the inclusion and exclusion criteria. Results: Based on the articles included in this review, it was possible to understand the different existing strategies for the treatment of Epidermolysis Bullosa. It was found that there are various types of therapies under development, although the results obtained are promising. Conclusion: As this is a very heterogeneous pathology, it is difficult to find a therapy that is effective and does not cause serious adverse effects. This is an area that should continue to be studied, with the aim of improving the quality of life of those affected.

Impact of Low-Temperature Plasma Radiofrequency Tonsillectomy on Pain, Inflammatory Markers, and Sleep Quality in Adults with Chronic Tonsillitis.

Chronic tonsillitis (CT) is a very common ear, nose, and throat disease worldwide, and in severe cases it can cause sleep apnea hypoventilation syndrome, which can affect the patient's health and can even be life-threatening. Low-temperature plasma radiofrequency tonsillectomy is one of the commonly used methods for treating CT with remarkable results, but more detailed reports are lacking. In this study, we aimed to explore the impact of low-temperature plasma radiofrequency tonsillectomy on pain, inflammatory markers, and sleep quality in adult CT patients for clinical reference. A retrospective study was performed on adult patients diagnosed with CT at our hospital between June 2019 and October 2023. Patients were categorized into a control group receiving traditional tonsillectomy and a treatment group undergoing low-temperature plasma radiofrequency tonsillectomy. The groups were compared in terms of baseline characteristics, surgical parameters, visual analogue scale (VAS) scores, 36-item short form (SF-36) health survey questionnaire scores, inflammatory markers, and Pittsburgh Sleep Quality Index (PSQI) scores. Group differences in postoperative complications were also analyzed. There were 160 patients, 80 in the treatment group (50 males and 30 females, mean age 28.90 ± 2.46 years) and 80 in the control group (46 males, 34 females, mean age 28.89 ± 2.01 years). Differences between the two groups in terms of age, sex, duration of disease, smoking history, body mass index, and other baseline characteristics were not statistically significant (p > 0.05). Operation time, intraoperative bleeding, return to normal diet, and pseudomembrane detachment time in the treatment group were all significantly lower than in the control group (p < 0.05). There were no significant differences in VAS or SF-36 scores before treatment (p > 0.05). Post-treatment, both groups had lower VAS scores and higher SF-36 scores in the treatment group compared to the control group (p < 0.05). There were no significant differences in levels of inflammatory markers before treatment (p > 0.05). Both groups showed increased levels of inflammatory markers post-treatment, but the treatment group had lower post-treatment levels of Interleukin-6 (IL-6) and hypersensitive-C reactive protein (hs-CRP) than the control group (p < 0.05). No significant difference was observed between the two groups in PSQI scores before treatment (p > 0.05). Following treatment, both groups had decreased PSQI scores, with lower scores in the treatment group than in the control group (p < 0.05). The complication rate was lower in the treatment group than in the control group, with rates of 8.75% and 23.75%, respectively (p < 0.05). Low-temperature plasma radiofrequency tonsillectomy for adult CT patients offers advantages such as shorter surgical time, reduced intraoperative bleeding, minimal trauma, and fewer postoperative complications. This procedure significantly alleviates pain, improves quality of life, reduces levels of inflammatory markers, and enhances sleep quality.

Flapless Dental Implant Surgery in Bleeding Disorders

Hemostasis disorders require particular attention in dental treatment. Dental implants are a very widespread and valid method for total rehabilitation. Flapless dental implant surgery is a minimally invasive treatment that allows the implants to be placed in the jaw bones with minimal surgical trauma. The aim of this study is to report the bleeding incidence in a group of patients with bleeding disorders treated with flapless implants. A total of 52 patients with bleeding disorders (46 in anticoagulant therapy; 4 with hemophilia; 2 with von Willebrandt disease) were treated with 188 flapless implant surgeries Anticoagulants were not discontinued. Patients with hemophilia and VWD were treated following specific protocols. Four late, easy to treat bleeding complications were reported (three mild bleeding, one ecchymosis). No additional sutures or other hemostatic measures were taken, no further infusions or transfusions were reported, and no severe bleeding complications requiring more than easy on-chair treatment, were reported. In conclusion, with adequate knowledge of the procedure and the pathology, dental implantology can be safely performed in patients with bleeding disorders.

A Co-MOF encapsulated microneedle patch activates hypoxia induction factor-1 to pre-protect transplanted flaps from distal ischemic necrosis

Avoiding ischemic necrosis after flap transplantation remains a significant clinical challenge. Developing an effective pretreatment method to promote flap survival postoperatively is crucial. Cobalt chloride (CoCl2) can increase cell tolerance to ischemia and hypoxia condition by stimulating hypoxia-inducible factor-1 (HIF-1) expression. However, the considerable toxic effects severely limit the clinical application of CoCl2. In this study, cobalt-based metal-organic frameworks (Co-MOF) encapsulated in a microneedle patch (Co-MOF@MN) was developed to facilitate the transdermal sustained release of Co2+ for rapid, minimally invasive rapid pretreatment of flap transplantation. The MN patch was composed of a fully methanol-based two-component cross-linked polymer formula, with a pyramid structure and high mechanical strength, which satisfied the purpose of penetrating the skin stratum corneum of rat back to achieve subcutaneous vascular area administration. Benefiting from the water-triggered disintegration of Co-MOF and the transdermal delivery via the MN patch, preoperative damage and side effects were effectively mitigated. Moreover, in both the oxygen-glucose deprivation/recovery (OGD/R) cell model and the rat dorsal perforator flap model, Co-MOF@MN activated the HIF-1α pathway and its associated downstream proteins, which reduced reperfusion oxidative damage, improved blood supply in choke areas, and increased flap survival rates post-transplantation. This preprotection strategy, combining MOF nanoparticles and the MN patch, meets the clinical demands for trauma minimization and uniform administration in flap transplantation. Statement of significanceCobalt chloride (CoCl2) can stimulate the expression of hypoxia-inducible factor (HIF-1) and improve the tolerance of cells to ischemia and hypoxia conditions. However, the toxicity and narrow therapeutic window of CoCl2 severely limit its clinical application. Herein, we explored the role of Co-MOF as a biocompatible nanocage for sustained release of Co2+, showing the protective effect on vascular endothelial cells in the stress model of oxygen-glucose deprivation. To fit the clinical needs of minimal trauma in flap transplantation, a Co-MOF@MN system was developed to achieve local transdermal delivery at the choke area, significantly improving blood supply opening and flap survival rate. This strategy of two-step delivery of Co2+ realized the enhancement of biological functions while ensuring the biosafety.

ЛАПАРОСКОПИЧЕСКАЯ ПАНКРЕАТОЦИСТОЕЮНОСТОМИЯ

Background. Pancreatic pseudocyst formation is known to be one of the most common complications of chronic pancreatitis. Despite the widespread use of the laparoscopy, it is still relatively rarely employed in pancreatic surgery. Objective. To analyze the outcomes of laparoscopic Roux-en-Y pancreatocytojejunostomy as well as to present a brief literature review. Material and methods. Data from diagnostic examinations, laboratory tests, as well as the outcomes of surgical treatment of a female patient for a pancreatic cyst are presented. It is worth noting that a laparoscopic Roux-en-Y pancreatocystojejunostomy was used for pancreatic cyst treatment in this case. Results. Successfully performed laparoscopic surgery enabled to preserve as much of the pancreas as possible and to avoid postoperative complications. Conclusions. The described case, along with the reviewed publications, indicate that laparoscopic internal drainage may be regarded as a feasible method for the treatment of encapsulated cysts of the body and tail of the pancreas in chronic pancreatitis. This is due to the fact that this surgical option doesn’t involve pancreatic parenchyma volume reduction and has a lower risk of relapse as compared with external drainage methods. Based on the above mentioned, the choice of this method is associated with relatively minimal surgical trauma, fewer complications and a short-term postoperative period. To perform such operations successfully, special tools and skills are required. The presence of domestically produced endoscopic staplers contributes to the further implementation of this type of intervention into practice.

Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery.

Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.

Should major trauma fractures be part of a fracture liaison service’s remit: a cost–benefit estimate

SummaryThe refracture rate after major trauma is approximately half (57%) the refracture rate after a minimal trauma injury.Extending Fracture Liaison Service activity to include major trauma patients creates significant additional direct cost, but remains essentially cost neutral if notional savings through refracture risk reduction are taken into account.PurposeTo compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations.MethodsPatients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service’s (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored.The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies.ResultsThe 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ − 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified.ConclusionThe 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account.

Clinical comparative study of laparoscopic partial splenectomy and open partial splenectomy.

The aim of the article was too investigate and compare the feasibility, safety, and early postoperative recovery associated with laparoscopic partial splenectomy (LPS) and open partial splenectomy (OPS) in patients with benign splenic tumours and traumatic splenic rupture. A retrospective analysis was conducted on clinical data from 110 patients undergoing splenic resection at our hospital between March 2019 and May 2022. Among them, 35 patients underwent OPS, 25 underwent LPS for traumatic splenic rupture, while 50 patients with benign splenic tumours underwent either OPS (n = 20) or LPS (n = 30). Preoperative, intraoperative, and postoperative data were collected and compared. Statistical analysis was conducted using SPSS software. There was no significant difference in the general data between the 2 groups of patients with benign splenic tumours and those with splenic trauma. Among patients with traumatic splenic rupture, the OPS group had a shorter operation time (p < 0.05). Regardless of whether they had traumatic splenic rupture or benign splenic tumours, the LPS group required less postoperative analgesia and had a shorter defecation recovery time (p < 0.05). Additionally, the LPS group displayed lower white blood cell count, white blood cell/lymphocyte ratio (WLR), neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), calcitonin (PCT), and interleukin-6 (IL-6) than the OPS group on the first and third days post-surgery (p < 0.05). In comparison to OPS, LPS presents significant advantages, including minimal surgical trauma, a reduced early postoperative inflammatory response, milder wound pain, and a faster recovery of gastrointestinal function.

EMERGENCY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIOPLASTY FOR GARANGEOT'S HERNIA: A CASE REPORT

Abstract Aims This video presentation aims to demonstrate the successful management of a rare and challenging case of Garangeot's hernia through Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty. The primary objectives include highlighting the surgical technique, intraoperative findings, and postoperative outcomes in the context of this uncommon hernia presentation. Materials and Methods An 84-year-old female presented to the emergency department with signs of femoral hernia incarceration. Upon exploration, a Garangeot's hernia, characterized by the presence of the appendix within a femoral hernia sac, was identified. In light of the emergency and the patient's deteriorating condition, an Emergency Laparoscopic TAPP Hernioplasty was performed. The procedure involved meticulous dissection of the hernia sac, reduction of the herniated appendix and appendectomy, and subsequent mesh reinforcement of the femoral defect. Results The video illustrates the step-by-step approach to Emergency Laparoscopic TAPP Hernioplasty in the context of Garangeot's hernia. Intraoperative findings, including the condition of the herniated appendix and associated anatomical structures, are presented. Postoperative outcomes, including recovery, complications, and follow-up observations, are discussed to provide a comprehensive understanding of the case. Conclusions Emergency Laparoscopic TAPP Hernioplasty emerges as a viable and effective intervention for Garangeot's hernia, offering advantages such as reduced morbidity, quicker recovery, and minimal surgical trauma. This video contributes valuable insights into the management of this rare hernia presentation, emphasizing the role of minimally invasive techniques in achieving successful outcomes.

Minimally invasive method of surgical treatment of Peyronie's disease

Objective. To improve the results of surgical treatment of Peyronie's disease. Materials and methods. 20 patients with Peyronie's disease aged 22 to 60 were treated in the urological departments of the Private Clinical Hospital “Russian Railways Medicine” and Astrakhan City Clinical Hospital No. 3 named after. C.M. Kirov. A method of surgical treatment of Peyronie's disease using a shortening technique without opening the tunica albuginea includes the application of a pressure tourniquet to the base of the penis, puncture of the cavernous bodies, injection of sterile saline into them until an erection is achieved, determination of the angle of curvature of the penis, removal of the tourniquet and surgery to eliminate curvature of the penis. Results. Neither postoperative complications nor formation of hematomas were observed. The patients were discharged on the 4th day in satisfactory condition. 1.5 years` observation showed no progression of angular deformation of the penis which could impede sexual intercourse. The mobility of the skin of the penis was preserved. Conclusions. In addition to the correction of penile deformity, our method eliminates the need for extensive incisions and preserves the physiological functions of the penis. As a result of using this surgical method, the following goals are achieved: minimal trauma to tissues in the surgical area, absence of scar processes in the plastic area and preservation of the skin of the penis mobility, absence of pronounced postoperative tissue edema, no need to drain the wound, reduction of the duration of the operation and minimal blood loss, short postoperative and rehabilitation period.

Safety and feasibility of mini-open Wiltse approach in posterolateral lumbar stabilization and fusion: intra- and post-operative evaluation

BackgroundExpected operative challenges in minimally invasive spine surgeries as a result of restricted surgical field, unfamiliarity with surgical approaches and fear of complications are behind the preference of using traditional "open" spine surgery.ObjectivesTo evaluate the safety and feasibility of mini-open Wiltse approach in comparison with the conventional midline approach for posterolateral lumbar stabilization and fusion.Patients and methodsA retrospective comparative study conducted on 49 patients with low grade single level lumbar spondylolithesis who were surgically treated in our Department between May 2020 and May 2022. Patients who were surgically treated with traditional midline approach were included in group (A) and patients in whom the mini-open Wiltse approach was used, were assigned to group (B). The two groups were compared regarding various intra and postoperative parameters.ResultsGroup (A) included 27 patients (55.1%) operated upon with the classic midline approach and 22 patients (44.9%) were surgically treated using the Wiltse approach (group B). The mean patients' age (50.43 ± 5.538) years and L4-5 was the most commonly affected level (71.4%). The intra-operative parameters (operation time, blood loss and fluoroscopy time) showed significant lower results (P < 0.001) among patients of group (B). No cases in the group (B) required blood transfusion versus 5 cases in group (A) (P = 0.033). Postoperatively, the Oswestry Disability Index (ODI) and Visual analogue scale (VAS) scores were significantly improved in each group in comparison to the preoperative scores (P < 0.001). However, after 3 months the ODI score in group (B) was superior to that in group (A) (P = 0.045) and postoperative VAS score in group (B) was significantly improved compared to that in group (A) at discharge (P = 0.016), and also after 1 and 3 months (P < 0.001). Patients operated with Wiltse approach had a shorter duration of hospital stay but the difference was not statistically significant (P = 0.090).ConclusionsBecause of minimal trauma to the muscles and soft tissues, the mini-open Wiltse approach can be faster, safer and requires less recovery time as opposed to the classic midline approach.

Molecular engineering to elevate reactive oxygen species generation for synergetic damage on lipid droplets and mitochondria

Photodynamic therapy (PDT), characterized by high treatment efficiency, absence of drug resistance, minimal trauma, and few side effects, has gradually emerged as a novel and alternative clinical approach compared to traditional surgical resection, chemotherapy and radiation. Whereas, considering the limited diffusion distance and short lifespan of reactive oxygen species (ROS), as well as the hypoxic tumor microenvironment, it is crucial to design photosensitizers (PSs) with suborganelle specific targeting ability and low-oxygen dependence for accurate and highly efficient photodynamic therapy. In this study, we have meticulously designed three PSs, namely CIH, CIBr, and CIPh, based on molecular engineering. Theoretical calculation demonstrate that the three compounds possess good molecular planarity with calculated S1-T1 energy gaps (ΔES1-T1) of 1.04 eV for CIH, 0.92 eV for CIBr, and 0.84 eV for CIPh respectively. Notably, CIPh showcases remarkable dual subcellular targeting capability towards lipid droplets (LDs) and mitochondria owing to the synergistic effect of lipophilicity derived from coumarin's inherent properties combined with electropositivity conferred by indole salt cations. Furthermore, CIPh demonstrates exclusive release of singlet oxygen (1O2)and highly efficient superoxide anion free radicals(O2⦁−) upon light irradiation supported by its smallest S1-T1 energy gap (ΔES1-T1 = 0.84 eV). This leads to compromised integrity of LDs along with mitochondrial membrane potential, resulting in profound apoptosis induction in HepG2 cells. This successful example of molecular engineering guided by density functional theory (DFT) provides valuable experience for the development of more effective PSs with superior dual targeting specificity. It also provides a new idea for the development of advanced PSs with efficient and accurate ROS generation ability towards fluorescence imaging-guided hypoxic tumor therapy.

Safety of single-use flexible ureteroscopy for dusting of upper urinary tract calculi in children

BackgroundFlexible ureteroscopy offers numerous advantages, such as increased reach, superior stone-free rate, reduced risk of bleeding, minimal surgical trauma, and faster recovery time. There are few studies discussing the effectiveness of single-use flexible ureteroscopy in children, and none so far have addressed its safety. This study aims to evaluate the effectiveness and safety of a single-use flexible ureteroscope for treating upper urinary tract stones in children.MethodsThis study included children with single upper urinary tract stones measuring less than 2 cm who underwent single-use flexible ureteroscopy between October 2020 and January 2023. We assessed the following patient characteristics: age, gender, stone type, size, position, pre and postoperative stent placements, use of a ureteral access sheath, stone-free rate, operation duration, and the rate of complications. A patient was considered stone-free if there were no residual stone particles larger than 3 mm after surgery.ResultsFlexible ureteroscopy and holmium laser lithotripsy were undertaken for 44 participants, with an average age of 8.5 years (range: 2–16 years). The typical stone size was 14 mm (range: 6–20 mm). The average operation time was 74 min (range 35–110 min). Ureteral access sheaths were used in 81.8% (36 out of 44) of procedures. After a single FURS session, 86.36% (38 out of 44) of patients achieved stone-free status. Postoperative JJ stent application was noted in 86.4% (38 out of 44) of patients. Complications were categorized using the Calvien system, revealing that 25% (11 out of 44) of patients experienced mild hematuria, colic, and low-grade fever (Calvien I). No severe side effects like mucosal avulsion or ureteral perforation were reported.ConclusionIn the short-term, single-use flexible ureteroscopy is a safe and effective method for managing single renal and proximal ureteric stones, measuring 2 cm or less, in children.

Osteoporosis and fracture risk assessment in adults with ischaemic stroke

PurposeTo study the prevalence of osteoporosis, falls and fractures in adults with ischaemic stroke.MethodsObservational cohort study of adults aged ≥ 50 years admitted with ischaemic stroke over a 12-month period were invited to participate in a telephone interview one-year post-stroke to ascertain falls and fracture. A Fracture Risk After Ischaemic Stroke (FRAC-stroke) score was calculated.ResultsOf the 1267 patients admitted to the stroke unit between 1 January 2020 and 31 December 2020, 624 had a modified Rankin Score documented. Of these, 316 adults ≥ 50 years had ischaemic stroke and 131 consented to a telephone interview. Mean age was 72.4 ± 10.7 years and 36.6% were female. 34 patients (25.9%) had a FRAC-stroke score of ≥ 15, equating to ≥ 5% risk of fracture in the year following stroke. Eleven (8.4%) patients (6 female) had a minimal trauma fracture in the 12 months post-stroke. There was a significant difference in patients experiencing falls pre- and post-stroke (19.8% vs 31.3%, p = 0.04). FRAC-stroke score was higher in those who had a fracture post stroke compared those who did not (20.4 vs 8.9, p < 0.001). Receiver operating characteristic analysis found an area under the curve of 0.867 for FRAC-stroke score (95% CI 0.785–0.949, p < 0.005). The optimal cutoff value for FRAC-stroke score predicting fracture was 12 with a sensitivity of 90.9% and specificity of 70%.ConclusionThe FRAC-stroke score is a simple clinical tool that can be used to identify patients at high risk of fracture post-stroke who would most benefit from osteoporosis therapy.SummaryStroke is a risk factor for fracture due to immobilisation, vitamin D deficiency and increased falls risk. This study found that a simple bedside tool, the FRAC-stroke score, can predict fracture after ischaemic stroke. This will allow clinicians to plan treatment of osteoporosis prior to discharge from a stroke unit.

Poroid Hidradenoma Presenting as a Malignant Neoplasm

Poroid hidradenoma is a rare adnexal neoplasm that presents with slow-growing solitary dermal or subcutaneous nodules with pink, red, or blue coloration. Malignant transformation has been reported in about 1%; however, clinical and histologic characteristics may present similarly with malignant neoplasms. A 60-year-old, Filipino, female presented with a 1-month history of a solitary, brownish-black papule on the right cheek progressing to a translucent friable nodule with associated bleeding after minimal trauma. The patient was initially assessed as a case of basal cell carcinoma due to its rapid growth. Hence, the patient was referred to a dermatologic surgeon for biopsy. Poroid hidradenoma was confirmed histologically and was managed with local excision. Poroid hidradenoma presenting with rapid growth is a very rare occurrence.

Abstract 1152: Hydrodissection Facilitates Endoscopic Vein Harvesting Of The Great Saphenous Vein For Coronary Artery Bypass Grafting

Coronary Artery Disease is the primary cause of mortality in the United States (US), ranking as the third leading cause of death globally. Coronary Artery Bypass Grafting (CABG) with left internal mammary artery to the left anterior descending artery is the gold standard for CABG with a patency rate of 90% at 15 years. The great saphenous vein (GSV) harvested by endoscopic vein harvesting (EVH) is the second most common vascular conduit used for CABG in the US. This is despite the poor long-term patency of this conduit due to vein graft failure (VGF). VGF is the number one technical problem associated with CABG, with 15-year patency rates of only 30 to 50%. While the "no touch" harvesting technique avoids VGF, with 15-year patency rates of 86%, it is technically demanding and results in increased leg wound healing, and not widely used. With this in mind, we developed the Minimally Invasive No Touch (MINT) technique that incorporates the best features of EVH and no touch. This procedure employs hydro dissection, a process that utilizes fluid pressure to gently harvest the GSV with minimal trauma. This approach effectively addresses two significant issues associated with using the GSV in CABG, namely VGF resulting from impaired endothelial function and excessive trauma to the GSV during the extended learning curve needed to master EVH. To evaluate this, harvesting was conducted by a PA, with over 2,000 standard EVH procedures. Our preliminary studies looked to evaluate the quality of GSVs harvested from patients using 1) standard EVH, 2) “no touch” harvesting techniques or 3) the MINT harvesting procedure, focused on evaluating the quality of the vessels by measuring the endothelial nitric oxide synthase (eNOS) activity and nitric oxide (NO) bioavailability. eNOS activity assays across harvested GSVs revealed a 3.4-fold increase in NO generation across MINT harvested samples compared to EVH and “no touch” samples, respectively. This data suggests that the GSVs harvested by the MINT procedure result in a structurally intact vein with elevated eNOS activity and NO bioavailability consistent with a functionally intact endothelium. Additional studies are necessary to uncover the array of vascular benefits associated with MINT GSV harvesting for CABG procedures.

A Novel Nomogram to Predict Prognosis in Elderly Early-Stage Hepatocellular Carcinoma Patients After Ablation Therapy.

Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer. Early diagnosis is crucial for improving prognosis. Elderly HCC patients often have underlying liver diseases such as chronic hepatitis and cirrhosis, leading to impaired liver function and suboptimal liver reserve. Radiofrequency ablation (RFA) has rapidly become one of the most important methods for treating early-stage hepatocellular carcinoma (EHCC) due to its advantages, including minimal trauma, short operation time, less intraoperative bleeding, quick postoperative recovery, cost-effectiveness, and few postoperative-complications. However, the prognostic model for early recurrence after local ablation in elderly EHCC patients has not been widely evaluated. We have developed a prognostic model for the recurrence of local RFA in elderly EHCC patients. This is expected to provide a new early warning system for preventing early recurrence in elderly EHCC patients, prolonging patient's life, and improving overall quality of life. In this study, we included 661 EHCC patients who underwent local ablation, dividing them into a Primary cohort and a Validation cohort in a 7:3 ratio. We characterized the cohorts and utilized the primary cohort to develop a prognostic nomogram model for recurrence after local ablation in elderly EHCC patients. Additionally, the validation cohort was used to assess the potential of the nomogram as a non-invasive biomarker for post-ablation recurrence in EHCC. The user-friendly nomogram incorporates common clinical variables including gender, BCLC stage, tumor number, tumor size, red blood cell (RBC), gamma-glutamyl transferase (GGT), and prothrombin time activity (PTA). The nomogram constructed using the identified seven variables exhibits robust discriminatory capabilities, favorable predictive performance, and noteworthy clinical utility. We developed a user-friendly nomogram based on the BCLC stage classification, which may provide prognostic assessments for elderly EHCC patients at 1, 3, and 5 years post-RFA.

A case of surgical treatment of neck phlegmon after gunshot wound complicated by total posterior mediastinitis using laparoscopic surgical techniques

The purpose of this article is to demonstrate the peculiarities of diagnosis and staged surgical treatment for neck phlegmon after gunshot wound complicated by total posterior mediastinitis using laparoscopic surgical techniques. Inflammatory complications in neck injuries are a serious complication with a rapid course. An important diagnostic method is multislice computed tomography. The use of multislice computed tomography in the dynamics of the postoperative period allows for timely detection of further spread of the mediastinal inflammatory process. In the surgical treatment of neck phlegmon, it is necessary to open all fascial spaces widely and perform drainage of the upper mediastinum. Laparoscopic access is a minimal trauma with good visualization of the posterior mediastinum (middle and lower), which allows for a complete revision, sanitation, and drainage of the posterior mediastinum. To prevent a leakage of purulent contents from the mediastinal cavity into the abdominal cavity, safety drains in both hypocostal areas are placed in subdiaphragmatic spaces to the oesophageal opening.

Advances in non-invasive treatment of aortic diseases

The current clinical treatment methods for aortic diseases including aortic aneurysm, aortic dissection,etc.,are open surgery and endovascular surgery. Compared to traditional open surgery, endovascular surgery has the advantages of minimal trauma, fast recovery, fewer complications, and better prognosis, which gradually becomes the main trend in the treatment of aortic diseases. However, with the further development and long-term follow-up of endovascular treatment for aortic diseases, increasing evidence shows that in many cases, there are difficulties in the diagnosis of causes, decision-making of treatment timing, and lack of effective evaluation of treatment prognosis in endovascular treatments. Therefore, it is necessary to conduct in-depth research on non-invasive treatment including prevention, diagnosis, treatment, and prediction of aortic diseases. The non-invasive treatment of aortic disease is mainly applied to high-risk populations with aortic dissection, regulating key targets and mechanisms, and adopting drug intervention in advance to achieve the goal of controlling aortic dilation and preventing the occurrence of dissection. Conducting precise multi omics analysis to determine the optimal intervention timing and treatment strategy and targeting complications related to aortic disease or endovascular treatment for patients with a positive family history of aortic dilation or those who have developed aortic dissection. Precise regulation can be achieved to control the progression of aortic aneurysm and aortic dissection, delay or achieve long-term stable coexistence with aortic disease, and even reverse disease progression and achieve benign aortic remodelingthrough new intervention vectors. Ultimately achieving the ideal state of complete thrombosis and mechanized healing of the aortic aneurysm or aortic dissection false lumen.

Osteoporosis Management in Patients with Hip Fracture post Fall

Introduction: Osteoporosis increases the risk of fragility fracture. Hip fractures are associated with poor outcomes. Men are under-screened and under-treated for osteoporosis, which tends to be secondary, and men have higher mortality and worse outcomes after hip fracture than do women. This study aimed to describe patients admitted with hip fracture following minimal trauma and to explore any gender differences in calcium and vitamin D deficiency and use of osteoporosis medication before admission. Methods: A retrospective cross-sectional study included all patients admitted to Bankstown-Lidcombe Hospital with a fracture of the hip post fall, with or without surgery, from January 1, 2019, to December 31, 2019. Each patient's electronic medical record was reviewed to collect data. The data were extracted and analysed using GraphPad Prism 9.5.1. Unpaired Student's t-tests and Fisher's exact test were used in the analysis. Results: A total of 203 patients were included with a mean age of 83.5 ± 8.8 years and a range of 40 to 103 years, with over half (51.2%) aged 81 to 90 years. Fifty-nine (29.1%) were male. Of 196 patients with vitamin D levels available, 78 (39.8%) had a deficiency, including 30 of 57 (52.6%) males and 48 of 139 (34.5%) females. Males were twice as likely to be vitamin D deficient as were females on admission (OR 2.106; 95% CI 1.143 to 3.939; p = 0.0243). Of 203 patients, 39 (19.2%) were on osteoporosis treatment before admission, including 6 of 59 (10.2%) male and 33 of 144 (22.9%) female patients. Males were 2.6 times more likely to have had no osteoporosis treatment before admission than were females (OR 2.626; 95% CI 1.059 to 6.340; p = 0.0486). Conclusions: Males were more likely to have vitamin D deficiency and not be prescribed osteoporosis medication before admission in a cohort of patients admitted to the hospital with hip fracture post minimal trauma. To prevent hip fracture and resultant hospitalization, increased awareness is needed in diagnosing and managing osteoporosis in men, ideally occurring in the community.