Minor Site Research Articles

Complications of Deep Venous Stenting and Their Management.

Complications after iliofemoral and inferior vena cava stenting are rare, and most can be managed effectively without significant long-term consequences for the patient. Nevertheless, the procedure is not without risk, and clinicians considering starting a venous practice must be aware of the range of complications that can occur, which range from minor access site bleeds to fatal arrhythmia from stent migration to the heart. Most complications can be avoided with appropriate patient selection, stent sizing, and careful access and deployment techniques.

Significant reduction of complications applying an optimized vascular access and post-interventional groin-site management during electrophysiology procedures

Abstract Background Catheter ablation of cardiac arrhythmias is an established treatment strategy. However, the optimal femoral vascular access strategy and post-interventional management in the electrophysiology (EP) setting is still under debate. Purpose To assess the impact of ultrasound-guided versus conventional femoral vascular puncture and of a modified post-interventional groin-site management strategy on complication rates. Method Patients undergoing EP procedures at the our university heart and vascular center are included in an institutional prospective registry. Conventional vascular access as well as post-interventional groin site pressure-bandage and bed rest of 6 hours (group I) was compared to a new strategy including ultrasound-guided vascular access, venous closure by a Z-suture and groin site pressure-bandage for only 2 hours plus additional 4 hours bed rest (group II). Incidences of minor and major groin site complications for both groups were compared. Hematoma, bleeding, arteriovenous fistula or pseudoaneurysm of the femoral artery without need for intervention (e.g. transfusion, thrombin injection, surgery) were classified as minor complications. Complications requiring intervention or retroperitoneal hematoma were defined as major complications. Results A total of 1535 procedures in 1381 patients (779 (51 %) procedures in 705 (51%) patients in group I and 756 (49%) procedures in 676 (49%) patients in group II) were analyzed. In group I and group II, respectively, 39%/44% procedures were index pulmonary vein isolations, 30%/29% repeat atrial fibrillation, 16 %/15% supraventricular tachycardia, 12%/11% PVC or VT ablations, and 4%/2% left atrial appendage occlusions. The total groin site complication rate was 9% (70/779 procedures) for group I, and 5% (38/756 procedures) for group II (OR 0.54 [95%-CI 0.35-0.82], p=0.003). Major groin site complications occurred in 2% (19/779 procedures) in group I and were reduced to 1% (10/756 procedures) in group II (OR 0.53 [95%-CI 0.22-1.22], p=0.156). Conclusion The overall groin site complication rate in EP-procedures was significantly reduced by implementing a novel institutional standard for vascular access management including ultrasound-guided puncture and a modified post-interventional groin site management.

Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Background: There is a paucity of evidence and controversies regarding prophylaxis strategies in low-risk patients undergoing knee arthroscopy. This study aims to evaluate the effectiveness and safety of aspirin and low-molecular-weight heparin (LMWH) in an arthroscopic anterior cruciate ligament (ACL) reconstruction for low-risk patients. Methods: We performed a preoperational evaluation a week before surgery for any sign of pulmonary embolism (PE) and deep vein thrombosis (DVT). For this purpose, we used single limited compression Doppler ultrasonography (CUS) of the lower extremities. Rehabilitation started before the time of the surgery to improve the range of motion (ROM) and quadriceps muscle function. A team of 3 orthopedists performed the procedures. The same surgical technique and graft were used with spinal anesthesia, and operation time was recorded. Results: The mean age of participants was 31.4 ± 5.6 years, with 93 individuals (67%) being men and 23% women. No cases of DVT or PE were observed. Three cases in the LMWH group and one case in the aspirin group experienced minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallel arms. Conclusion: The use of LMWH or aspirin after simple arthroscopic ACL reconstruction in low-risk patients showed no difference in effectiveness. Hence, the routine use of thromboprophylaxis in this setting is questionable although adverse events are rare

CheB localizes to polar receptor arrays during repellent adaptation.

Adaptation of the response to stimuli is a fundamental process for all organisms. Here, we show that the adaptation enzyme CheB methylesterase of Escherichia coli assembles to the ON state receptor array after exposure to the repellent l-isoleucine and dissociates from the array after adaptation is complete. The duration of increased CheB localization and the time of highly clockwise-biased flagellar rotation were similar and depended on the strength of the stimulus. The increase in CheB at the receptor array and the decrease in cytoplasmic CheB were both ~100 molecules, which represents 15 to 20% of the total cellular content of CheB. We confirmed that the main binding site for CheB in the ON state array is the P2 domain of phosphorylated CheA, with a second minor site being the carboxyl-terminal pentapeptide of the serine chemoreceptor. Thus, we have been able to quantify the regulation of the signal output of the receptor array by the intracellular dynamics of an adaptation enzyme.

Long-term results of treatment of Gustilo-Anderson type 3A-B tibia fractures due to combat-related high-energy ballistic injuries treated with external circular fixator: Experience of the Military Medical Academy.

The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy. Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted. The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%). Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

Suture closure AFtEr large bore vein access (SAFE-VEIN): A randomized, prospective study of the efficacy and safety of venous closure device.

Perclose ProGlide (PPG) Suture-Mediated Closure System™ is safe and can reduce time to hemostasis following procedures requiring arterial access. We aimed to compare PPG to figure of 8 suture in patients who underwent interventional catheter procedures requiring large bore venous access (LBVA) (≥13 French). In this physician-initiated, randomized, single-center study [clinicaltrials.gov ID: NCT04632641], single-stick venous access was obtained under ultrasound guidance. Eligible patients were randomized 1:1, and 100 subjects received allocated treatment to either PPG (n = 47) or figure of 8 suture (n = 53). No femoral arterial access was used in any patient. Primary outcomes were time to achieve hemostasis (TTH) and time to ambulation (TTA). Secondary outcomes were time to discharge (TTD) and vascular-related complications and mortality. Wilcoxon rank-sum test was used to compare TTH, TTA, and TTD. TTH (minutes) was significantly lower in PPG versus figure of 8 suture [median, (Q1, Q3)] [7 (2,10) vs. 11 (10,15) respectively, p < 0.001]. TTA (minutes) was significantly lower in PPG compared to figure of 8 suture [322 (246,452) vs. 403 (353, 633) respectively, p = 0.005]. TTD (minutes) was not significantly different between the PPG and figure of 8 suture arms [1257 (1081, 1544) vs. 1338 (1171,1435), p = 0.650]. There was no difference in minor bleeding or access site hematomas between both arms. No other vascular complications or mortality were reported. PPG use had lower TTH and TTA than figure of 8 suture in a population of patients receiving LBVA procedures. This may encourage same-day discharge in these patients.

Reconstruction of Defects After Oral Cancer Surgery With the Superior Thyroid Artery Perforator Flap.

The superior thyroid artery perforator flap (STAPF) was previously presented as a type of locoregional pedicled flap for lateral facial and temple defects. In this study, we aimed to present our clinical experience with this flap for the reconstruction of soft tissue defects after oral cancer surgery. From February 2019 to December 2022, 24 patients with oral cancers at the School and Hospital of Stomatology,Peking University were included. Among these patients, 10 had cancers located in the tongue, five in the cheek inside the oral cavity, three in the lower gingiva, two in the upper gingiva, two in the floor of the mouth, and two in the palate. All patients were treated with extended tumor resection, neck dissection, and STAPFs to reconstruct the soft tissue defects. The details of the flap, including the flap size, venous flow, vascular pedicle length, the attatched muscle, and operation time were evaluated. The dimensions of the flap skin paddle ranged from 3 cm × 5 cm to 6 × 14 cm. Fourteen patients had a closely concomitant superior thyroid vein perforator. Ten patients had non-closely concomitant superior thyroid veins perforators which retrograde external jugular vein. The vascular pedicle length ranged from 5 to 9 cm. The infrahyoid muscle group or sternocleidomastoid muscle was included in the flaps in three patients. A total of 23/24 flaps were successful. The STAPF is a viable reconstructive option for patients with oral cancers. It has the advantages of being robust, being thin, short operation time, and minor donor site complications. 4 Laryngoscope, 2024.

Elms (Ulmus L.) in the Branch “Myrhorod Forestry” of the State Specialized Forest Enterprise “Forests of Ukraine”

Introduction Elms are spread in forests, landscaping settlements, and protective forest belts. After several waves of elm mortality from Dutch elm disease (DED) in the 20th century, individual populations recovered or formed resistant hybrids. However, epiphytoties of bacterial and fungal diseases sometimes develop, particularly due to pathogen vectoring by bark beetles. In Ukraine, the spread of elms and their damage by different causes are relatively poorly investigated. This research aimed to discover the features of Ulmus sp. distribution by stand origin, age, and forest site condition in the forest fund of the Branch “Myrhorod Forestry”. Materials and Methods The data as of 2010 and 2017 on the forest fund of enterprises belonging to the Branch “Myrhorod Forestry” of the State Specialized Forest Enterprise “Forests of Ukraine” were selected from the database of Ukrainian State Forest Management Planning Association “Ukrderzhlisproekt” using SQL-query and converted to the *.xls files. Area distribution by types of forest site conditions was assessed following the Ukrainian school of forest typology. Such distributions for the entire area covered with forest vegetation, for subcompartments with elms in the stand composition, and with elms as the dominant species were compared for various elm species and stand origins, using c2-test. The percentages of stand areas of different origins and elm species in 2010 and 2017 were compared using z-test in the two proportions comparisons. The data for subcompartments with various elms as the dominant species and as a part of stands composition have been analyzed by 10-year age classes for different origins (natural and planted). The proportion of the stand area of each 10-year age class was assessed for each set of subcompartments. Then the proportion of the stands’ area, which survives up to a certain age, was evaluated. Results and Conclusions In the Branch “Myrhorod forestry”, an area of natural stands with Ulmus sp. as the dominant species for 2010–2017, and the proportion of U. minor has significantly increased. The most dramatic decrease in the survival rate of all elm species of natural stands occurred in the VI age class and planted stands in the V age class. Respective natural and planted stands were formed in the 1960s and 1970s when the peak of DED occurred in many regions. In the Branch “Myrhorod Forestry”, U. minor prefers moist fertile forest site conditions. U. laevis grows mainly in moist forest site conditions, U. pumila occurs in dry to wet habitats, U. glabra is present only in natural stands and absent in plantations. As part of stand composition, the same elm species grow in a wider range of forest site conditions than elms as the dominant species. 2 Figs., 8 Tables, 31 Refs.

Advanced practice nurse-coordinated same-day-discharge after atrial fibrillation ablation

Abstract Background Catheter ablation is an effective atrial fibrillation (AF) therapy, but a complex, resource-intensive procedure. Same-day discharge (SDD) reduces utilization of health care resources including personell and hospital beds, and may help to accommodate the increasing demand for AF ablation. However, besides structural adaptations, SDD requires more efficient logistics and coordination. Purpose Against this background, we established and validated a streamlined SDD program fully coordinated by an advanced practice nurse. Methods As dedicated SDD coordinator the advanced practice nurse was in charge of the full SDD protocol, including patient eligibility, patient flow, in-hospital logistics, patient education, discharge and short-term follow-up. For inclusion, basic home support and accessibility of the hospital within 60 minutes had to be warranted. Patients with LVEF &amp;lt;35% were excluded. Ablation was performed at the operator’s discretion. Ultrasound-guided femoral puncture was at the operator’s discretion for the first 150 SDD patients but became mandatory per protocol for all subsequent patients. Discharge by the SDD coordinator followed a standardized protocol including supervised ambulation, patient education, femoral inspection and echo. On post-ablation days 1 and 3, patients were called by the SDD coordinator to ensure well-being and good aspect of the femoral access site (smartphone foto control). In addition, patients could consult the SDD coordinator via mobile phone any time during working hours. In-person follow-up visits were scheduled at 2 weeks and 3, 6 and 12 months post-ablation. Results 420 consecutive patients were evaluated by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were lack of home support (4.5%), living remotely (6.9%), or LVEF &amp;lt;35% (4.0%). 300 of the eligible patients (91%) were successfully discharged the same day (Fig. 1). Rates of unplanned medical attention (4.0%) and 30d-readmission (1.6%) were extremely low. Importantly, there was no major post-SDD complication. Unplanned medical attention and hospital readmissions were largely driven by minor femoral access site complications. Of note, those were significantly reduced upon introduction of mandatory ultrasound-guided puncture after the first 150 SDD patients (p=0.0145, Fig. 2). SDD coordination by the advanced practice nurse streamlined patient flow and in-hospital logistics and significantly reduced the total workload of nursing and medical staff. This resulted in great acceptance of the SDD program and satisfaction both among staff and patients. Conclusions Advanced practice nurse-coordinated SDD after AF ablation is safe and efficient. In fact, the position of a dedicated coordinator may be a key in the forthcoming transition of hospitals to SDD. Importantly, ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.Figure 1Figure 2

Lower trapezius and latissimus dorsi transfer relieve teres minor activity into the physiological range in Collin D irreparable posterosuperior massive rotator cuff tears: a biomechanical analysis

Tendon transfers are established techniques to regain external rotation mobility in patients suffering from an irreparable, posterosuperior massive rotator cuff tear (MRCT). Posterosuperior MRCT with intact teres minor (Type D MRCT) can lead to excessive teres minor loading to maintain external rotation. We hypothesize that tendon transfers are effective in relieving teres minor loading in Type D MRCTs. Our aim was to biomechanically assess muscle synergism with latissimus dorsi (LD-Transfer) and lower trapezius (LT-Transfer) tendon transfer during external rotation at different abduction heights. Using musculoskeletal modeling, we analyzed and compared the moment arm, muscle torque and muscle activity between a healthy and Type D MRCT pathological model with and without the LD- or LT-Transfer at infraspinatus and teres minor insertion sites. Output measures were analyzed during external rotation at different abduction angles and 10 to 50N resistance against external rotation. We assessed its impact on teres minor loading in a Type D MRCT. Morphological variations were parameterized using the critical shoulder angle and the acromiohumeral distance to address variations among patients. Both transfer types reduced teres minor torque and activity significantly, reaching physiological state at 40N external resistance (p<0.001), with insertion to infraspinatus site being more effective than teres minor site (p<0.001). External rotation moment arms of LD-Transfer were larger than LT-Transfer at 90° abduction (25.1±0.8mm vs. 21.2±0.6mm, p<0.001) and vice versa at 0° abduction (17.4±0.5mm vs. 24.0±0.2mm, p<0.001). While the healthy infraspinatus was the main external rotator in all abduction angles (50-70% torque), a Type D MRCT resulted in a 70-90% increase of teres minor torque and an up to sevenfold increase in its activity leading to excessive loadings beyond 10N resistance against external rotation. Varying the critical shoulder angle and the acromiohumeral distance led to minor variations in muscle moment arm and muscle activity. We identified biomechanical efficacy of both tendon transfers in Type D MRCT regarding teres minor load relieve and superior performance of the transfers at the infraspinatus insertion site.

Transcriptional regulation of the alternative sex hormone-binding globulin promoter by KLF4

In most mammals the major site of sex hormone-binding globulin (SHBG) synthesis is the liver wherefrom it is secreted into the bloodstream and is the primary determinant of sex steroid access to target tissues. The minor site of SHBG synthesis is the testis and in lower mammals testicular SHBG has long been known to be synthesized and secreted by Sertoli cells. However, human testicular SHBG is expressed in developing germ cells from an upstream alternative promoter (altP-SHBG). Transcripts arising from this region comprise an alternative first exon (1A) with the resultant protein confined to the acrosomal compartment of the mature spermatozoa. I have dissected the regulatory components of the alternative SHBG promoter and identified motifs that are required for optimal transcriptional activity from this region. Transcriptional activity is driven by two CACCC elements that appear to be functionally redundant. The transcription factor KLF4 interacts with promoter the region spanning these elements in vivo. Knockdown of Klf4 results in decreased altP-SHBG activity, while Klf4 overexpression relieves the effects of knockdown. Based on their shared patterns of expression in vivo, I conclude that KLF4 is a transcriptional regulator of SHBG in male germ cells.

Latissimus dorsi myocutaneous free flap for the laryngopharyngectomy defect.

Partial or total laryngopharyngectomy defects have traditionally been reconstructed using the radial forearm, anterolateral thigh, or jejunal free flaps. The latissimus dorsi myocutaneous free flap (LDMFF) is an option for high-risk patients with complex laryngopharyngeal ± cutaneous neck defects. Retrospective single-surgeon case series from 2017 to 2022. Outcomes were assessed at both the back donor site and head and neck. Twenty-four patients were identified. Flap survival was 100%. There was 1 (4.2%) pharyngocutaneous fistula and 2 (8.3%) tracheo-esophageal peristomal fistulas. At last follow-up, 17 (71%) were sustaining weight on oral intake, and 7 (29%) were G-tube dependent with 4 of these able to do some type of oral intake. Seven (29.2%) had post-operative stricture/stenosis requiring dilation. There were only minor donor site complications, all managed conservatively. The LDMFF can be a robust reconstructive option, particularly for radiated high-risk patients with complex pharyngeal defects, including skin.

Surgical Outcome of Pharmaco Refractory Epilepsy in the National Epilepsy Center of Sri Lanka

IntroductionThe National Epilepsy Center (NEC) in Sri Lanka was established in 2017. Seizure outcome, effects on quality of life (QOL) and surgical complications among non-pediatric patients who underwent epilepsy surgery from October 2017 to February 2023 are described. Material and methodsNineteen patients (≥14 years) underwent epilepsy surgery at the NEC. We used Engel classification and Quality of Life in Epilepsy 31 (QOLIE-31) questionnaire to assess seizure outcome and QOL respectively. Surgical complications were categorized into neurological and complications related to surgery. ResultsNine female and 10 male patients underwent surgery (mean age 27.5 years (range 14-44years). The mean follow-up duration was 10.5 months (range 6-55 months). Twelve patients underwent temporal lobe resections. At 6-months follow-up, 83.3% (10/12) had favorable seizure outcomes with Engel class I/II. At 1-year follow-up 6/8 patients (75.0 %) and at 2-year follow-up, 5/7 patients (71.4%) had a favorable outcome. Seven patients had extra-temporal lobe surgeries and one defaulted. Seizure freedom was observed in 6/6 at 6 months, 3/3 at one-year, and 2/2 at 2-year follow-up. Five patients (26.3%) experienced minor post-operative surgical site infection. Two (11.1%) had persistent quadrantanopia. Meaningful improvement in QOL (change in QOLIE-31 score ≥11.8) was observed irrespective of seizure outcome or type of surgery (P <0.001). ConclusionsEpilepsy surgery is effective in developing countries. Seizure outcomes in our patients are comparable to those worldwide. Clinically important QOL improvement was observed in our series. This is the first published data on epilepsy surgery outcomes in non-pediatric patients from Sri Lanka.

A functional and structural comparative analysis of large tumor antigens reveals evolution of different importin α-dependent nuclear localization signals.

Nucleocytoplasmic transport regulates the passage of proteins between the nucleus and cytoplasm. In the best characterized pathway, importin (IMP) α bridges cargoes bearing basic, classical nuclear localization signals (cNLSs) to IMPβ1, which mediates transport through the nuclear pore complex. IMPα recognizes three types of cNLSs via two binding sites: the major binding site accommodates monopartite cNLSs, the minor binding site recognizes atypical cNLSs, while bipartite cNLSs simultaneously interact with both major and minor sites. Despite the growing knowledge regarding IMPα-cNLS interactions, our understanding of the evolution of cNLSs is limited. We combined bioinformatic, biochemical, functional, and structural approaches to study this phenomenon, using polyomaviruses (PyVs) large tumor antigens (LTAs) as a model. We characterized functional cNLSs from all human (H)PyV LTAs, located between the LXCXE motif and origin binding domain. Surprisingly, the prototypical SV40 monopartite NLS is not well conserved; HPyV LTA NLSs are extremely heterogenous in terms of structural organization, IMPα isoform binding, and nuclear targeting abilities, thus influencing the nuclear accumulation properties of full-length proteins. While several LTAs possess bipartite cNLSs, merkel cell PyV contains a hybrid bipartite cNLS whose upstream stretch of basic amino acids can function as an atypical cNLS, specifically binding to the IMPα minor site upon deletion of the downstream amino acids after viral integration in the host genome. Therefore, duplication of a monopartite cNLS and subsequent accumulation of point mutations, optimizing interaction with distinct IMPα binding sites, led to the evolution of bipartite and atypical NLSs binding at the minor site.

Investigating archaeological remains at Stracciacappe, Rome: comparing traditional sources with UAV-based multispectral, thermal and microtopographic analysis

This study investigates the applicability of drone technology in examining Stracciacappe, a minor archaeological site through low-altitude aerial photography. Using multispectral and thermal sensors mounted on DJI Phantom Multispectral and DJI Mavic Enterprise Advanced drones, several flight missions were conducted in November 2020, May 2021, and April 2022. The effectiveness of analyzing multispectral and thermal raw images was limited by the area’s irregular vegetation, which hindered the clear detection of archaeological anomalies. However, microtopographic analysis employing various visualization techniques revealed significant traces, aligning with the site’s description found in numerous documentary sources. This includes the identification of two distinct areas within the castrum: the elevated cassarum and the burgus, along with potential traces of defensive structures within these areas. Drone analysis delineated a cassarum comprising a tower, palatium, and defensive walls, while the burgus seemed devoid of buildings, supporting the notion of a village primarily constructed with perishable materials. Thus, the study highlights the importance of using diverse sensor-based drone analyses to enhance archaeological investigations at minor sites.

Specific Propyne Trapping Sites within a Robust MOF for Efficient Propyne/Propadiene Separation with Record Propadiene Productivity.

Separating propyne/propadiene to produce pure propadiene is extremely challenging in industry due to their similar properties. Herein, a novel ZrF6 2- anion pillared cage-like metal-organic framework (termed as CuZrF6 -TPA) for highly efficient propyne/propadiene separation is reported. It exhibits high propyne capacity (177.4/188.6 cm3 /cm3 at 0.5/1.0 bar and 298 K), benchmark separation selectivity (6.0), and remarkable separation potential (5.7 mol L-1 ) simultaneously. Record propadiene productivity (≈4.7 mol L-1 ) is achieved through a single adsorption process in breakthrough experiments with excellent recycle stability even under humid conditions. Based on the structure of propyne-loaded single crystals, two binding sites are identified, including a major propyne trapping site at the windows and a minor binding site located in the large cages. Modelling studies further confirm that the contracted cage windows surrounded with rotating Lewis basic F atoms and aromatic rings are the optimal bonding sites to capture propyne with multiple hydrogen bonding and π···π interactions.

Interaction studies of water-soluble Zn(II) complex with calf thymus DNA using biophysical and molecular docking methods"

The binding between a fluorescent water-soluble Zn(II) complex of {2-[N-(2-hydroxyethylammonioethyl) imino methyl] phenol} and calf thymus DNA (ct-DNA) was investigated using spectroscopic techniques. The complex was prepared and identified by FT-IR, and 1H NMR spectroscopies. The significant changes in the absorption and the circular dichroism spectra of ct-DNA in the presence of the Zn(II) complex implied the interaction between the Zn(II) complex and ct-DNA. Upon addition of ct-DNA, the fluorescence emission intensity of the Zn(II) complex was increased and indicated the interaction between the Zn(II) complex and ct-DNA was occurred. The binding constant values (Kb) resulted from fluorescence spectra clearly showed the Zn(II) complex affinity to ct-DNA. The fluorescence studies also approved the static enhancement mechanism in the Zn(II) complex-DNA complexation process. The thermodynamic profile exhibited the exothermic and spontaneous formation of ct-DNA-Zn(II) complex system via hydrogen bonds and van der Waals forces. The competitive fluorescence investigation by methylene blue (MB), and Hoechst 33258 demonstrated that the Zn(II) complex could replace the DNA-bound Hoechst and bind to the minor groove binding site in ct-DNA. The viscosity changes were negligible, representing the Zn(II) complex binding to DNA via the groove binding mode. Molecular docking simulation affirmed that the Zn(II) complex is located in the minor groove of ct-DNA near the DG12, DA17, DA18, and DG16 nucleobases.

Abstract 250: Radial vs femoral access for neuroendovascular diagnostic and therapeutic procedures. A systematic review and Meta‐analysis

Introduction Transradial access (TRA) has become increasingly utilized among neurointerventionalists. There is evidence of reduced complications and higher patient satisfaction compared to transfemoral access (TFA), but more data directly comparing the safety and efficacy of the two approaches is needed. To assess the proportion of technical success and complications with TRA versus TFA in patients who underwent neuroendovascular diagnostic and therapeutic procedures. Methods PRISMA guidelines were used to conduct a systematic review of the literature with PubMed/Medline, Scopus, Embase, and Cochrane databases up to February 2023. Randomized clinical trials (RCT) and observational studies that compared TRA and TFA were included. Studies reporting results of patients who underwent diagnostic angiograms, endovascular management of acute stroke, aneurysm repair, and carotid or vertebral stenting were included. Our primary outcome was technical success, defined as successful arterial access and completion of the intended procedure without crossover. Secondary safety outcomes were rate of complications including access site and non‐access site related, and other efficacy measures such as procedure duration, fluoroscopy time, and radiation exposure. Random effects model was used to perform a meta‐analysis. The Mantel‐Haenszel method was used to calculate risk ratio (RR) and 95% confidence intervals (CI) for each outcome. Heterogeneity was evaluated using I2 and considered high if over 70%. Results Twenty‐nine studies comprising 14,523 patients met inclusion criteria. TRA was attempted in 5,865 (40.38%) patients and TFA in 8,658 (59.62%). Baseline characteristics were similar between groups. The rate of technical success was 95.46% (95% CI: 93.59 – 96.81; p &lt; 0.01) in the TRA group compared with 98.43% (95% CI: 97.60 – 98.97; p = 0.02) in the TFA group. Patients who underwent a diagnostic or therapeutic angiogram via TRA had a slightly lower chance of achieving technical success (RR = 0.98; 95% CI: 0.96 – 0.99; p &lt; 0.01) compared to TFA, with substantial heterogeneity (I2 = 68%). Major access site complications were non‐significantly lower in the TRA group (RR = 0.64; 95% CI: 0.29 – 1.41; p = 0.81) with null heterogenicity (I2 = 0%) between groups. Minor access site complications were significantly lower in the TRA group (RR = 0.43; 95% CI 0.28 – 0.67; p &lt; 0.01), with moderate heterogeneity (I2 = 57%). Non‐access site related complications (including mortality) were lower in the TRA group (RR = 0.69; 95% CI 0.51 – 0.94; p = 0.14) with low heterogeneity (I2 = 26%) between groups; for this outcome, the TRA approach shows a protective but not statistically significant result. Conclusion Our study suggests TRA is feasible and safe for diagnostic and therapeutic neuroendovascular procedures with low certainty of evidence. Minor complications were lower in the TRA group. RCTs directly comparing TRA vs TFA for these procedures are needed to confirm these results.

Outcomes of Early Weightbearing Following Open Reduction and Internal Fixation in the Geriatric Population

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common extremity fracture, and its incidence is increasing in the elderly [1,2]. While the operative indications in ankle fractures have been established, there is no consensus regarding timing of weightbearing. There has been a growing trend towards early weightbearing due to its advantages in rehabilitation and return to function [3,4,5]. Even so, a survey study revealed that physicians tend to increase the non-weightbearing period for their geriatric population [6]. Expanding on our prior data which advocated for early weightbearing in ankle ORIF patients with syndesmotic injuries, we investigated the effects of early weightbearing after ankle ORIF in the geriatric population [7]. We hypothesized that there would not be an increased complication rate in this study cohort. Methods: A retrospective review was performed of patients over the age of 60 that underwent ankle ORIF at a level 1 trauma center and three neighboring community hospitals from 2015 to 2023. One of three senior surgeons were involved in all cases. Patient demographics, medical comorbidities, concomitant injuries, fixation method and complications were recorded. Maisonneuve injuries, fractures with articular surface involvement greater than 25%, open fractures, and revision cases were excluded. Patients with neuropathy were also excluded. All patients underwent an ORIF with possible syndesmotic fixation depending on intraoperative findings. Postoperatively, patients were 50% partial weightbearing for 2-3 weeks for a period of soft tissue and wound healing. After that, all patients were permitted to bear as much weight as tolerable. Results: 113 patients were identified that met our criteria. The average age was 72.6 years old. 25 were male and 88 were female. The average BMI was 26.8%. 60.2% of patients reported one or more medical comorbidities. The average follow-up time was seven months. We had zero major postoperative complications to report. We considered major complications to include: hardware failure, gross loss of reduction, need for revision ORIF, and accelerated post traumatic arthritis. Four patients were noted to have delayed wound healing. An additional four patients had minor surgical site infections that resolved with oral antibiotics. Six patients underwent hardware removal for various reasons. 65/113 (57%) patients received syndesmotic fixation of some form. Conclusion: This is the largest study to date reporting on effects of early weightbearing in the geriatric ankle ORIF population. In our study of 113 patients, all patients were allowed to weight bear as tolerated after short period of soft tissue rest, indiscriminate of syndesmotic injury or osteoporosis. We report no major complications and a limited number of soft tissues related complications. In a patient population with a known morbidity from prolonged immobility, as evidenced from the hip fracture literature, we hope our data helps to build confidence in early postoperative weightbearing [8].

Acute appendicitis in pregnancy

Introduction: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis.Methods: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest.Results: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up.Conclusion: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.