Non-randomized Observational Study Research Articles

Comparison between staged laparoscopic technique in children with high intra-abdominal undescended testis: a systematic review and meta-analysis

Background: This study performed a systematic review and meta-analysis to compare the outcomes of the staged laparoscopic Fowler-Stephens Laparoscopic Orchiopexy (FSLO) and Staged Laparoscopic Traction Orchiopexy (SLTO) in patients with intra-abdominal testes (IAT). Methods: This study reviewed literature published from 2016 to 2023. A systematic literature search was conducted on three databases: PubMed, ScienceDirect, and Google Scholar, using keywords (High intra abdominal testis) AND (("Fowler Stephens laparoscopic orchiopexy" OR (FSLO)) OR (Staged Laparoscopic traction orchiopexy OR (SLTO)). Non-randomized trials and observational studies comparing staged laparoscopic FSLO and SLTO, without any time range restriction are included. Studies without FLSO orchidopexy as a control, case reports, case studies, duplicate publication, no full text and non-English studies are excluded. This study used the PRISMA protocol, the Jadad Scale, and the Newcastle Ottawa Scale (NOS) to evaluate the included studies. To analyze statistical data, the Review Manager (RevMan) software was used. The Chi-squared test was used to calculate statistical heterogeneity in the meta-analysis. Results: This study included four studies of 151 patients (72 SLTO group and 79 FSLO group). There was no significant difference between the two groups in terms of testicular descent (p=0.08), and there was no testicular atrophy in the SLTO group compared to the FSLO group (p=0.04). Statistical analysis revealed a significantly shorter first-stage operation time in the FSLO group (p 0.0001), whereas the SLTO group reported a significantly shorter second-stage operation time (p = 0.04). Conclusions: In terms of testicular descent, the SLTO technique yields similar results to the FSLO technique. The SLTO position is preferable to the FSLO position. Both techniques have advantages and disadvantages, and we recommend SLTO as the first choice in children with a high IAT of 4 cm. PROSPERO registration: CRD42023412407

Compensatory Corneal Epithelial Changes After Femtolaser - Assisted Intracorneal Rings Implantation in Early and Moderate Cases of Keratoconus.

To study the compensatory corneal epithelial changes after femtolaser-assisted intracorneal ring segment (ICRS) implantation in early and moderate cases of keratoconus (KC) using anterior segment optical coherence tomography (AS-OCT). A prospective observational non-randomized study of 40 eyes with mild to moderate KC received femtolaser-assisted ICRS implantation. Ferrara ICRS with different arc lengths and thicknesses were used according to the patients' tomographic pattern. Patients had a clear central cornea, keratometry reading < 60 diopters, and corneal thickness > 400 microns. AS-OCT was performed preoperatively and at 1, 3, and 6 months after surgery. Corneal epithelial thickness (CET) was measured over 17 points (2 mm central and 16 points on 2-5 mm and 5-7 mm annular zones) over the pupil center. All data were collected and analyzed. Comparing the preoperative and postoperative data, there was a statistically significant increase in the CET postoperatively throughout the 6-month follow-up period in all zones (p<0.001). The epithelial thickness (ET) was noticed shortly around and central to the ring ridges by the first month (5-7 mm zone). By the third month, the flattened central cornea (2 mm zone) and the 2-5 mm zone showed a significant increase in ET up to the 6th month. ICRS implantation in KC results in a thicker and more regular epithelium in the central corneal zone as a secondary response to the corneal stromal changes induced by the implants.

Age and Sex Differences in Patients with Chronic Heart Failure

Introduction. The increasing burden of morbidity from heart failure, which is determined to be an age-related disease, new information about sex differences of this pathology determines the need of reviewing existing data on this problem particularly in older patients. The objective is to systematize data on gender differences in heart failure among older patients.Materials and methods. A search of literature for 2011–2023 was conducted in the PubMed, Cochrane Library, Embase, Google Scholar databases, eLibrary. Data on sex and age differences of heart failure was included. The preferred languages were Russian and English. During the initial search, 4,228 sources were found. Full-text peer reviewed journal publications with the results of randomized and non-randomized clinical trials, meta-analyses, systematic reviews, and observational studies were selected.Results and discussion. Gender differences in risk factors, epidemiology, pathophysiology, clinical manifestations, treatment of heart failure (HF), particularly in older and oldest-old patients were characterized. Presented information proves the need for a differentiated approach for managing patients of both sex with HF in advanced age.Conclusion. It is necessary to develop new scientific programs and clinical recommendations for the differentiated management of patients with HF, including older and oldest-old patients in order to improve the prognosis and quality of life.

Auditory Brainstem Response Testing in Children with Speech and Language Pathology: A Non-Randomized Observational Study

Introduction: The aim of this study was to compare auditory brainstem response (ABR) findings of normal-hearing preschool children with different types of speech and language pathology. Methods: This retrospective, non-randomized, cohort study was conducted at a tertiary speech and hearing rehabilitation institution according to STROBE guidelines. The study enrolled 123 preschool children diagnosed with speech language pathology and normal hearing. The participants included children with developmental language disorder, autism spectrum disorder, isolated articulation pathology, organic brain lesions, cognitive delay, and a group of very young children with clinically significant speech development delay. All patients underwent standard ABR procedures. Results: The latencies were the longest in the group of children with organic lesion, followed by the group of children with autism spectrum disorder, then the group with developmental language disorder, and the young children group. In the group of children with articulation pathology and the cognitive delay group, the latencies were the shortest. Conclusion: This study showed a connection between several groups of children with language pathology that includes comprehension problems and prolongation of ABR latencies.

Circulating microRNAs and cardiomyocyte proliferation in heart failure patients related to 10years survival.

Mechanochemical signalling drives organogenesis and is highly conserved in mammal evolution. Regaining recovery in myocardial jeopardy by inducing principles linking cardiovascular therapy and clinical outcome has been the dream of scientists for decades. Concepts involving embryonic pathways to regenerate adult failing hearts became popular in the early millennium. Since then, abundant data on stem cell research have been published, never reaching widespread application in heart failure therapy. Another conceptual access, using mechanotransduction in cardiac veins to limit myocardial decay, is pressure-controlled intermittent coronary sinus occlusion (PICSO). Recently, we reported acute molecular signs and signals of PICSO activating regulatory miRNA and inducing cell proliferation mimicking cardiac development in adult failing hearts. According to a previously formulated hypothesis, 'embryonic recall', this study aimed to define molecular signals involved in endogenous heart repair during PICSO and study their relation to patient survival. We previously reported a study on the acute molecular effects of PICSO in an observational non-randomized study. Eight out of the thirty-two patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT) were treated with PICSO. Survival was monitored over 10years, and coronary sinus blood samples were collected during intervention before and after 20min and tested for miRNA signalling and proliferation when co-cultured with cardiomyocytes. A numerically lower death rate post-CRT and PICSO as compared with control CRT only, and a non-significant reduction in all-cause mortality risk of 42% was observed (37.5% vs. 54.0%, relative risk=0.58, 95% confidence interval: 0.17-2.05; P=0.402). Four miRNAs involved in cell cycle, proliferation, morphogenesis, embryonic development, and apoptosis significantly increased concomitantly in survivors and PICSO compared with a decrease in non-survivors (hsa-miR Let7b, P<0.01; hsa-miR- 421, P<0.006; hsa-miR 363-3p, P<0.03 and hsa-miR 19b-3p P<0.01). In contrast, three miRNAs involved in proliferation and survival, determining cell fate, and recycling endosomes decreased in survivors and PICSO (hsa miR 101-3p, P<0.03; hsa-miR 25-3p, P<002; hsa-miR 30d-5p P<0.04). In vitro cellular proliferation increased in survivors and lowered in non-survivors showing a pattern distinction, discriminating longevity according to up to 10-year survival in heart failure patients. This study proposes that generating regenerative signals observed during PICSO intervention relate to patient outcomes. Morphogenetic pathways induced by periods of flow reversal in cardiac veins in a domino-like pattern transform embryonic into regenerative signals. Studies supporting the conversion of mechanochemical signals into regenerative molecules during PICSO are warranted to substantiate predictive power on patient longevity, opening new therapeutic avenues in otherwise untreatable heart failure.

Lower limb muscle strength and balance in older adults with a distal radius fracture: a systematic review

BackgroundDistal radius fractures are common fractures in older adults and associated with increased risk of future functional decline and hip fracture. Whether lower limb muscle strength and balance are impaired in this patient population is uncertain. To help inform rehabilitation requirements, this systematic review aimed to compare lower limb muscle strength and balance between older adults with a distal radius fracture with matched controls, and to synthesise lower limb muscle strength and balance outcomes in older adults with a distal radius fracture.MethodsWe searched Embase, MEDLINE, and CINAHL (1990 to 25 May 2022) for randomised and non-randomised controlled clinical trials and observational studies that measured lower limb muscle strength and/or balance using instrumented measurements or validated tests, in adults aged ≥ 50 years enrolled within one year after distal radius fracture. We appraised included observational studies using a modified Newcastle-Ottawa Scale and included randomised controlled trials using the Cochrane risk-of-bias tool. Due to the clinical and methodological heterogeneity in included studies, we synthesised results narratively in tables and text.ResultsNineteen studies (10 case-control studies, five case series, and four randomised controlled trials) of variable methodological quality and including 1835 participants (96% women, mean age 55–73 years, median sample size 82) were included. Twelve included studies (63%) assessed strength using 10 different methods with knee extension strength most commonly assessed (6/12 (50%) studies). Five included case-control studies (50%) assessed lower limb strength. Cases demonstrated impaired strength during functional tests (two studies), but knee extension strength assessment findings were conflicting (three studies). Eighteen included studies (95%) assessed balance using 14 different methods. Single leg balance was most commonly assessed (6/18 (33%) studies). All case-control studies assessed balance with inconsistent findings.ConclusionCompared to controls, there is some evidence that older adults with a distal radius fracture have impaired lower limb muscle strength and balance. A cautious interpretation is required due to inconsistent findings across studies and/or outcome measures. Heterogeneity in control participants’ characteristics, study design, study quality, and assessment methods limited synthesis of results. Robust case-control and/or prospective observational studies are needed.RegistrationInternational prospective register of systematic reviews (date of registration: 02 July 2020, registration identifier: CRD42020196274).

Effectiveness and safety of fluocinolone acetonide intravitreal implant in diabetic macular edema patients considered insufficiently responsive to available therapies (REACT): a prospective, non-randomized, and multicenter study

ObjectiveTo assess the effectiveness and safety of the intravitreal fluocinolone-acetonide implant (FAc-i) in patients with chronic diabetic macular edema who did not sufficiently respond to other available therapies.MethodsThis was a multicenter, prospective, non-randomized, and phase-IV observational study conducted on patients with recurrent-DME who were insufficient responders to currently available therapies (REACT-Study). The primary end-point was the mean change in best-corrected-visual-acuity from baseline to month-24 values.ResultsThirty-one eyes from 31 patients were included in the study. Mean age was 68.0 ± 7.7 years, and 10 (32.3%) were women. Study patients had received 5.3 ± 7.3 previous DME treatments before starting the study. In the overall study sample, BCVA improved from 56.1 ± 12.3 letters at baseline to 62.4 ± 17.0 letters at month-24 (p = 0.0510). The eyes with a baseline BCVA < 70 ETDRS letters had a significant improvement in BCVA from 53.2 ± 10.2 letters at baseline to 61.5 ± 17.9 letters at month-24 (p = 0.0165). In the overall study population, central-subfoveal-thickness (CST) was significantly reduced from 474.0 ± 135.1 µm at baseline to 333.4 ± 135.6 at month-24 (p < 0.0001). Similarly, macular-volume (MV) was significantly reduced from 10.7 ± 2.7 mm3 at baseline to 9.6 ± 2.9 mm3 (p = 0.0027) at month-24. Among the 31 study eyes, 19 (61.3%) required an additional treatment for DME. Throughout the study, 9 (29.0%) eyes required ocular hypotensive medication for controlling their intraocular-pressure and 5 (16.1%) eyes underwent cataract surgery.ConclusionsIn DME eyes who did not sufficiently respond to previous therapies, the FAc-i was associated with an improvement in visual and anatomic outcomes. There were no unexpected adverse-events.Trial registration numberEudraCT identifier: 2016-001680-37.

Side effects following vaccination in multiple sclerosis: a prospective, multi-centre cohort study

Vaccines play a crucial role in preventing infections in patients with multiple sclerosis (MS), although concerns have been raised about potential worsening of the underlying disease. To investigate this, we conducted a prospective, multicentre, non-randomized observational study assessing changes in disease activity, safety, and clinical tolerability of vaccination in 222 MS patients on disease-modifying drugs. The majority of patients were female (76.6%) and 89.6% had relapsing–remitting MS. The vaccines administered were primarily seasonal influenza (56.3%) or tetanus-based vaccines (33.8%). Disease activity, as measured by annualized relapse rate, decreased significantly from 0.64 the year prior to vaccination to 0.38 in the following year. Moreover, the extended disability status scale remained stable within six months after vaccination in comparison to pre-vaccination values. Side effects were reported in 19.2% of vaccinated subjects, most commonly local side effects (65.2%) or flu-like symptoms (34.8%). Our findings suggest that standard non-live vaccines are safe and well-tolerated in MS patients and do not negatively impact disease activity.

Clinical Characteristics Associated With Secondary Generalization in Ocular Myasthenia Gravis Patients: A Systematic Review and Meta-analysis.

Ocular myasthenia gravis (OMG) is an autoimmune disorder resulting in ocular symptoms such as diplopia and ptosis. The proportion of patients who convert to secondary generalised myasthenia gravis (SGMG) reported in the literature has been varied. The aim of this systematic review was to determine the clinical characteristics of patients with OMG and determine on the proportion of SGMG conversion. We conducted an electronic database search for randomised controlled trials, prospective non-randomised studies, observational studies and retrospective studies in EMBASE, CENTRAL, MEDLINE and Web of Science. We included studies with patients with OMG who initially presented with ocular symptoms and signs only who were seen in clinical practice, reporting on characteristics and the outcomes of SGMG. We excluded studies with paediatric and congenital myasthenia gravis populations. Eligibile studies included articles written in any language and containing data on patients with OMG. Main outcome measured was the proportion of patients with OMG who converted to SGMG and risk factors associated with secondary generalisation of OMG. Two independent reviewers screened titles and abstracts and extracted data from full texts, reporting findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodology was evaluated using the Joanna Briggs Institute critical appraisal forms. PROSPERO registration number: CRD2021285257 RESULTS: 31 studies were included in the quantitative and qualitative analysis. The proportion of generalisation ranged from 11 to 84%. The pooled proportion was 39% (95% CI 32%, 47%, I2=95·86%, p<0·001 unweighted, low certainty). Pooled risk ratio of female gender for conversion to SGMG was 1.06 (95%CI 0·96,1·17, I2=0% p=0·614, 21 studies included, very low certainty) and pooled risk ratio of AChR positivity was 1·30 (95%CI 1·05,1·56, I2=0% p=0·455, 16 studies included, very low certainty). Risk factors such as female gender and anti-AChR positivity have been identified as possible associations with SGMG but there are not enough quality observational studies. There is a need for a prospective global database of OMG patients, including all countries with different populations.

Effect of Preoperative Intravenous Iron for Anemic Patients on Outcomes after Cardiac Surgery: A Systematic Review

Abstract Background Iron-deficiency anemia is a global health problem and a common medical condition seen in everyday clinical practice and especially with patients going through cardiac surgery. The most rapid and effective method of correcting anemia is by transfusion of red blood cells. However, blood transfusion itself is not without risk. Treatment of perioperative anemia using iron replacement therapy is, in contrast to blood transfusion, a safe, cheap, and relatively convenient therapy Aim of the Work This study aims to perform a systematic review regarding the effect of preoperative intravenous iron therapy on the need for perioperative blood transfusion and the incidence of major morbidity in anemic patients undergoing cardiac surgery. Search Methodology The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and articles were identified by searching PubMed, Web of Science, EMBASE, COCHRANE Database of systematic reviews (CDSR), Scopus, and Web of Science. Quality of the studies was assessed using the Cochrane Risk of Bias Tool 2 (ROB-2) and Risk of Bias in Non-randomized Studies tool (ROBANS). The primary outcomes are change in hemoglobin and hematocrit after cardiac surgery and perioperative need for blood transfusion, while secondary outcomes are postoperative length of hospital stay and incidence of major adverse outcomes. Results Of the articles reviewed a total of six randomized controlled trials (RCT) and seven non-randomized observational studies (NRSI) were included in the review. Across studies, 1,732 patients were enrolled. The quality of the RCTs was mostly high, while the quality of the NRSTs was low, primarily due to issues related to blinding of assessors. Two studies showed higher hemoglobin with iron therapy, and only one study showed significant differences in multiple outcomes such as transfusion and morbidity. Hospital stay was reported in 4 studies and averaged 9 days. Conclusion Our results showed benefits of preoperative intravenous iron administration in reducing the likelihood of allogeneic blood transfusion and providing a modest increase a modest increase in hemoglobin concentration in anemic patients undergoing caridac surgery.

Enhancing Intermediate Vision in Patients Affected by Epiretinal Membrane Treated by Phaco-Vitrectomy.

The aim of this research was to see if a refractive enhanced monofocal IOL (Eyhance IOL, IOL Abbott Medical Optics, Inc., Santa Ana, CA, USA) can provide better intermediate vision in patients undergoing phaco-vitrectomy due to cataract and epiretinal macular membrane (ERM). A nonrandomized prospective observational comparative study enrolled patients affected by cataract and ERM undergoing phaco-vitrectomy. A follow up of 6 months was established. Corrected and uncorrected visual acuity of both monocular and binocular types were assessed regarding intermediate and far distances. The CATQUEST 9-SF questionnaire was administered preoperatively and at the last follow-up. Twenty-three eyes of twenty-three patients were enrolled, with 11 in the enhanced monofocal group. The uncorrected and corrected distance visual acuity after 6 months was not statistically different. Both monocular and binocular uncorrected intermediate visual acuity after 6 months were higher in the enhanced monofocal group (p < 0.001). The corrected intermediate visual acuity after 6 months was higher in the enhanced monofocal group (p = 0.01). The CATQUEST-9SF questionnaire showed significant differences in the variation between the preoperative condition and six-month postoperative results (p < 0.001). This refractive enhanced monofocal IOL can provide better intermediate vision compared to a standard monofocal IOL in patients undergoing phaco-vitrectomy due to cataracts and ERM. Further studies are necessary to confirm these results.

Efficacy of bioadhesives in the management of oral mucositis in patients undergoing radio-chemotherapy for treatment of head and neck cancer-a systematic review and meta-analysis.

Management of head and neck cancers requires a multidisciplinary approach where surgery followed by radio and chemotherapy is the mainstay of treatment. The above-mentioned treatment can cause mucositis, a severely debilitating side effect. This can have a significant impact on quality of life. A recent advancing mode of drug delivery is the bioadhesive system. This interacts with mucosa by adhering to it and thereby improving the efficacy of the therapeutic agent delivered. The purpose of this systematic review is to evaluate the effectiveness of bioadhesives in reducing oral mucositis and relieving pain associated with mucositis in head and neck cancer patients receiving radio-chemotherapy. Studies assessing the effectiveness of bioadhesives for the treatment of radiation-induced oral mucositis were retrieved from specialized databases (PubMed/MEDLINE, Scopus, ProQuest, Google Scholar, LILACS, OpenGrey) as well as institutional repositories. Data on incidence, pain reduction, resolution, and improvement of oral mucositis using bioadhesive were compiled. A Cochrane tool was used for randomized controlled trials and a JBI tool for non-randomized controlled trials and observational studies to assess the quality of included studies. Based on the eligible study data, a meta-analysis was conducted with STATA version 16, 2019 software, and 95% confidence intervals and p values greater than 0.05. A total of 15 studies were included which assessed the effectiveness of bioadhesives in managing mucositis and its associated pain. Studies included in the review described either reduction,resolution,or incidenceof oral mucositis respectively. A total of three meta-analyses were conducted to assess the incidence of oral mucositis and the pain associated with it, as well as the reduction in incidence. Bioadhesives showed statistically significant differences in the incidence of severe mucositis (p = 0.04). A meta-analysis comparing bioadhesives efficacy in reducing mucositis and pain associated with it found no statistically significant differences (p = 0.36). Bioadhesives are emerging as a novel drug delivery method for treating radio-chemotherapy-induced oral mucositis because of their rapid absorption and easy application. Regardless of its benefits, clinical trials comparing it with conventional treatment methods are necessary to assess its efficacy in treating oral mucositis.

Mental health awareness programmes to promote mental well-being at the workplace among workforce in the low-income and middle-income countries: a scoping review protocol

IntroductionAn understanding of the mental health awareness programmes among workforces in low/middle-income countries (LMICs) is lacking significantly in literature. Such understanding is crucial for the employers, government agencies and other...

A single centre prospective study of three device-assisted therapies for Parkinson’s disease

Comparative studies assessing outcomes with the three device-assisted therapies could help to individualise treatment for patients living with Parkinson’s disease. We designed a single-centre non-randomised prospective observational study assessing the quality of life (QoL), motor and non-motor outcomes at 6 and 12-months in patients treated with subcutaneous apomorphine continuous 16-hours infusion (APO), levodopa-carbidopa intestinal gel (LCIG) or subthalamic nucleus deep brain stimulation (STN-DBS). In this study, 66 patients were included (13 APO; 19 LCIG; 34 STN-DBS). At baseline, cognitive, non-motor and motor scores were significantly less severe in the STN-DBS group, whereas the LCIG group had a longer disease duration and higher non-motor scores. In the APO group, there were no statistically significant changes in non-motor, motor and QoL scales. The LCIG group had significant changes in QoL and motor scales that were significant after multiple comparison analysis at 6 and 12-months. The STN-DBS group showed improvement in QoL scores and non-motor and motor scores at 6 and 12-months after multiple comparison analysis. In this real-life prospective study, device-assisted therapies showed differences in their effects on QoL and motor and non-motor function at 12-months. However, there were also differences in baseline characteristics of the patient groups that were not based on pre-determined selection criteria. Differences in characteristics of patients offered and/or treatment with different device-assisted therapies may reflect within-centre biases that may, in turn, influence perceptions of treatment efficacy or outcomes. Treatment centres should be aware of this potential confounder when assessing and offering device-assisted treatment options to their patients and potential baseline differences need to be taken into consideration when comparing the results of non-randomised studies.

Pars plana vitrectomy versus intravitreal antibiotics for endophthalmitis management following intravitreal anti-VEGF agents: A meta-analysis.

In this meta-analysis, we aim to compare the efficacy and safety of pars plana vitrectomy (PPV) versus tap-and-inject (TAI) of intravitreal antibiotics for the management of endophthalmitis secondary to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents. A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central (January 2005-October 2022). The primary analysis compared initial PPV versus TAI and the secondary analysis examined the efficacy and safety of TAI alone compared to TAI followed by PPV. The quality of non-randomized observational studies was assessed using the Newcastle-Ottawa Scale. The quality of the evidence was assessed for each outcome. A random effects meta-analysis was performed. Weighted mean differences (WMDs) with 95% confidence intervals were reported. Of the 7474 screened studies, nine studies reporting on 153 eyes were included. The change in mean best corrected visual acuity (BCVA) between endophthalmitis presentation and last follow-up did not significantly differ between the initial TAI versus PPV groups (WMD = 0.05 units; 95% CI -0.12 to 0.22; p = 0.59; heterogeneity p = 0.41). The difference in pre- to post-treatment mean BCVA did not significantly differ between eyes that received TAI alone or TAI followed by PPV (WMD = 0.04 units; 95% CI -0.42 to 0.51; p = 0.85; heterogeneity p = 0.74). While the meta-analysis revealed no significant difference in the change in BCVA between PPV and TAI to treat endophthalmitis secondary to anti-VEGF agents, the quality of evidence was low with potential for confounding and selection bias. Further well-designed studies in this setting are needed.

Mobile Dressing Trolleys Improve Satisfaction and Logistics on Pediatric Surgery Wards.

Evidence-based data on the effect of dressing trolleys on children's postoperative recovery are not available. The aim of this study was to evaluate a specific pediatric surgical dressing trolley on patient and caregiver satisfaction, as well as temporal and logistical aspects of the dressing change procedures. In a prospective observational non-randomized study, a total of 100 dressing changes were observed before (group 1) and after (group 2) the introduction of a pediatric surgical dressing trolley and the satisfaction, time and logistical factors were recorded on site. The median preparation time, the duration of the dressing change and the total time decreased significantly from group 1 to group 2 by 1:11 min (p < 0.001); 1:56 min (p = 0.05) and 5:09 min (p = 0.001), respectively. The patient's room was left significantly less often in group 2 to retrieve missing bandages. The median satisfaction of the medical staff increased by 12% in group 2 (p < 0.001). The satisfaction of the parents increased by 2.5% in group 2 (p = 0.042), and that of the nursing staff increased by 9.25% in group 2 (p = 0.015). Our results demonstrate the positive effects of a dressing trolley for pediatric surgical dressing changes by minimizing postoperative handling and manipulation of the child. It improves time and logistical factors as well as the satisfaction of those involved, which may lead to a faster recovery.

Partial weight reduction protocols in cats lead to better weight outcomes, compared with complete protocols, in cats with obesity.

To date, there have been no studies comparing outcomes of cats with obesity following either complete or partial weight reduction protocols. Fifty-eight cats participated in this non-randomized observational cohort study, including 46 (79%) and 12 (21%) that underwent complete or partial weight reduction protocols, respectively. Weight loss outcomes, body composition changes and essential nutrient intake were compared between cats in the two groups. All cats remained healthy, and those on a complete weight reduction protocol lost a median of 23% (range 10-39%) of starting body weight (SBW) over 294 days (113-967 days), whereas those undergoing partial restriction lost 25% (10-41%) over 178 days (54-512 days). Neither duration nor percentage weight loss differed between groups, but those that followed a partial weight reduction protocol lost weight at a faster rate (0.81% per week) and required fewer visits (4-19) than those that followed a complete weight reduction protocol (0.61% per week, p = 0.028; 11, 4-40 visits, p = 0.009). Further, lean tissue mass declined in cats on a complete weight reduction protocol (pre: 4.20 kg, 2.64-5.72 kg; post: 3.90 kg, 2.76-5.24 kg, p < 0.001), whereas lean tissue mass was unchanged in cats on partial weight reduction protocols (pre: 3.45 kg, 2.79-4.71 kg; post: 3.41 kg, 2.90-4.59 kg, p = 0.109). In 33 (57%) cats, median intake of selenium per day was less than NRC AI and RA recommendations, whilst intake was under FEDIAF recommendation in 42 (72%) cats. Median intake of choline per day was less than NRC MR and RA recommendations in 22 (38%) and 53 (91%) cats, respectively, whereas it was under the FEDIAF recommendation in 51 (88%) cats. In a small proportion (12-14%) of cats, phenylalanine/tyrosine and potassium were under recommendations; besides these, no other essential nutrient deficiencies were seen, and there were no differences between cats undergoing complete and partial weight reduction. Partial weight reduction protocols in cats lead to quicker average weight loss, with the possibility that lean tissue loss might be minimized. Such protocols might be more suitable for older cats and those with marked obesity.

Intramuscular ketamine provides better sedation and scan conditions in children undergoing magnetic resonance imaging: A single-blinded observational study.

The objectives of this study were to compare the quality of sedation provided by intravenous (i.v.) and intramuscular (im) ketamine for pediatric magnetic resonance imaging (MRI). This study was a non-randomized, single-blinded, and prospective observational study. After receiving approval from the Institutional Ethics Committee, a total of 108 children aged 2-7 years were divided into two groups, with 54 children in each group. In the i.v. group, children received ketamine at a dose of 1.5 mg/kg intravenously, while in the im group, children received ketamine at a dose of 4 mg/kg intramuscularly. If a Ramsay sedation score of 6 (RSS-6) was not achieved, half of the loading dose of ketamine was repeated. In both groups, rescue propofol boluses of 1 mg/kg intravenously were administered whenever the child moved. The primary outcome measure was the quality of sedation, which was assessed by a blinded radiologist. The time taken to reach RSS-6, the number of rescue propofol boluses, the total time wasted in taking repeat sequences, and the time required to achieve a modified Aldrete score of 9 (MAS-9) were recorded. The im group demonstrated significantly better sedation quality. In the i.v. group, the time to achieve RSS-6 was significantly shorter, but it required more rescue propofol boluses to maintain sedation. The i.v. group also experienced a notable increase in the total time wasted during repeat sequences. On the other hand, the i.v. group exhibited a shorter time to reach MAS-9 compared to the im group. The im group showed superior sedation quality when compared to the i.v. group. However, it is important to consider that the im group experienced a longer recovery time.

Single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: A systematic review and meta-analysis.

The possibilities of minimally invasive cholecystectomy have emerged since the beginning of single-incision laparoscopic cholecystectomy (SILC) and single-site robotic cholecystectomy (SSRC). This study aimed to compare the feasibility, safety, and pain scores between SSRC and SILC. The authors searched randomized or non-randomized controlled trials and observational studies in PubMed, EuroPMC, and ClinicalTrials.gov from April 2012 until April 2022. The authors analyzed the operation time, hospital stay, blood loss volume, conversion rate, intraoperative complication rates, postoperative complications, visual analog scale (VAS) immediately after surgery, and VAS at hospital discharge. This study aligned with PRISMA and AMSTAR guidelines. Thirteen studies were selected with 817 and 757 patients who underwent SSRC and SILC. Thus, this study demonstrated a lower incidence of intraoperative complication rates [relative risk (RR) 0.57 (95% CI 0.34-0.96), p = 0.03] and lesser VAS score at hospital discharge [Std. Mean Difference (SMD) -0.23 (95% CI -0.46, -0.01), p = 0.04] in the SSRC group. Regarding operation time and cost, SSRC revealed a longer time [SMD 1.02 (95% CI 0.45, 1.59), p = 0.0004] and higher cost [SMD 4.18 (95% CI 1.77, 6.58), p < 0.00001], respectively. Meanwhile, SSRC did not differ from SILC during a hospital stay, blood loss volume, conversion rate, postoperative complication rates, and VAS immediately after surgery. Concerning intraoperative complication rates and VAS score at hospital discharge, SSRC was superior to SILC. Thus, SSRC is considered a feasible and safe procedure.

Three-dimensional analysis for measuring volumetric changes after a noninvasive treatment performed with a new system delivering microwave energy for unwanted abdominal fat reduction.

A growing demand for aesthetic treatments for localized abdominal unwanted fat has developed as a healthy lifestyle is not always able to improve abdomen appearance. The purpose of this retrospective nonrandomized observational study was to evaluate the efficacy and safety of a new device delivering microwaves energy for unwanted fat reduction, using three-dimensional (3D) imaging analysis. Twenty patients (both female and male) were treated in the abdominal area. Subjects received 4 treatments with the study device. Follow-up evaluations were conducted to estimate safety and efficacy. A Numerical Rating Scale (NRS) was used for pain assessment. Patient's 3D imaging analysis was performed at baseline and at 3 months follow-up. Finally, a satisfaction questionnaire was filled in by all the patients. All subjects completed the whole cycle of treatments and presented for the follow-up visits. Analysis of 3D imaging yielded a significantly reduction in circumference (cm) and volume (cm3 ), passing, respectively, from 85.2 ± 8.1 cm and 1950.6 ± 471.0 cm3 at baseline to 80.8 ± 8.2 cm and 1728.9 ± 490.9 cm3 (p < 0.001) at 3-months follow-up after the last treatment. According to the NRS results, the treatment was well tolerated. From the analysis of the satisfaction questionnaire the 90% of patients are interested in carrying out the same treatment in other body areas. With the use of three-dimensional imaging techniques, the efficacy of a new system delivering microwaves energy for the reduction of abdominal volume correlated to a subdermal fat reduction while preserving/improving skin tightening, was quantitatively and objectively demonstrated.