OR Group Research Articles

Immune Indicator Changes in Hepatocellular Carcinoma Undergoing TACE Plus ICIs and Anti-VEGF Antibodies/TKIs: A Prognostic Biomarker Analysis.

To explore changing trends in circulating immune indicators of hepatocellular carcinoma (HCC) undergoing TACE plus immune checkpoint inhibitors (ICIs) and anti-VEGF antibodies/TKIs and to elucidate the relationship between immune response and tumor prognosis. This single-center retrospective study included patients with unresectable HCC undergoing TACE plus ICIs and anti-VEGF antibodies/TKIs from March 11, 2019, to February 15, 2024. Peripheral blood samples were collected at baseline and every cycle, from which blood cell counts and immune indicators were analyzed. The primary outcome was the objective response rate (ORR) at the first evaluation. According to the first evaluation based on mRECIST, patients were classified into PD, SD, and OR groups for analysis. Further subgroup analysis was performed on the OR group based on whether experiencing progression after the first evaluation. Lymphocyte subsets were measured by flow cytometry. Immunoglobulins were measured using the immune turbidimetric method. The neutrophil-to-lymphocyte ratio (NLR) was measured by the complete blood count. Simple linear regression was employed to examine the dynamic trends. A total of 63 patients were enrolled, with an ORR of 55.6% and a disease control rate (DCR) of 87.3% at the first evaluation. The median overall survival (mOS) was 27.5 months (95% CI: 22.5-32.5 months). In the OR group (n=35), more active immune responses, expressed in a decrease in CD3-CD19+ (p=0.004), CFB (p=0.027), NLR (p<0.001) and an increase in Ig λ (p=0.010), Ig κ (p=0.037), Ig A (p=0.005), Ig G (p=0.006), were related to better prognosis, while similar patterns seen in the OR-nPD subgroup. Concurrently, no significant differences were noted in the PD group (n=8). The combination therapy may modify the tumor microenvironment of HCC. Changing trends in circulating immune indicators and NLR can serve as potential biomarkers for predicting tumor response and guiding clinical treatment.

Short- and Long-Term Outcomes of Thoracoscopic and Open Repair For Esophageal Atresia and Tracheoesophageal Fistula

BackgroundThe aim was to evaluate short- and long-term outcomes for thoracoscopic repair of EA/TEF and compare with open repair. MethodsPatients who underwent EA/TEF repair during 2000–2020 were evaluated retrospectively. Patients with delayed repair were excluded. Demographic, operative, outcome data was collected. Outcomes were compared using Wilcoxon-rank sum tests for continuous, Chi-squared/Fisher's exact tests for categorical data. ResultsThere were 104 patients with primary repair, 49 (47.1%) underwent thoracoscopic repair per surgeon's choice. Type C accounted for 101 (97.1%) of the cases. Gestational age and birth weight were higher in the thoracoscopy group (p = 0.001). The rate of ≥3 VACTERL anomalies was higher in the OR group (p = 0.016). Operative time, rate of anastomotic leak, time to first oral feeding were similar (p > 0.05). Thoracoscopy group had decreased length of ventilation (p = 0.026) and length of stay (p = 0.029). The incidence of anastomotic stricture was higher in the thoracoscopy group (p = 0.012). Recurrent TEF was one case in each group. Rates of tube feeding at discharge and in first year were similar (p > 0.05), rate in third year was decreased (p = 0.032) in the thoracoscopy group. Rates of anti-reflux medication in first and third years, and fundoplication rate were similar (p > 0.05). ConclusionsMany of the short- and long-term outcomes are comparable between thoracoscopic and open repair of EA/TEF. Length of ventilation, length of stay are decreased in the thoracoscopy group. Anastomotic stricture is higher, the need for long-term tube feeding is lower after thoracoscopic repair. Although these results could be affected by selection bias, they are still promising for advancing thoracoscopic repair of EA/TEF safely and efficiently. Level of EvidenceLevel III.

Outcome of Obstructing vs Nonobstructing Colorectal Carcinomas: Comparative Study at Tertiary Care Hospital in Kashmir.

Colorectal cancer (CRC) is the commonly diagnosed malignancy presenting either in obstruction or without obstruction. Bowel obstruction (BO) is usually a complication of advanced cancer, significantly reducing the quality of life. We aimed to study the outcomes of these obstructed colorectal cancers requiring emergency intervention and compare it with nonobstructed cancers. In our observational comparative study, patients were divided into groups on basis of their presentation and site of lesion: nonobstructing colon group/obstructing colon group nonobstructing rectum group/obstructing rectum group. A total of 232 patients with known modes of presentation between 2015 and 2018 were included; 144 colonic, 88 rectal carcinomas with 71 being completely obstructive ones. Our study showed higher recurrence in obstructive groups with local recurrence being more common. The median interval for recurrence was early in obstructive group (p < 0.001*). The overall 5-year survival rates were better in Nonobstructing colon group, (p = -0.046* in OR vs NOR) (p = -0.031* in OC vs NOC). 5-year disease-free survival rates statistically insignificant (p = 0.203 in NOC and OC groups), (p = 0.307 in NOR and OR groups). Immediate post-op, complications except for SSI, there was no significant difference between the two groups. Our study showed higher proportion of R0 resection in NOC groups as compared with obstructive groups (p = 0.021* in in OC vs NOC and p = 0.037* in OR vs NOR) with better lymph node retrieval in NOC groups. On comparing outcome of patients who had completed multi-modal therapy in both groups, there was significantly better outcome for patients who have presented without obstruction. Ul Haq MF, Bhat GA, Wani MA, et al. Outcome of Obstructing vs Nonobstructing Colorectal Carcinomas: Comparative Study at Tertiary Care Hospital in Kashmir. Euroasian J Hepato-Gastroenterol 2024;14(1):75-80.

Controlled engineering of high-purity pseudo-boehmite with large pore volume by aluminum alkoxide hydrolysis: Mechanistic understanding and reforming catalysis

The mechanistic understanding of the pore formation during aluminum alkoxide hydrolysis is of crucial importance for the controlled engineering of large pore volume pseudo-boehmite. The time-dependent structure evolution during n-hexanol-aluminum hydrolysis and the DFT calculations were performed to monitor the changes in the aluminum coordination. The results show that the hydrolysis, oxolation and alcoxolation reactions dominate the pore construction in turn with the continuous addition of water. The aluminum coordination undergoes aggregation from Al tetra-coordinates to Al hexa-coordinates and further stable Al3hexa-coordinates as repeating units for linear growth. The rate and amount of water injection is critical for the retention of at least one OR (R = -C6H13) group, which acts as a directed pore-forming group to promote the large cyclization growth of the Al3hexa-coordinates. Consequently, 1.44 cm3/g pore volume of high-purity pseudo-boehmite was obtained, and the prepared PtSn-Al2O3 catalyst exhibits a > 80 % of toluene selectivity for n-heptane reforming.

Neoadjuvant S-1 plus cisplatin-based chemoradiotherapy compared with surgery alone for locally advanced gastric cancer: Randomized, phase II trial.

4076 Background: Patients with locally advanced gastric cancer (LAGC), are known to have a high risk of recurrence even after surgery. This study was designed to delineate whether neoadjuvant concurrent chemoradiotherapy (CCRT) using the S-1/Cisplatin (SP) regimen can effectively downstage the T stage in patients with clinically T4 stage compared with surgery alone (OP). Methods: This is a randomized phase II open label trial and gastric cancer patients with initial clinical T4 were enrolled. Patients were randomized into neoadjuvant CCRT or OP. For the CCRT group, S-1 (20 mg/m2 twice daily, 2 weeks on and 1 week off) and cisplatin (30 mg/m2/day, first day of week 1, 2, 4, and 5) were administered concurrent with radiotherapy (day 1-5 for 5 weeks, total 45 Gy/25 fractions,). Surgery was performed within 3 to 6 weeks after the completion of CCRT. For the OP group, curative surgery was performed within 3 weeks after randomization. Post-operative adjuvant chemotherapy was chosen as S-1 monotherapy or combination of Capecitabine, and Oxaliplatin according to the physician’s choice. The primary objective of this study was to compare the downstaging rates between the groups (65% and 40% for the CCRT and OP group). Using a type I error rate of 0.10 and a power of 0.80, the planned sample size was 51 patients per group but the study was closed prematurely. Results: Between November 2016 and August 2021, 49 patients with T4 were enrolled. Of those, 26 (CCRT) and 23 (OP) patients were randomized but diagnostic laparoscopy for preoperative screening revealed peritoneal seeding in some patients. Finally, 23 (CCRT) and 17 (OP) patients were evaluable and clinicopathologic characteristics were well balanced between the two groups in per protocol analysis. For CCRT, 19 out of 23 (82.61%) patients satisfied downstage, while among 8 out of 17 (47.06%) patients in OP group satisfied downstage ( P=0.038). The median disease-free survival (DFS) was 27.91 months in CCRT group, and 45.96 months in OP group ( P=0.985). The median overall survival (OS) was not reached in CCRT group, and 51.2 months in OR group ( P=0.335). There were no statistically significant differences between neoadjuvant CCRT and surgery group in the aspect of both hematologic and non-hematologic adverse events. Conclusions: In this study, neoadjuvant SP based CCRT significantly increased downstaging in T stage compared than OP alone. The prespecified genomic analysis with transcriptomic sequencing will be available at the meeting. Clinical trial information: NCT03814759 .

Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps.

The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser. Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention. Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications. Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities. 3 Laryngoscope, 134:S1-S20, 2024.

Midterm outcomes of "wide neck" abdominal aortic aneurysm after open or endovascular repair in two European centers: a propensity score matching analysis.

The aim of this study was to compare mid-term clinical and morphological outcomes in patients undergoing open (OR) and endovascular aortic repair (EVAR) with a proximal wide neck abdominal aortic aneurysm (WN-AAA). Between 2009 and 2014 data of all patients undergoing OR at IRCCS San Raffaele Hospital and EVAR at German Aortic Center Hamburg were retrospectively analyzed. Primary endpoints were aneurysm-related mortality at 5 years, reintervention, and overall mortality. Secondary endpoint was proximal neck enlargement. A 1:1 propensity score matching (PSM) was performed. Survival and freedom from AAA-related reintervention were investigated in matched OR and EVAR group by Kaplan-Meier analysis. Of all OR performed at IRCCS San Raffaele Hospital 70 were found to have a proximal neck >28 mm (mean age: 69.8±7.2 years, 67 [95.71%] male); of all consecutive EVAR performed at German Aortic Center Hamburg, 52 required an endograft size of at least 32 mm (mean age of 73.1±8.7 years, 49 [94.2%] male). After PSM, the study cohort consisted of 30 OR and EVAR. One early mortality was registered in both groups (P=NS). Mid-term freedom from reintervention compared in OR and EVAR, with no statistically significant differences (P=0.979). Eight (15.4%) patients treated with EVAR developed a significant proximal diameter enlargement (≥3 mm) while only 1 (1.4%) patient in the OR group had the same evolution (P<0.01). In WN-AAA neck enlargement is observed more frequently in patients undergoing EVAR, but reintervention rate was similar in the 2 groups, demonstrating that both options were safe and effective.

The right stuff: Salutogenic and pathogenic responses over a year in Antarctica

IntroductionEver since the first human reached the South Pole, studies have sought to explore the impact of an isolated, confined, and unusual environment on human adaptation. The findings have highlighted both negative and salutogenic effects on crews. Although several studies have focused on adaptation in the polar regions, we still do not fully understand its mechanisms. Thus, the objectives of the present study are: (1) to investigate the impact of a one-year stay in Antarctica on health adaptation; and (2) to assess recovery from this experience two days later. MethodSeventeen healthy participants were recruited to stay for one year at the French Dumont d’Urville station in Antarctica. Psychological, physiological, and exteroceptive measures were recorded on the day of arrival at the station (baseline), during each quarter of the wintering season (M4, M7, M10, M12), and two days after the return to the continent (D+2). Subjects were allocated to two groups according to their scores on the General Health Questionnaire at baseline, as follows: very limited or no existence of minor non-psychiatric or psychotic disorders (higher than normal, HN); and standard values for non-psychiatric or minor psychotic disorders within the general population (ordinary range, OR). ResultsOur results highlight both an adaptative response during the winter months, and pathogenic states during the last quarter of the mission and at recovery (D+2), which are still below normal values for psychological disorders and stress. The analysis of OR and HN groups during overwintering highlights a decrease in psychosensory responses, and thus poorer adaptation. ConclusionSpending a year in Antarctica no longer has harmful consequences (except during the third quarter of the mission), and the harshness of the environment in midwinter does not seem to be an aggravating factor for the winterers included in this study. Nevertheless, the General Health Questionnaire indicates two levels of adaptation during the mission. The latter observation suggests that there is a need to select the most-adaptable crews to maintain high performance during overwintering, and to prepare for the return to the continent. Taken together, our results contribute to a better understanding of adaptation in extreme environments, notably future dark space exploration.

A Study on Distinguishing ChatGPT-Generated and Human-Written Orthopaedic Abstracts by Reviewers: Decoding the Discrepancies.

ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States)is an artificial intelligence (AI)-based language model that generates human-resembling texts. This AI-generated literary work is comprehensibleand contextually relevant and it is really difficult to differentiate from human-written content. ChatGPT has risen in popularity lately and is widely utilized in scholarly manuscript drafting. The aim of this study is to identify if 1) human reviewers can differentiate between AI-generated and human-written abstracts and2) AI detectors are currently reliable in detecting AI-generated abstracts. Seven blinded reviewers were asked to read 21 abstracts and differentiate which were AI-generated and which were human-written. The first group consisted of three orthopaedic residents with limited research experience (OR). The second group included three orthopaedic professors with extensive research experience (OP). The seventh reviewer was a non-orthopaedic doctor and acted as a control in terms of expertise. All abstracts were scanned by a plagiarism detector program. The performance of detecting AI-generated abstracts of two different AI detectors was also analyzed. A structured interview was conducted at the end of the survey in order to evaluate the decision-making process utilized by each reviewer. The OR group managed to identify correctly 34.9% of the abstracts' authorship and the OP group 31.7%. The non-orthopaedic control identified correctly 76.2%. All AI-generated abstracts were 100% unique (0% plagiarism). The first AI detector managed to identify correctly only 9/21 (42.9%) of the abstracts' authors, whereas the second AI detector identified 14/21 (66.6%). Inability to correctly identify AI-generated context poses a significant scientific risk as "false" abstracts can end up in scientific conferences or publications.Neither expertise nor research background was shown to have any meaningful impact on the predictive outcome. Focus on statistical data presentation may help the differentiation process. Further research is warranted in order to highlight which elements could help reveal an AI-generated abstract.

Transarterial interventions in civilian gunshot wound injury: experience from a level-1 trauma center

PurposeTo assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW).Materials and methodsA retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model.ResultsTwenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p < 0.0001) at the time of initial presentation. Technical success was achieved in all 40 cases in which targeted embolization was attempted (100%). Empiric embolization was performed in 6/46 (13.0%) patients based on computed tomographic angiogram (CTA) and operative findings. Stent-grafts were placed in 3 patients for subclavian artery injuries. Availability of pre-intervention CTA was associated with shorter fluoroscopy time (19.8 ± 12.1 vs 30.7 ± 18.6 min, p = 0.030). A total of 41 patients were discharged in stable condition (89.1%). Hollow organ injury was associated with mortality (p = 0.039).ConclusionEndovascular embolization and stenting were effective in managing hemorrhage due to GSW in a carefully selected population. Hollow organ injury was a statistically significant predictor of mortality. Pre-intervention CTA enabled targeted, shorter and equally effective procedures.

Intraoperative Versus Postoperative Hydroxocobalamin for Vasoplegic Shock in Cardiothoracic Surgery

Hydroxocobalamin inhibits nitric oxide pathways contributing to vasoplegic shock in patients undergoing cardiopulmonary bypass (CPB). The objective of this study was to evaluate the effect of intraoperative versus postoperative application of hydroxocobalamin for vasoplegic shock in patients undergoing CPB. This was a historic cohort study. The study was conducted at a quaternary academic cardiovascular surgery program. Adults undergoing cardiac surgery using CPB were participants in the study. Hydroxocobalamin (5 g) intravenously over 15 minutes. The treatment groups were assigned based on the receipt location of hydroxocobalamin (ie, intensive care unit [ICU] versus operating room [OR]). The primary outcome was vasopressor-free days in the first 14 days after CPB. Of the 112 patients included, 37 patients received hydroxocobalamin in the OR and 75 in the ICU. Patients in the OR group were younger than those in the ICU group (57.5 v 63.9 years, p=0.007), with statistically similar American Society of Anesthesiologists scores. The mean CPB duration was 3.4 hours in the OR group and 2.9 hours in the ICU group (p=0.09). In both groups, the norepinephrine-equivalent dose of vasopressors at hydroxocobalamin was 0.27 µg/kg/min. Days alive and free of vasopressors were not different between the OR and ICU groups (hazard ratio 0.48 [95% CI 1.76-2.72], p=0.67). The odds of postoperative renal failure, mesenteric ischemia, ICU, hospital length of stay, and in-hospital mortality were also similar between groups. A difference in vasopressor-free days after CPB was not found between patients who received hydroxocobalamin intraoperatively versus postoperatively for vasoplegic shock.

A Modified Technique of Percutaneous Fixation of Displaced Pediatric Lateral Humeral Condyle Elbow Fractures (aka the Martini Technique): A Brief Case Series.

Displaced lateral humeral condyle (LHC) fractures have routinely been treated with open reduction, which has known postoperative complications. Recent reports show that closed reduction and percutaneous pinning (CRPP) is a valid treatment. Five pediatric patients with displaced LHC fractures were included in a retrospective case series. Closed reductions (CRs) were facilitated by Kirschner wire placement into the capitellum through a toothed drill guide. The Kirschner wire and drill guide were used like a joystick to manipulate the fragment and maintain reduction for placement of additional Kirschner wires. Patient records were used to determine the number of patients diagnosed with LHC fractures between 2011 to 2022 among six pediatric orthopaedic surgeons at one institution along with the treatment and associated complications. Satisfactory reduction of displaced LHC fractures was achieved with CRPP in all patients with no complications using the "martini" modification. Of 26 LHC fractures, 16 were treated with CRPP/CRPS and 10 with open reduction and percutaneous pinning/open reduction and internal fixation, with four converted from CR to OR. Complications included one superficial infection in the CR group and four stiff elbows and one nonunion in the OR group option for LHC fractures. CRPP is an effective treatment option with a decreased risk of complications. Our modified reduction technique may help improve the success and results of closed treatment of LHC fractures.

Determination of Total Phenolic Compounds and SPF ( Sun Protection Factor)Value of Methanol Extract &amp; Fraction Brotowali Leaves ( Tinospora crispa L.)

Flavonoid is one of the compounds that are important for the body because it has a function as an antidote to free radicals by overcoming and preventing the occurrence of oxidative stress conditions are antioxidants. Phenolic compounds are known to have antioxidant activity due to the substitution of hydroxy groups at the ortho and para positions to the – OH and –OR groups. Phenolic compounds are known to have various pharmacological activities, one of that is photoprotective which useful for protecting the skin from the dangers of UV exposure. Brotowali contains secondary metabolites such as alkaloids, phenolics, steroids, and tannins. The presence of these compounds indicates that brotowali has the ability to inhibit free radical compounds. This study aims to determine the total phenolic levels and SPF (Sun Protection Factor) in methanol extract and leaf fraction of brotowali (Tinospora crispa L.). The research methods include maceration, fractionation, phytochemical screening test, specific and non-specific parameter testing, assay by Folin-Ciocalteau method using gallic acid as a standard, and SPF (Sun Protection Factor) value. Based on the research results obtained, the ethyl acetate fraction of brotowali leaves contains phenolic compounds of 675.6522 mg GAE/gram sample with the highest SPF value at a concentration of 1000ppm of 48.79.

CLINICAL EFFECTS OF SINGLE PILL COMBINATION THERAPY OF ANTIHYPERTENSIVES AND STATIN ON BLOOD PRESSURE, LIPID, AND CARDIOVASCULAR RISK PROFILES IN PATIENTS WITH NEWLY DIAGNOSED HYPE

Objective: Hypertension and dyslipidemia are the major risk factors for athersclerotic cardiovascular disease (ASCVD). The single pill combination (SPC) covering these risk factors are commonly used but has little data. The clinical effect of these SPCs on blood pressure and lipid profile with ASCVD risk change were evaluated in middle aged borderline risk group. Design and method: Seventy-two patients (age: 53.6±10 years) who were simultaneously diagnosed with hypertension and dyslipidemia were randomized to the two SPC groups: amlodipine 5 with atorvastatin 20 (AA) versus (vs.) olmesartan20 with rosuvastatin 10mg (OR). Before and after medication for six months under the active life style change, 24-hour ambulatory blood pressure (BP) monitoring (ABPM), lipid profile, carotid ultrasonography, ankle-brachial index (ABI), and ASCVD risk parameters including glucose profiles were also compared. Results: Baseline 24-hr mean systolic BP were higher in OR group (AA vs. OR: systolic BP 142.8±8.9 vs. 148.3±8.8mmHg, p = 0.039). The level of LDL cholesterol were slightly higher without significance in OR group (LDL 121.3±31.2 vs. 136.4±26.6mg/dL, p = 0.091). Follow-up mean BP were similar on 24-hr ABPM (systolic BP 127.3±9.4 vs. 125.1±7.3mmHg, p = 0.416; diastolic BP 85.6±6.6 vs. 81.4±7.8mmHg, p = 0.083). The changes in reduction of mean systolic BP markedly greater in OR group (systolic BP -15.1±11.5 vs -22.8±11.7, p = 0.048). Reduction of LDL cholesterol were similar (-53.1±24.7 vs. -62.5±29.1 mg/dL, p = 0.331). The level of fasting glucose was increased in only OR group and those of hemoglobin A1c were increased at both group and its changes were greater in OR group (0.12±0.30 vs. 0.23±0.28%, p = 0.048). The carotid intima-media thicknesses were slightly reduced in both group while ABI were not changed. ASCVD risk score were decreased after treatment (5.3 to 2.9 vs. 6.9 to 3.8%) with its similar rate between both group (45.3 vs 45.6%). Conclusions: In treating the middle aged patients with newly diagnosed hypertension and dyslipidemia using SPCs of AA and OR, OR is beneficial in blood pressure control while AA is advantageous to glucose control. After 6-months simultaneous treatment of hypertension and dyslipidemia, their grades of ASCVD risks were shifted from borderline to lower group.

Hybrid and open repair for patients with acute limb ischemia of the lower extremities.

Hybrid revascularization procedures for acute limb ischemia (ALI) are becoming increasingly common, bibliographic data on outcomes is however sparse. Single-center, retrospective study of consecutive patients with ALI that underwent either surgical treatment (ST) or hybrid treatment (HT) between January 2015 and December 2021. The composite outcome of amputation-free survival (AFS) was the primary endpoint. Technical success, overall survival, amputation, and re-intervention rates were the secondary endpoints. During the study period 266 patients (mean age 70.2±14.5 years; 49.6% males) were treated for ALI, 67.3% undergoing ST and 32.7% HT. HT was more frequently used in patients with a previous vascular intervention in the index limb (38/87; 43.7% HT vs. 40/179; 22.3% ST, P=0.001), a stent- or stent graft-occlusion (16/87; 18.4% HT vs. 10/179; 5.6% ST, P=0.002) and/or a bypass occlusion (16/87; 18.4% HT vs. 16/179; 8.9% ST, P=0.043). Technical success was higher in the OR group (75/87; 86.2% HT vs. 173/179; 96.6% ST, P=0.003). Amputation-free survival rate during follow-up (43/87; 49.4% HT vs. 94/179; 52.5% ST, HR 0.76, 95% CI: 0.49 to 1.18, P=0.22) and overall survival (32/87; 36.8% HT vs. 84/179; 46.9% ST, HR 0.81, 95% CI: 0.49 to 1.34, P=0.41) were comparable between the two groups. No statistical differences were observed between the groups regarding major amputation (19/87; 21.8% HT vs. 15/179; 8.4% ST, HR 0.85, 95% CI: 0.33 to 2.23, P=0.74) or reintervention during follow-up (45/87; 51.7% HT vs. 65/179; 36.3% ST, HR 0.92, 95% CI: 0.56 to 1.51, P=0.73). Hybrid and open surgical treatments showed comparable results in our cohort, even though significantly more patients undergoing HT presented with stent and bypass occlusions rather than de-novo lesions.

Surgical interventions and outcome in a population of feline trauma patients.

To determine signalment, injury type, trauma severity score, and outcome of feline trauma patients undergoing surgical (emergency room [ER] and operating room [OR]) and nonsurgical treatments in addition to time to surgery, specialty services involved, and cost in the OR surgery population. Retrospective evaluation of medical record and hospital trauma registry data on feline trauma cases. University teaching hospital. Two hundred and fifty-one cats presenting for traumatic injury between May 2017 and July 2020. None. Demographics and outcomes were compared for cats undergoing surgical intervention in an OR (12%, 31/251) or an ER (23%, 58/251) setting and feline trauma patients without surgical intervention (65%, 162/251). Between the 2 surgical groups, 99% survived to discharge compared to 73.5% of the nonsurgical group (P<0.0001). For the OR surgical cohort, electronic medical records were reviewed to determine the specialty surgery service involved, time to and duration of anesthesia and surgery, and visit cost. The most common surgery services involved were orthopedics (41%, 12/29) and dentistry (38%, 11/29), and the most common surgeries performed were mandibular fracture stabilization (8/29) and internal fixation for long bone fractures (8/29). The ER surgical group had a significantly lower Animal Trauma Triage score than the OR group (P<0.0001), but a significant difference was not found between OR surgical and nonsurgical groups (P=0.0553). No difference in modified Glasgow Coma Scale score was found between any groups. Surgical intervention in feline trauma patients appears to be associated with higher survival rates, but no difference in mortality was found across surgery services. OR surgical intervention, in particular, orthopedic surgery, was associated with increased length of hospitalization, increased cost, and increased use of blood products.

Serum antimüllerian hormone concentrations in female cats. Relation with ovarian remnant syndrome, ovarian cysts and gonadectomy status

The aim of this study was to reveal (1) the determination of the serum antimüllerian hormone concentrations in cats with ovarian remnant syndrome and ovarian cyst, (2) the effectiveness of the serum antimüllerian hormone concentrations in detecting gonadectomy status, and (3) ovarian expression of the antimüllerian hormone in the ovarian cysts and ovarian remnant tissue. For this purpose, a total of 31 domestic cats older than 1 year, including ORS (n = 9), OC (n = 3), spayed (n = 8), and intact (n = 11), were used in the study. Serum and intrafollicular AMH concentrations were determined by the electrochemiluminescence immunoassay, and expression of the AMH was determined by the immunohistochemical method. The serum AMH concentration in the ORS group was 1.49 ± 1.24 ng/ml (0.10–3.63 ng/ml) whereas it was 1.78 ± 0.92 ng/ml (0.8–2.63 ng/ml) in the OC group. AMH concentration in the intrafollicular fluid was determined as 0.023 ng/ml in a cat with an ovarian cyst. While the serum AMH concentration was below 0.01 ng/ml in spayed cats, it was 5.80 ± 3.30 ng/ml (1.88–11.86 ng/ml) in the intact cats. There was a significant difference between the spayed and intact groups in terms of serum AMH concentration (p < 0.05). Moreover, in cats with ovarian cyst and ovarian remnant syndrome, no difference was found between the groups in terms of serum AMH concentration (p > 0.05). No difference was found between the ovarian remnant syndrome and intact cats in terms of serum AMH concentration (p > 0.05). In immunohistochemical staining, ovarian cysts were found to be negative for AMH while a moderate (+2) AMH positivity was observed in other follicles. Furthermore, in cats with ovarian remnant syndrome, severe (+3) AMH positivity was observed. As a result, it was determined that gonadectomy status can be accurately diagnosed by the AMH measurement. Ovarian remnant syndrome cannot be diagnosed accurately by AMH measurement. In addition, it was found that AMH did not seem to play a role in the pathogenesis of ovarian cysts in cats.

Evaluation of Cost and Parental Satisfaction in Type B Polydactyly Excision Completed in Office Vs. Operating Room

Background/Objective:One in 500 children in the US are born with polydactyly, extra digits on hands or feet. Out of those children, 95% of cases comprise of type B polydactyly, in which the extra digit is attached by neurovascular bundle without bones. Surgeries to remove type B polydactylies by excision have been traditionally performed in operating rooms. Even though operating room surgeries are successful, they can be expensive and time consuming. In contrast, the surgeries performed in physician’s office, while non-traditional, can minimize expenses and save time and effort. We hypothesize that excisions conducted in offices are safe alternatives to operating room excision and are associated with definitive financial savings for patients’ families and hospitals, while increasing satisfaction of parents.&#x0D; Methods:Using CPT codes and reviewing electronic medical records, we identified all patients from 2019 to 2022 who had been treated for Type B Polydactyly with either office procedures or OR procedures, all of which had been performed at Riley Children’s Hospital. Patient billing data were obtained from Indiana University Hospital billing department. Average charge to patients for total cost of procedure and estimated removal of one digit were analyzed and compared. A 9-question parental satisfaction questionnaire was administered to patient’s parents over phone call.&#x0D; Results:Thus far, out of 93 patients who underwent type B polydactyly removal, 36 patients received procedures in physician’s offices, and 57 patients received procedures in ORs. Average charge to patients per digit removed for in-office group was around $500 cheaper than that of OR group. Average total charge to patients for in-office group was around $600 cheaper than that of OR group. Parental satisfaction data are pending.&#x0D; Conclusion and Potential Impact:This study shows the cost effectiveness of type B polydactyly excision in office. With analysis of future satisfaction survey data, we hope to gauge parental satisfaction associated with in-office excisions and promote in-office excisions as effective alternative to OR excisions.

Suppressive role of vascular endothelial growth factor on intestinal apoptosis in induced necrotizing enterocolitis in rats.

Necrotizing enterocolitis (NEC) is a devastating disease that can cause mortality in preterm babies. NEC may develop through an apoptotic pathway that is known to be inhibited by vascular endothelial growth factor (VEGF). This study determined whether VEGF exerted a protective effect against the development of NEC and apoptosis in rats. To determine the effect of VEGF in NEC rats, neonatal rats were randomized into 4 groups: the control group, the NEC group, the NEC + intraperitoneal VEGF (50 ng/kg) group (NEC + VEGF IP group), and the NEC + oral VEGF (50 ng/kg) group (NEC + VEGF OR group). NEC was induced by lipopolysaccharide/hypoxia and cold stress. The animals were sacrificed 72 hours later. After laparotomy, we obtained a region of the proximal small bowel from the ileocecal valve about 18 cm in length. The NEC histological grade, apoptosis histological score, and caspase-3 activity were lower in the NEC + VEGF IP and OR groups than in the NEC group. In the NEC + VEGF IP and OR groups, the messenger RNA expression of apoptotic and inflammatory genes, such as Bax, NF-κB, p53, Fas, FasL, and PAF-R, but not that of Bcl-2, was decreased, as was the Bax/Bcl-2 protein ratio. Histological analysis revealed that the apoptosis-blocking effect of VEGF was more effective in the NEC + VEGF IP group than in the NEC + VEGF OR group. We identified apoptotic and inflammatory genes to confirm the preventive effect of VEGF pretreatment on NEC in rats. This study presents a novel approach to prevent apoptosis via VEGF pretreatment in rats with lipopolysaccharide/hypoxia-induced NEC.

K-wire Fixation of Closed Hand Fractures Outside the Main Operating Room Does Not Increase Infections

A multicenter prospective analysis of patients undergoing CRIF of metacarpal or phalangeal fractures inside or outside the OR was performed. Demographic data, injury characteristics, surgery information and postoperative infectious complications were recorded, including cellulitis, frank pus, and osteomyelitis. The study involved 1042 patients with a total of 2265 Kirschner-wires (K-wires). Infection rates were not statistically higher in the 719 patients who had CRIF outside of the OR (cellulitis 2.5%, frank pus 1.4%) compared with the 323 patients with CRIF in the OR group (cellulitis 3.4%, frank pus 2.5%). The OR group had a longer time to operation and a longer procedure time, but a shorter time with the K-wires in place. K-wire fixation of closed hand fractures outside of the OR under field sterility is safe because it does not increase infectious complications compared to CRIF in the main OR under full sterility.