Physiological Complications Research Articles

O-arm navigation without apnoea in thoracolumbar and lumbar spine surgery: Outcomes and considerations in a prospective study

BackgroundIntra operative three dimensional navigation-assisted pedicle screw insertion typically requires apnoea for reliable image production. However this carries potential risks to the physiologically compromised patients such as patients having COPD, obesity, cardiac illnesses, and anaemia. In such patients’ safe apnoea time may be as low as 1 min, and can cause life threatening complications. Therefore, this study was done to evaluate the accuracy of thoracolumbar and lumbar pedicle screw insertion using O-arm without using apnoea during imaging, to prevent such possible complications. MethodsThis is a single centre prospective study of 238 patients treated with pedicle screw implantation under O-arm guidance, without using apnoea while imaging. The pedicle breach rate during screw insertion was graded on Gertzbein classification. Also, two senior spine surgeons independently evaluated motion artifacts in the intra operative images and rated them as ‘Significant’ or ‘Non-Significant’ for the procedure. Values of p < 0.05 were considered statistically significant. ResultsDespite not using apnoea in 238 patients with 1120 screws, there were nil screw related complications. Only in one paediatric case of dorsal spine deformity, there were blurred and inaccurate images because of chest expansion, without apnoea. Hence he was given apnoea to render the image reliable for pedicle screw insertion. The screw placement in the pedicles was checked intraoperatively and graded for breach. Grade 2 breach were seen in only 2 cases (n = 3 screws) which were revised intra operatively. The interobserver agreement on motion artifacts was good (κ = 0.565, p < 0.001). ConclusionsThe results of pedicular screw insertion performed without induced apnea are comparable to those achieved with apnea when using O-arm imaging. This technique has proven to be a safe and reliable method for pedicle screw insertion in the thoracolumbar and lumbar spine, potentially mitigating physiological complications. Nonetheless, even minor motion artifacts, on the order of a few millimeters, can significantly impact outcomes in the cervical and upper thoracic spine. Therefore, further research is warranted to evaluate the efficacy and safety of this approach in these regions of the spine.

A wireless, battery-free device for electrical neuromodulation of bladder contractions

Lower urinary tract dysfunction (LUTD) is a prevalent condition characterized by symptoms such as urinary frequency, urgency, incontinence, and difficulty in urination, which can significantly impair patient's quality of life and lead to severe physiological complications. Despite the availability of diverse treatment options, including pharmaceutical and behavioral therapies, these approaches are not without challenges. The objective of this study was to enhance treatment options for LUTD by developing a wireless, battery-free device for managing bladder contractions. We designed and validated a compact, fully implantable, battery-free pulse generator using the magnetic induction coupling mechanism of wireless power transmission. Weighing less than 0.2 g and with a volume of less than 0.1 cubic centimeters, this device enables precise stimulation of muscles or neurons at voltages ranging from 0 to 10 V. Wireless technology allows real-time adjustment of key stimulation parameters such as voltage, duration, frequency, pulse width, and pulse interval. Our findings demonstrate that the device effectively controlled bladder contractions in mice when used to stimulate the Major Pelvic Ganglion (MPG). Additionally, the device successfully managed micturition in mice with bilateral transection of the pudendal nerve. In conclusion, the development of this innovative wireless pulse generator provides a safer and more cost-effective alternative to conventional battery-powered neurostimulators for bladder control, addressing the limitations of such devices. We anticipate that this novel technology will play a pivotal role in the future of electrical stimulation therapies for voiding dysfunctions.

Gender-specific characteristics of heart failure with preserved ejection fraction in women: focus on pregnancy factors

The prevalence of heart failure with preserved ejection fraction (HFpEF) is relentlessly increasing, especially in women. Therefore, an important task is search for novel markers and early predictors of the disease. Evaluation of the association between physiological factors and complications of pregnancy and the development both early and longterm heart failure (HF) is also a substantial question. The younger women cohort is of particular interest because of the high prevalence of HFpEF among women in Russia. The purpose of the review is to assess gender differences in the HF, as well as to summarize the results of studies on the association of adverse pregnancy outcomes and development of HFpEF. The article describes the gender characteristics of the development of various HF types. We considered the morphofunctional, neurohumoral and age factors associated with the HF development in women, as well as the differences in the influence of the leading risk factors for HF between men and women. Particular attention is paid to the role of pregnancy factors in the development of various HF types. The following HF development variants in women have been identified: early (peripartum) and late (diagnosed in postmenopause). The pathophysiological mechanisms of the impact of extragenital pregnancy complications on HF development are described separately. Particular attention is paid to studying the relationship between pregnancy complications and HFpEF development in the long-term prognosis, as the most characteristic form of HF for women. The leading pregnancy complications associated with HFpEF development in postmenopause are hypertensive disorders (including preeclampsia and eclampsia) and gestational diabetes mellitus. A wider study of the association of pregnancy complications with HFpEF in a woman’s future is necessary to identify new mechanisms for its development.

Comparison of implant placement at crestal and subcrestal levels in aesthetic zone: A finite element analysis.

The success rate of the implant treatment, including aesthetics and long-term survival, relies heavily on preserving crestal peri-implant bone, as it determines the stability and long-term outcomes. This study aimed to demonstrate the stress differences in the crestal bone resulting from dental implant placement at various depths relative to the crestal bone level using finite element analysis. Three study models were prepared for implant placement at the crestal bone level (CL), 1 mm depth (SL-1),and 2mm depth (SL-2). Implants were placed in the maxillary central incisor region of each model, and 100 N vertical and oblique forces were applied. The von Mises, maximum principal (tensile), and minimum principal (compressive) stresses were evaluated. The CL model exhibited the highest stresses on the implant, abutment, and abutment screws under vertical and oblique forces. For maximum principal stress in the crestal bone under vertical force, the SL-2, SL-1, and CL models recorded values of 6.56, 6.26, and 5.77MPa, respectively. Under oblique forces, stress values for SL-1, SL-2, and CL were 25.3, 24.91, and 23.76MPa, respectively. The CL model consistently exhibited the lowest crestal bone stress at all loads and the highest stress values on the implant and its components. Moreover, considering the yield strengths of the materials, no mechanical or physiological complications were noted. Placing the implant at the crestal level or subcrestally beyond the cortical layer could potentially reduce stress and minimize crestal bone loss. However, further studies are warranted for confirmation.

From traditional to transactional: exploration of khat use in Ethiopia through an interpretative phenomenological analysis

Khat, a naturally growing stimulant, has seen a significant increase in both consumption and cultivation in eastern Ethiopia. This reliance on khat in the region comes despite its known physiological complications, with users unable to restrict khat use due to its pervasive impact on their livelihood. This qualitative study sought to understand the meaning that those in eastern Ethiopia attribute to khat and explore their firsthand experiences with the substance. In June and July of 2023, six unstructured interviews were conducted among residents of the Haramaya District in Ethiopia. To promote a holistic comprehension of the participants’ lived experiences, an interpretative phenomenological analysis approach was employed when collecting and analyzing the data. Participant responses were coded independently from one another by two different researchers identifying superordinate and corresponding subordinate themes. Among the participants, six superordinate themes were captured: economic backbone of the region, market disruption & fluctuation, pesticide use, societal relationships around khat, applications of khat, and access to healthcare. The participants’ responses indicated that the normalization of khat use, coupled with the downplaying of its addictive potential, has established a framework where khat consumption is not only allowed but, in some cases, even encouraged. The unique interplay between communal practice and individual preservation creates a cyclical effect of using khat to supplement energy to farm khat and then sell or stimulate further work on their farm. This study illuminates the transitionfrom what was once the traditional or spiritual use of khat, to a more practical use for ensuring economic livelihood.

Surgical pathway for HIV‑infected patients based on the ERAS strategy (Review).

Enhanced recovery after surgery (ERAS), which is based on evidence-based medicine, focuses on patients and aims to reduce the psychological and physiological trauma stress reactions and complications of patients, thus shortening the duration of hospitalization, promoting rapid recovery and reducing medical expenses, readmission rate and mortality rates. Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV) infection. Patients with HIV/AIDS, as with other patient populations, can suffer from several surgical-related diseases. Therefore, the need for surgery in this group of patients exists and the surgical services required by patients with AIDS has gradually become an urgent matter of concern. According to relevant literature and the authors' clinical experience, the present review summarizes the current surgical approaches for patients infected with HIV based on ERAS. In the present review, the related issues observed at different stages of surgery, including pre-operative, intra-operative, post-operative and follow-up stages, are discussed.

An update on the perioperative management of postcraniotomy pain.

Pain after craniotomy is often severe and undertreated. Providing adequate analgesia while avoiding medication adverse effects and physiological complications of pain remains a perioperative challenge. Multimodal pain management includes regional anesthesia and analgesic adjuncts. Strategies aim to reduce or eliminate opioids and the associated side effects. Many individual pharmacologic interventions have been studied with beneficial effects on acute pain following craniotomy. Evidence has been accumulating in support of scalp blockade, nonsteroidal anti-inflammatory drugs (NSAIDs), dexmedetomidine, paracetamol, and gabapentinoids. The strongest evidence supports scalp block in reducing postcraniotomy pain and opioid requirements. Improving analgesia following craniotomy continues to be a challenge that should be managed with multimodal medications and regional techniques. Additional studies are needed to identify the most effective regimen, balancing efficacy and adverse drug effects.

Hepatoprotective Effects of Aqueous Extract of Perilla fructescens against Alcohol-Induced Liver Injury in Mice

Excessive alcohol intake leads to significant physiological complications, particularly alcoholic liver diseases (ALD). The extent of liver damage caused by ethanol correlates with increased oxidative stress and accumulation of lipids in the hepatic tissue. In this study, we investigated the defense properties of the aqueous extract of Perilla frutescens Briton Var. acuta Kudo (PF) on hepatic injury in chronically ethanol-treated mice. The mice were orally administered the water extract from PF for 4 weeks with ethanol treatment (3 g/kg. P.O.). The level of malondialdehyde (MDA) in the liver tissues was determined. A substantial increase in MDA generation was detected in the livers of mice subjected to ethanol exposure, whereas the administration of PF markedly reduced MDA levels in hepatic tissues. Additionally, histological analysis of the liver tissue was performed. Histopathological investigation revealed a significant reduction in hepatocellular necrosis in the PF-treated group. This study demonstrated that the aqueous extract of Perilla frutescens Briton Var. acuta Kudo (PF) attenuated chronic ethanol-induced liver injury by augmenting the antioxidant capacity of mice. These results can be utilized for the development of high-value-added products using PF.

BCLA CLEAR presbyopia: Management with intraocular lenses

Cataract surgery including intraocular lens (IOL) insertion, has been refined extensively since the first such procedure by Sir Harold Ridley in 1949. The intentional creation of monovision with IOLs using monofocal IOL designs has been reported since 1984. The first reported implantation of multifocal IOLs was published in 1987. Since then, various refractive and or diffractive multifocal IOLs have been commercialised. Most are concentric, but segmented IOLs are also available. The most popular are trifocal designs (overlaying two diffractive patterns to achieve additional focal planes at intermediate and near distances) and extended depth of focus designs which leave the patient largely spectacle independent with the reduced risk of bothersome contrast reduction and glare. As well as mini-monovision, surgical strategies to minimise the impact of presbyopia with IOLs includes mixing and matching lenses between the eyes and using IOLs whose power can be adjusted post-implantation. Various IOL designs to mimic the accommodative process have been tried including hinge optics, dual optics, lateral shifts lenses with cubic-type surfaces, lens refilling and curvature changing approaches, but issues in maintaining the active mechanism with post-surgical fibrosis, without causing ocular inflammation, remain a challenge. With careful patient selection, satisfaction rates with IOLs to manage presbyopia are high and anatomical or physiological complications rates are no higher than with monofocal IOLs.

Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion

BackgroundThe Enhanced Recovery After Surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing Posterior Cervical Fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. MethodsA retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015-July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), non-home discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (p<0.05) and multivariate analyses, using mixed-effect models, (p<0.0125), were performed. ResultsThere were a total of 174 patients, 71 frail (41%). Of the frail patients, 61% were also myelopathic and 56% underwent ERAS. Of the non-frail patients, 43% were myelopathic and 57% underwent ERAS. On univariate analyses, frail patients with ERAS had less drains placed (p<0.0001), decreased urinary retention (p=0.0002), decreased LOS (p=0.013), and were less likely to have a non-home discharge (p=0.001). On multivariate analysis, LOS (p=0.0003), time to return of physiologic function (p=0.004), complications (p=0.001), and non-home discharges (p<0.0001) were decreased with ERAS, irrespective of groups. ConclusionsERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of non-home discharges, and reduce complications, irrespective of frailty or myelopathy status.

An ensemble-based machine learning model for predicting type 2 diabetes and its effect on bone health

BackgroundDiabetes is a chronic condition that can result in many long-term physiological, metabolic, and neurological complications. Therefore, early detection of diabetes would help to determine a proper diagnosis and treatment plan.MethodsIn this study, we employed machine learning (ML) based case-control study on a diabetic cohort size of 1000 participants form Qatar Biobank to predict diabetes using clinical and bone health indicators from Dual Energy X-ray Absorptiometry (DXA) machines. ML models were utilized to distinguish diabetes groups from non-diabetes controls. Recursive feature elimination (RFE) was leveraged to identify a subset of features to improve the performance of model. SHAP based analysis was used for the importance of features and support the explainability of the proposed model.ResultsEnsemble based models XGboost and RF achieved over 84% accuracy for detecting diabetes. After applying RFE, we selected only 20 features which improved the model accuracy to 87.2%. From a clinical standpoint, higher HDL-Cholesterol and Neutrophil levels were observed in the diabetic group, along with lower vitamin B12 and testosterone levels. Lower sodium levels were found in diabetics, potentially stemming from clinical factors including specific medications, hormonal imbalances, unmanaged diabetes. We believe Dapagliflozin prescriptions in Qatar were associated with decreased Gamma Glutamyltransferase and Aspartate Aminotransferase enzyme levels, confirming prior research. We observed that bone area, bone mineral content, and bone mineral density were slightly lower in the Diabetes group across almost all body parts, but the difference against the control group was not statistically significant except in T12, troch and trunk area. No significant negative impact of diabetes progression on bone health was observed over a period of 5-15 yrs in the cohort.ConclusionThis study recommends the inclusion of ML model which combines both DXA and clinical data for the early diagnosis of diabetes.

Resting-state fMRI network efficiency as a mediator in the relationship between the glymphatic system and cognitive function in obstructive sleep apnea hypopnea syndrome: Insights from a DTI-ALPS investigation

IntroductionObstructive sleep apnea hypopnea syndrome (OSAHS) is associated with cognitive impairment and physiological complications, necessitating further understanding of its mechanisms. This study investigates the relationship between glymphatic system function, brain network efficiency, and cognitive impairment in OSAHS patients using diffusion tensor image analysis along the perivascular space (DTI-ALPS) and resting-state fMRI. Materials and methodsThis study included 31 OSAHS patients and 34 age- and gender-matched healthy controls (HC). All participants underwent GE 3.0T magnetic resonance imaging (MRI) with diffusion tensor image (DTI) and resting-state fMRI scans. The DTI-ALPS index and brain functional networks were assessed. Differences between groups and correlations with clinical characteristics were analyzed. Additionally, the mediating role of brain network efficiency was explored. Finally, receiver operating characteristics (ROC) analysis assessed diagnostic performance. ResultsOSAHS patients had significantly lower ALPS-index (1.268 vs. 1.431, p < 0.0001) and moderate negative correlation with Apnea Hypopnea Index (AHI) (r = −0.389, p = 0.031), as well as moderate positive correlation with Montreal Cognitive Assessment (MoCA) (r = 0.525, p = 0.002). Moreover, global efficiency (Eg) of the brain network was positively correlated with the ALPS-index and MoCA scores in OSAHS patients (r = 0.405, p = 0.024; r = 0.56, p = 0.001, respectively). Furthermore, mediation analysis showed that global efficiency partially mediated the impact of glymphatic system dysfunction on cognitive impairment in OSAHS patients (indirect effect = 4.58, mediation effect = 26.9 %). The AUROC for identifying OSAHS and HC was 0.80 (95 % CI 0.69 to 0.91) using an ALPS-index cut-off of 1.35. ConclusionsOSAHS patients exhibit decreased ALPS-index, indicating impaired glymphatic system function. Dysfunction of the glymphatic system can affect cognitive function in OSAHS by disrupting brain functional network, suggesting a potential underlying pathological mechanism. Additionally, preliminary findings suggest that the ALPS-index may offer promise as a potential indicator for OSAHS.

Analysis of the Effect and Efficiency of Tension-Free Hernia Repair and Traditional Surgery in The Treatment of Hernia

Objective: To analyze the efficiency of tension-free hernia repair and traditional surgery in the treatment of hernia. Methods: A total of 80 patients with hernias were selected and randomly into a control group (traditional hernia repair) and an observation group (tension-free hernia repair), of 40 cases each. The perioperative indicators, pain, physiological stress indicators, complications, and recurrence rates between the two groups were compared. Results: The perioperative indexes of the observation group were better than those of the control group (P &lt; 0.05). The postoperative pain score, postoperative physiological stress index level, incidence of complications, and recurrence rate of the observation group were lower than those of the control group (P &lt; 0.05). Conclusion: In the surgical treatment of hernia, tension-free hernia repair was less traumatic and had a better effect than traditional hernia repair.

DeepChestGNN: A Comprehensive Framework for Enhanced Lung Disease Identification through Advanced Graphical Deep Features.

Lung diseases are the third-leading cause of mortality in the world. Due to compromised lung function, respiratory difficulties, and physiological complications, lung disease brought on by toxic substances, pollution, infections, or smoking results in millions of deaths every year. Chest X-ray images pose a challenge for classification due to their visual similarity, leading to confusion among radiologists. To imitate those issues, we created an automated system with a large data hub that contains 17 datasets of chest X-ray images for a total of 71,096, and we aim to classify ten different disease classes. For combining various resources, our large datasets contain noise and annotations, class imbalances, data redundancy, etc. We conducted several image pre-processing techniques to eliminate noise and artifacts from images, such as resizing, de-annotation, CLAHE, and filtering. The elastic deformation augmentation technique also generates a balanced dataset. Then, we developed DeepChestGNN, a novel medical image classification model utilizing a deep convolutional neural network (DCNN) to extract 100 significant deep features indicative of various lung diseases. This model, incorporating Batch Normalization, MaxPooling, and Dropout layers, achieved a remarkable 99.74% accuracy in extensive trials. By combining graph neural networks (GNNs) with feedforward layers, the architecture is very flexible when it comes to working with graph data for accurate lung disease classification. This study highlights the significant impact of combining advanced research with clinical application potential in diagnosing lung diseases, providing an optimal framework for precise and efficient disease identification and classification.

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

IntroductionPatients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are...

Frequency of tracheal intubation associated adverse events and contributing factors in the Pediatric Intensive Care Unit (PICU).

Objective: To determine the frequency of adverse events associated with immediate tracheal intubation in children (1-18 years) from Pediatric Intensive Care Unit of Tertiary Care Hospital of Karachi, Pakistan. Study Design: Observational study. Setting: PICU of the Aga Khan University Hospital Karachi. Period: September 2020 to August 2021. Methods: A total of 183 intubations occurred during the study period. Data was extracted using the pre-designed peri-intubation proforma, data recorded on the checklist by the observer (Staff) who was fully trained by the Physician, later on compared by the researcher using the video recorded laryngoscopy used during the intubation procedure. Results: There were 183 intubations occurred during study period. Maximum intubations were in age group of 1-5 years (27.3%) and among total intubations, there were 11(6%) intubation related complications occurred. 6 (3.3%) cases have hypoxia, 3 (1.6%) bradycardia and 2 (1.1%) others (hypotension and esophageal intubation). Majority of the complications were observed during morning hours with statistically significant association. 63.60% TI related cases survived whereas 36.40% of them expired, 54.5% stayed in PICU for 0-10 days. Conclusion: Tracheal intubation related adverse events were 6% and majority of them lead to hypoxia. Physiological and mechanical complications with the procedure do occur inspite of our best efforts. Recognizing the complications associated with tracheal intubation can help physicians better care for patients requiring intubation.

Renal Replacement Therapy During Liver Transplant Surgery

Liver transplant is the treatment available for eligible patients with end-stage liver cirrhosis. Acute kidney injury and electrolyte abnormalities are associated with liver disease and can be exacerbated by surgery. Intraoperative renal replacement therapy has been tried in some large centres. The authors discuss the physiological changes and complications during liver transplant surgery, and review literature on the safety, feasibility, benefits, and drawbacks of intraoperative renal replacement therapy during liver transplant surgery.

Numerical modelling of the interaction between dialysis catheter, vascular vessel and blood considering elastic structural deformation.

The dialysis catheter indwelling in human bodies has a high risk of inducing thrombus and stenosis. Biomechanical research showed that such physiological complications are triggered by the wall shear stress of the vascular vessel. This study aimed to assess the impact of CVC implantation on central venous haemodynamics and the potential alterations in the haemodynamic environment related to thrombus development. The SVC structure was built from the images from computed tomography. The blood flow was calculated using the Carreau model, and the fluid domain was determined by CFD. The vascular wall and the CVC were computed using FEA. The elastic interaction between the vessel wall and the flow field was considered using FSI simulation. With consideration of the effect of coupling, it was shown that the catheter vibrated in the vascular systems due to the periodic variation of blood pressure, with an amplitude of up to 10% of the vessel width. Spiral flow was observed along the catheter after CVC indwelling, and recirculation flow appeared near the catheter tip. High OSI and WSS regions occurred at the catheter tip and the vascular junction. The arterial lumen tip had a larger effect on the WSS and OSI values on the vascular wall. Considering FSI simulation, the movement of the catheter inside the blood flow was simulated in the deformable vessel. After CVC indwelling, spiral flow and recirculation flow were observed near the regions with high WSS and OSI values.

Eight Benefits of Regular Exercise for the Diabetic Patient

Summary of 8 major physiological complications from diabetes. Each complication is discussed and the benefits from exercise that a patient with diabetes can get as a result in engaging in regular exercise is discussed for each one of the 8 complications. The eight areas of benefits from exercise are controllable heart rate and blood pressure, stabilized blood sugar, better healing of venous statis wounds, improved flexibility, Improved balance/proprioception, improved mental health, improved skin health, and decrease in body mass index.

Pediatric anterior thoracic wall reconstruction: a successful case of extensive resection and repair

BackgroundThoracic tumors are a challenge for pediatric surgeons. They comprise a heterogeneous group of neoplasms classified based on histological variety, location, presentation, biological behavior, treatment response, and prognosis. Primary tumors of the thoracic wall in children and adolescents are sporadic, accounting for only 1–2% of all pediatric thoracic neoplasms, with two-thirds of them being malignant.Case presentationWe present the case of a 16-year-old male patient with osteoblastic osteosarcoma localized in the right anterior rib cage. The patient underwent extensive tumor resection using titanium bars.ConclusionThoracic reconstruction following extensive resection in pediatric cancer patients has been underexplored and poorly described. Nevertheless, it has been demonstrated to be feasible, particularly considering the 5-year survival rate of 60% following tumor resection. This approach helps prevent anatomical and physiological complications that may arise without reconstruction. We report a successful single-stage resection and thoracic reconstruction case in a pediatric patient. This case underscores the importance of considering reconstruction in patients with thoracic tumors, as it can contribute to improving prognosis and preventing associated complications.