Postoperative Period Research Articles

The Effect of Cataract Surgery on Stereoacuity, Balance, and Falls in Patients With Senile Cataract.

To investigate the effect of cataract surgery on visual acuity, stereoacuity, balance, and falls in patients with senile cataract. Prospective, cross-sectional study. The patients were divided into group 1 if the first surgery was performed on the dominant eye and group 2 on the nondominant eye. After a complete ophthalmologic examination, all patients underwent stereoacuity tests (Titmus and TNO test); Berg Balance Scale and the number of falls in the last 36 months were recorded. All assessments were performed at three time points: the preoperative period, 6 months after the first surgery (primary endpoint), and 24 months after the second surgery (secondary endpoint). The mean number of falls was 4.95±2.6/year in the preoperative period and 1.43±0.59/year in the postoperative period. The incidence of falls after the second surgery decreased by 53.15% compared with the preoperative period. The number of falls and preoperative stereoacuity were negatively and moderately correlated (r=-0.546) (P=0.033). In univariate and multivariate analysis, only low preoperative corrected distance visual acuity in the dominant eye was associated with poor stereoacuity (P=0.001) and a high number of falls (P<0.001) in the preoperative period. Cataract surgery in patients with senile cataracts not only improves visual acuity but also increases stereoacuity level, improves balance, and decreases falls. These effects should be further studied in multicenter, large-participant studies.

Evaluation of the effect of carotid sinus blockade on hemodynamic stability in carotid surgery: A retrospective study.

This study assesses the effect of carotid sinus blockade applied with a local anesthetic on hemodynamic parameters during carotid endarterectomy (CEA) operations performed under general anesthesia. The medical records of patients who underwent CEA under general anesthesia between January 2020 and December 2022, were retrospectively reviewed. It was recorded whether the patients received carotid sinus block with 2 mL of 2% prilocaine. Intraoperative and 48-hour postoperative hemodynamic data were examined in the patients included in the study. A total of 129 patients were evaluated in the study, with 70 patients who received carotid sinus blockade (Group I) and 59 patients who did not receive blockade (Group II) during CEA. The comparison of heart rate variability immediately before clamping, immediately after clamping, and at 5, 10, and 20 minutes post-clamping indicated a significantly greater reduction in Group II compared to Group I (P < .05). In the postoperative period, the total dose of glyceryl trinitrate administered was 40.8 ± 31.9 mg in Group I and 53 ± 17.2 mg in Group II, showing a statistically significant difference (P = .001). Additionally, blood pressure measurements during this period were significantly higher in Group II than in Group I (P < .05). While the application of a local anesthetic during CEA appears to provide better intraoperative heart rate and postoperative blood pressure control, attributing these results solely to local anesthesia may not be entirely accurate. Hemodynamic instability observed during and after CEA is influenced by various factors.

Comparison of colorectal cancer surgery patients in intensive care between rural and metropolitan hospitals in Australia: a national cohort study.

A small proportion of colorectal cancer (CRC) surgical patients will require an admission to an intensive care unit (ICU) within the early postoperative period. This study aimed to compare the characteristics and outcomes of patients admitted to an ICU following CRC surgery per hospital type (metropolitan vs. rural) over a decade in Australia. A retrospective cohort analysis was undertaken of all adult patients admitted to a participating Australian ICUs following CRC surgery between January 2011 and December 2021. The primary outcome was in-hospital mortality. Over the 10-year period, 19,611 patients were treated in 122 metropolitan ICUs and 4,108 patients were treated in 42 rural ICUs. Rural ICUs had a lower proportion of annual admissions following CRC surgery (20 vs. 36, P<0.001). Patients admitted to a rural ICU were more likely to have undergone emergency CRC surgery compared to those admitted to a metropolitan cohort (28.5% vs. 13.8%, P<0.001). There was no difference in in-hospital mortality between metropolitan and rural hospitals (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.73-1.35; P=0.500). There was a general trend for lower mortality in later years of the study with the odds of death in the final year of the study (2021) almost half that of the first study year (OR, 0.52; 95% CI, 0.34-0.80; P=0.003). There was no difference between in-hospital mortality outcomes for CRC surgical patients requiring ICU admission between metropolitan and rural hospitals. These findings may contribute to discussions regarding rural scope of colorectal practice within Australia and globally.

Huscher modified technique for robotic pancreaticojejunostomy: a video report.

Pancreaticojejunostomy (PJ) is a critical step in pancreaticoduodenectomy (PD), often complicated by the risk of postoperative pancreatic fistula (POPF). This video report demonstrates a novel robotic PJ technique employing a self-expandable metallic stent. The method involves the use of the Da Vinci Xi robotic system and the WallFlex™ Biliary RX Stent for improved anastomotic support, particularly in high-risk cases defined by soft pancreatic texture and narrow duct diameter (<3 mm). Key steps include precise deployment of the self-expandable stent using a modified Seldinger technique and completion of the anastomosis with barbed sutures. The self-expandable stent dynamically adapts to the pancreatic duct, reducing tension and enhancing ductal drainage during the critical postoperative period, without requiring balloon expansion or fluoroscopy. This innovation addresses limitations associated with traditional stents and facilitates robotic procedures. Compared to Huscher's use of coronary artery stents (CAS), this technique offers simplicity and adaptability to minimally invasive settings. Outcomes of the robotic PJ approach highlight potential benefits, including reduced POPF rates and improved anastomotic precision. The integration of barbed sutures enhances efficiency and reproducibility, though considerations of pancreatic tissue fragility remain essential. This report underscores the feasibility and advantages of combining advanced robotic surgery with innovative stenting techniques to optimize outcomes in pancreatic surgery.

Evaluation of autologous venous allograft for lower limb in the treatment of critical limb ischemia. The REVATEC (REVAscularisation par greffons veineux bioproTEC) study.

Chronic limb-threatening ischemia (CLTI) requires revascularization whenever it is possible. The great saphenous vein represents the surgical conduit of choice. However, it is not always available, in particular in multi-operated patients. In such cases, alternative efficient biological conduits are needed but data remains limited. This study aims at evaluating the performance of cold stored venous allografts provided by Bioprotec® society. Prospective multi-center cohort. The primary endpoint was limb salvage rate at one year following revascularization with cold stored venous allografts. Follow-up based on clinical examination and duplex-scan. Uni- and multivariate analyses were performed to analyze predictive factors of endpoints. Overall, 39 patients (40 limbs) were included between 2018 and 2021. Patients had a median of 2 [0-6] revascularizations prior to inclusion. A total of 97 grafts were used (median of 3 [1-4] grafts per procedure). In the postoperative period (30 days) no death and 4 major amputations were noted. The median length of follow-up was 13.4 [0.7-31.1] months. The six-months, one-year and two-year freedom from major amputation rates were 79% [95% CI: 68-93], 75% [95% CI 62-91] and 68% [95% CI: 51-90], respectively. The six months, one-year and two-year survival rates were 95% [88-100], 83% [95% CI: 71-98] and 79% [95% CI: 65-96], respectively. Primary patency rates were 77% [95% CI: 64-91] at six months, and 47% [95% CI: 32-70] at one and two years. Secondary patency rates were 82% [95% CI: 70-95] at 6 months and 50% [95% CI: 34-73] at one and two years. The analysis identified the number of previous revascularizations as a significant risk factor for graft patency (Hazard Ratio: 1.59; 95% Confidence Interval: 1.13-2.24). Revascularization of CLTI patients with previous failed interventions is highly challenging. The use of cold stored venous allograft showed encouraging limb salvage rate despite modest patency rates and thus may represent an alternative to other substitute in some selected cases. More studies are necessary to identify the potential of CSVA in CLTI patients.

Postoperative guidelines following pediatric cataract and glaucoma surgeries: a survey of preferred surgeon instructions.

Background Recommendations regarding long-term postoperative activity are intended to prevent adverse events, but no common policy or best practice exists among ophthalmologists for pediatric patients. We surveyed ophthalmologists on their postoperative guidelines after the one-month postoperative period following childhood cataract and glaucoma surgeries. Methods A 28-question anonymous Qualtrics survey was distributed via listservs and social media. The survey was designed to elicit respondents' preferred long-term postoperative guidelines (after month 1) for participation in five water-based activities, nine sports, and three other "high-risk" activities, according to type of surgery: primary cataract extraction with or without intraocular lens (IOL) implantation, angle-based glaucoma surgeries, glaucoma drainage device surgeries, and glaucoma filtering surgeries. Results A total of 49 responses were collected from June to August 2023. Most respondents reported no long-term postoperative restrictions for water-based activities (72%-84%), sports (47%-84%), or high-risk activities (72%-88%). Most respondents did not change their postoperative restrictions based on nuances of surgical technique or clinical examination, such as an "iris claw" IOL (79%), prior trauma (65%), contact lens removal (83%), eye pressure (86%-87%), or bleb appearance (80%). For glaucoma surgeries, although the majority allow complete participation, ophthalmologists were more likely to recommend complete restrictions than sports participation with protective eyewear. For cataract surgery, children with aphakia were more likely to be encouraged to wear safety glasses and less likely to have complete restriction of an activity than those with an IOL. Conclusions Most ophthalmologists do not impose long-term postoperative restrictions following childhood intraocular surgeries.

Gabexate mesylate thermo-sensitive in-situ gel is effective for treating grade-III pancreatic trauma in beagle dogs guided by contrast-enhanced ultrasound.

This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel (GMTI) in the treatment of beagle grade III pancreatic trauma (PT) with the assistance of contrast-enhanced ultrasound (CEUS) and investigates its mechanism of action. A grade III PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate (GM) (1.54 mL/10 kg, TID) and peripancreatic injection of GMTI (4.63 mL/10 kg, QD) guided by CEUS within 24 h post-surgery. Ascites and serum levels of amylase (AMY), lipase (LPS), C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and urinary trypsinogen activating peptide (TAP) were detected by ELISA. Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining. CEUS accurately displayed pancreatic lesions and guided catheterisation. Compared to the control group, the ascites was significantly reduced after treatment (p < 0.01). AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day (p < 0.01). The levels of AMY, LPS, CRP, IL-6, and TNF-α in serum were decreased (p < 0.05 or p < 0.01). Urinary TAP was decreased 1 and 2 days after treatment (p < 0.05 or p < 0.01, respectively). In the control group, pancreatic tissue necrosis was evident in the wound area. Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment. The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period. Guided by CEUS, daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.

Home-Based Intervention Tool for Cardiac Telerehabilitation: Protocol for a Controlled Trial.

Among cardiovascular diseases, adult patients with congenital heart disease represent a population that has been continuously increasing, which is mainly due to improvement of the pathophysiological framing, including the development of surgical and reanimation techniques. However, approximately 20% of these patients will require surgery in adulthood and 40% of these cases will necessitate reintervention for residual defects or sequelae of childhood surgery. In this field, cardiac rehabilitation (CR) in the postsurgical phase has an important impact on the patient by improving psychophysical and clinical recovery in reducing fatigue and dyspnea to ultimately increase survival. In this context, compliance with the rehabilitation program is a key element for the therapeutic benefits of the program. The increase of mobile health care devices and software has greatly extended self-care capabilities across the spectrum of health care activities. Moreover, the possibility of telemonitoring the progress of this self-care provides elements of empowerment and awareness of one's state of health. As a branch of telehealth, CR can be optimized and facilitated using remote telemedicine devices. The principal goal of the Innovation in Postoperative Rehabilitation Training and Monitoring (IPOTERI) study is to design, realize, and test a composite and integrated system for postsurgical rehabilitation therapies at home specialized for cardiac surgery. The secondary aims are to implement the system in a "real-life" context of postcardiac surgical rehabilitation, and to create a data set and a data collection methodology to prototype data analytics algorithms and artificial intelligence techniques for customizing the rehabilitation pathway. The IPOTERI method consists of a telemonitoring platform that guarantees continuity of postoperative care, an intelligent home station based on an Android app for the patient with a user-friendly interface to record vital signals (electrocardiogram, blood pressure, oxygen saturation, and body weight) and access the planning of rehabilitation activities, and a decision support system that communicates with hospital medical records to transmit alerts and specific support information for the formulation and updating of the treatment and care plan. The pilot test started in June 2023 (protocol number 20406/2021) including 50 patients who will be monitored for 12-14 weeks using the developed platform, as described in the Procedures subsection of the Methods section. The IPOTERI approach, based on the processing of data recorded during the monitoring of telemedicine devices used at home during the postsurgical rehabilitation of a cardiac patient, together with clinical data from the perioperative and postoperative periods could have positive effects on adherence to the rehabilitation program and clinical improvement as well as result in overall improvement of quality of life. DERR1-10.2196/47951.

Early and Late Outcomes of Transcatheter Aortic Valve Replacement in Patients With Prior Chest Radiation: A Systematic Review and Meta-Analysis.

Patients with prior history of chest or mediastinal radiation are deemed high risk for surgical AVR. Transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative for these patients, however, this patient population was underrepresented in prior TAVR trials. To compare the outcomes of TAVR in patients with versus without a history of prior chest or mediastinal radiation. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic search of electronic databases was conducted up to September 2023. We compared early and late mortality as well as complications. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. Seven studies comprising 6358 patients were included in this meta-analysis. Patients undergoing TAVR in the radiation group had a higher risk for heart failure exacerbation (OR: 2.06; 95% CI: 1.18-3.59) and aortic valve reintervention (OR: 5.68; 95% CI: 1.83-17.67) in the early postoperative period compared to the nonradiation group. Analysis revealed similar short-term (in-hospital or 30-day) all-cause-mortality (OR: 1.63; 95% CI: 0.89-2.98) between the two groups. Other perioperative complications including myocardial infarction (MI), stroke, pacemaker insertion requirement, major bleeding as well as access-related complications were not significantly different between the two groups. TAVR in the radiation group was not associated with increased all-cause mortality compared to the nonradiation group (OR: 1.40; 95% CI: 0.93-2.11) after a mean follow-up of 17.6 months. Other endpoints including MI, stroke, need for pacemaker insertion, heart failure readmission rate, and need for aortic valve reintervention were similar in the mid-term follow-up between the two groups. TAVR in patients with a history of prior chest or mediastinal radiation was associated with similar short-term and mid-term mortality compared to patients without radiation. The history of chest or mediastinal radiation was associated with more frequent heart failure hospitalizations and aortic valve reintervention in the postoperative period. No difference was found in mid-term complications. Future studies are warranted to validate our findings.

Analysis of Factors Affecting Prolonged Air Leak and Expansion Failure in the Lung after Resection in Patients with Pulmonary Malignancy and Predictive Value of Preoperative Quantitative Chest Computed Tomography.

The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation area (LAA%) measured on preoperative quantitative chest computed tomography (Q-: CT) in predicting the development of postoperative PAL and the expansion time of the remaining lung (ET) in patients undergoing resection for lung malignancy was investigated. The data of 202 cases who underwent lung resection between July 2020 and December 2022 were analyzed. The factors affecting the development of PAL and ET were investigated using univariate and multivariate analyses. The cut-off value for LAA% was determined and its relationship with postoperative results was examined. In univariate analyses, for PAL, age (p = 0.022), presence of chronic obstructive pulmonary disease (COPD; p < 0.001), body mass index (BMI; p = 0.006), FEV1 (p = 0.020), FEV1/FVC (p < 0.001), LAA% (p = 0.008), diagnosis (p = 0.007), and surgical procedure (p < 0.001); for ET, diagnosis (p < 0.001) and surgical procedure (p = 0.001) were significant factors. A negative correlation between ET and BMI and FEV1/FVC (p < 0.01) and a positive correlation (p < 0.05) was detected with LAA%. The cut-off value for LAA% was calculated as 1.065. Multivariate analyses showed that the probability of developing PAL, increased 3.17-, 7.68-, and 3.08-fold in patients with COPD, lobectomy, and those above the cut-off value for LAA%, respectively (p = 0.045, p < 0.001, and p = 0.011). In addition, FEV1/FVC (p = 0.027), BMI (p = 0.016), and surgical procedure (p = 0.001) were shown to be independent factors affecting ET. Our study revealed the factors affecting PAL and expansion failure in the lung. Within this scope, it was concluded that preoperative Q-CT may have an important role in predicting the development of PAL and ET in the postoperative period and that LAA% measurement is an effective, objective, and practical method for taking precautions against possible complications.

Volume and quality of the gluteal muscles are associated with early physical function after total hip arthroplasty.

Identifying muscles linked to postoperative physical function can guide protocols to enhance early recovery following total hip arthroplasty (THA). This study aimed to evaluate the association of preoperative pelvic and thigh muscle volume and quality with early physical function after THA in patients with unilateral hip osteoarthritis (HOA). Preoperative Computed tomography (CT) images of 61 patients (eight males and 53 females) with HOA were analyzed. Six muscle groups were segmented from CT images, and muscle volume and quality were calculated on the healthy and affected sides. Muscle quality was quantified using the mean CT values (Hounsfield units [HU]). Early postoperative physical function was evaluated using the Timed Up & Go test (TUG) at three weeks after THA. The effect of preoperative muscle volume and quality of both sides on early postoperative physical function was assessed. On the healthy and affected sides, mean muscle mass was 9.7cm3/kg and 8.1cm3/kg, and mean muscle HU values were 46.0 HU and 39.1 HU, respectively. Significant differences in muscle volume and quality were observed between the affected and healthy sides. On analyzing the function of various muscle groups, the TUG score showed a significant association with the gluteus maximum volume and the gluteus medius/minimus quality on the affected side. Patients with HOA showed significant muscle atrophy and fatty degeneration in the affected pelvic and thigh regions. The gluteus maximum volume and gluteus medius/minimus quality were associated with early postoperative physical function. Preoperative rehabilitation targeting the gluteal muscles on the affected side could potentially enhance recovery of physical function in the early postoperative period.

Pathology-Independent Expansion of Indications for Rapid-Deployment Aortic Valve Replacement: Midterm Outcomes.

This study evaluated the midterm outcomes of rapid deployment aortic valve replacement (RDAVR) performed regardless of pathology for various aortic valve diseases at a single center. Of the 344 patients who underwent RDAVR using Edwards INTUITY during the study period at our institution, 176 had bicuspid valve diseases (51.2%), 20 had pure aortic regurgitation (5.8%), and 4 had infective endocarditis (1.2%). Median follow-up duration was 28.6 months (maximum: 86.4 months). Midterm clinical outcomes were evaluated, and the changes of valve hemodynamics from early postoperative period to 5 years after surgery were also investigated. Mean age was 68.9 ± 9.8 years, and 46.2% of the patients were female. Isolated RDAVR was performed in 90 patients (26.2%), and concomitant procedures, including aortic surgery (48.8%), mitral valve surgery (20.3%), arrhythmia surgery (9.0%), tricuspid valve surgery (7.0%), and coronary artery bypass grafting (5.5%), were performed in 254 patients (73.8%). Operative mortality occurred in 11 patients (3.2%), and permanent pacemaker implantation was required in 5 patients (1.5%) in early postoperative period. Overall survival rate was 86.9% at 5 years, and cumulative incidence of cardiac death was 6.3% at 5 years. No deterioration of valve hemodynamics was observed at midterm echocardiographic evaluation in either the overall population or for each size of valve. Isolated or concomitant aortic valve replacement using rapid-deployment valves was performed for various aortic valve diseases regardless of the underlying pathology at our institution, and the clinical and hemodynamic outcomes were excellent for up to 5 years.

Butorphanol Tartrate Nasal Spray for Post-Cesarean Analgesia and Prolactin Secretion.

BACKGROUND Butorphanol, an opioid receptor agonist and antagonist, is widely used for post-cesarean section analgesia in the form of intravenous or intramuscular injection, but nasal sprays are less used. This study aimed to evaluate the analgesic effect of butorphanol nasal spray on uterine contraction pain after cesarean section and explore its effect on postpartum prolactin secretion. MATERIAL AND METHODS We randomly divided 120 patients scheduled for cesarean section into 3 groups (40 per group): intranasal saline (control), butorphanol intranasal (BI), and butorphanol pumped intravenously (BV). The same analgesic pump protocol was used in all groups. The visual analog scale (VAS) and Ramsay sedation scale (RASS) were used to evaluate analgesic and sedation levels 6, 12, and 24 h postoperatively. We recorded the start time of breastfeeding, number of PCIA presses, consumption of butorphanol, and preoperative and postoperative serum prolactin levels. RESULTS At 6 h postoperatively, the BI and BV groups had lower VAS and higher RASS (P<0.05) than the control group, no difference between the BI and BV groups, but the consumption of butorphanol was lower in the BI group (P<0.05). The analgesic and sedative effects in the BI group were lower than those in the BV group at 12 h (P<0.05). No difference in the start time of breastfeeding, serum prolactin levels among the 3 groups (P>0.05). CONCLUSIONS Patients may prefer butorphanol tartrate nasal spray because they can obtain satisfactory analgesia in the early postoperative period, with high non-invasive comfort and reduced use of opioids. No effect on prolactin levels or lactation initiation was observed.

Inorganic phosphorus as a predictor of postoperative low cardiac output syndrome in congenital heart disease surgery.

Low cardiac output syndrome (LCOS) is the most common complication after cardiac surgery in children with congenital heart disease (CHD). The aim of this study was to assess the predictive value of serum inorganic phosphorus (SIPL) as an indicator of LCOS in the postoperative period. From June 2018 to December 2019, a single-center prospective study was conducted in patients with CHD undergoing surgery who required extracorporeal circulation (ECC). In the postoperative period, patients were divided into group 1 with LCOS and group 2 without LCOS. Blood samples were extracted in pre and postoperative periods. Serial measurements of SIPL, NT-proBNP, troponin T and creatinine were collected and compared between both groups. Multivariate analyses were conducted to identify the risk factors of SBGC. A total of 97 patients were included, with 31 in group 1 and 66 in group 2. There was an increment of SIPL which peaked at the 8-hour postsurgery (5.3 mg/dL, 4.6-5.8). Postoperative median SIPL in the group 1 were significantly higher than in the group 2. All consecutive SIPL measurements also were significantly higher in group 1. Changes in SIPL over time approached statistical significance (P < .001). Logistic regression analyses indicated that ECC (OR: 1.01; 95% CI: 0,9-1.01), SIPL (OR: 1.02; 95% CI: 1-1.04), NT-ProBNP (OR: 1; 95% CI; 1-1.0) were the independent risk factors of LCOS. The increase in SIPL was more pronounced in LCOS group 1. SIPL emerged as a new predictive risk factors of LCOS.

Determining ED90 of Flumazenil for Selective Respiratory Distress Improvement Using Remimazolam During Endoscopic Submucosal Dissection of Gastric Neoplasms: A Prospective Study.

Patients undergoing endoscopic submucosal dissection under monitored anesthesia care (MAC) with remimazolam may develop respiratory distress during the procedure. In these cases, low doses of flumazenil improved respiratory distress without completely reversing sedation, which is a novel phenomenon. This study aimed to explore the ED90 of flumazenil to selectively improve respiratory distress in patients with MAC treated with remimazolam. Flumazenil dose determination followed a biased-coin up-and-down design. Starting with a dose of 5 mcg, if respiratory distress improved, the biased-coin method was used to give the same dose in the next patient with a probability of 8/9, and a decreased dose of 5 mcg in the next patient with a probability of 1/9. Any improvement in respiratory distress within 30 s of flumazenil administration was recorded. After the procedure, patients were asked whether they had any memory recall during the procedure. Centered isotonic regression was used to determine the ED90 of flumazenil. Sixty patients were included in the study. The estimated ED90 was 76.72 mcg (95% CI: 68.07-102.62). Memory recall occurred in two of thirteen patients (15%) near the ED90 dose range (75 mcg and 80 mcg). None of the patients developed major postoperative complications (bleeding, perforation, or aspiration) within the 2-day postoperative period. This study determined that the ED90 of flumazenil for effectively alleviating respiratory distress in patients undergoing MAC with remimazolam was 76.7 mcg, without reversing consciousness. These findings provide valuable guidance for the care of patients undergoing sedation.

Computed tomography coronary angiography as an alternative to invasive coronary angiography in preoperative evaluation for mitral surgery.

The aim of this study was to assess the effectiveness of non-invasive coronary computed tomography angiography (CTA) as an alternative to traditional invasive coronary angiography (ICA) for preoperative evaluation of low risk patients with an indication for non-emergent mitral surgery and to assess any difference in adverse outcomes from this strategy. This was a retrospective cohort study from a single center with data collected from July 2014 - June 2020 for 1576 patients undergoing mitral valve surgery of all etiologies - excluding patients requiring coronary artery bypass surgery. We performed a 1:2 propensity score matching for patients evaluated with CT (n=345) to those evaluated with ICA (n=602). The primary outcome was a composite of major adverse events in the immediate postoperative period, including death, stroke, new onset renal failure, post-operative cardiac arrest, need for unplanned coronary artery bypass grafting or percutaneous coronary re-vascularization. The odds ratio was calculated for occurrence of major adverse events in the CT angiography group compared to the catheterization group. The mean age (standard deviation) was 55.62 years (11.54) for the CTA group and 58.22 years (10.11) for the ICA group. In the CTA group 334 (96.8%) and from the ICA group 582 (96.7%) patients underwent mitral valve repair. 13 (3.8%) patients in the CTA group experienced a major adverse event compared to 25 (4.2%) patients in the ICA group. Of these, there were no mortalities in the CTA group but one (0.2%) operative mortality in the ICA group. Four (1.2%) patients in the CTA group had a post-operative stroke compared to three (0.5%) patients in the ICA group. One (0.3%) patient in the CTA group required renal replacement therapy postoperatively compared to 11 (1.8%) in the ICA group. Percutaneous coronary intervention was required in one (0.3%) patient in CTA group and 2 (0.3%) patients in ICA group for a coronary complication of valve surgery despite non-obstructive coronary anatomy being confirmed in both groups pre-operatively. The odds ratio for having a major adverse event when worked up by CTA compared to ICA was 0.904 (0.443, 1.761). There were no increased odds of experiencing a major adverse event for low risk mitral valve patients undergoing preoperative coronary evaluation with CTA compared to ICA. This data has modified our practice pattern where we now offer coronary CTA to all elective patients who are low risk for coronary artery disease.

Functional Outcome and Balance Compensation in Patients with Unilateral Vestibular Schwannoma After Surgical Treatment-Short- and Medium-Term Observation.

Objective: The aim was to evaluate vestibular function in patients with unilateral vestibular schwannoma before and in the short and medium term after surgical treatment to analyze vestibular compensation. The identification of the prognostic factors determining incomplete and slower balance recovery was assessed. Methods: Forty-five patients with unilateral vestibular schwannoma treated surgically through the middle cranial fossa and translabyrinthine approach were enrolled in this study. The data were collected in the period between April 2022 and August 2023. The clinical data, vestibular tests (video head impulse test, sensory organization test) and the dizziness handicap inventory (DHI) before and after surgery were evaluated. Results: One month after surgery, a temporary deterioration in the DHI results occurred (DHI total score before surgery 24.36 vs. one month after surgery 31.64); however, a significant increase was found only by analyzing the functional subscale (p = 0.0395) for the DHI functional, emotional and physical subscale results; in addition, the total score before and three months after the surgery did not differ significantly. No statistically significant differences between the preoperative sensory organization test and the test one month after the surgery were found, while a significant improvement in the vestibular parameters was observed three months after the surgery compared to the preoperative results (C5 0.0306, C6 0.0002, VEST 0.0294, COMP 0.0023). A negative correlation was found between the DHI total score and C5 (-0.3198, -0.3266), C6 (-0.3448, -0.46379), VEST (-0.3100, -0.3252) and COMP (-0.4018, -0.4854) one and three months after the surgery, respectively. A significant deterioration was found between the LSC gain results on the tumor side (p < 0.001) and on the healthy side before the surgery vs. one month afterwards (p = 0.0079) and before the surgery vs. three months afterwards (p = 0.0419). The middle cranial fossa or translabyrinthine approach had no influence on the postoperative results. Conclusions: In the postoperative period, vestibular compensation occurs spontaneously. The results show that the functional level deteriorates one month after surgery but then improves significantly three months after the surgery, which confirms that compensation occurs gradually. The DHI functional subscale results before surgery and three months afterwards did not differ significantly, which demonstrates that functional recovery after vestibular denervation should take place within that time. In the present study, no predictive factors for unsatisfactory functional postoperative outcomes were found.

The influence of high doses of vitamin C on functional recovery and postoperative pain in patients with trochanteric fracture after intramedullary nailing during a three-month follow-up: a pilot study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; To determine the effects of high peri- and postoperative doses of vitamin C administration on severity of pain in postoperative period and functional outcome of the patients with trochanteric fracture treated with intramedullary nailing during a three-month follow-up.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; A prospective, randomized, pilot study included 56 patients who were randomly divided into vitamin C (intervention) and control groups. In the intervention group, patients received vitamin C perioperatively by an intravenous route for 2 days, and oral vitamin C for 38 days postoperatively. Baseline characteristics, postoperative metamizole consumption, Visual Analogue Scale (VAS) score, Harris Hip Score (HHS) value, and the prevalence of complications were evaluated in both groups.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; No significant differences were noted between the groups regarding age, gender, length of hospitalization, and distribution in fracture type. Postoperative metamizole consumption was notably higher in the control group compared to the vitamin C group (p=0.006). Postoperative VAS score was higher in the control group (p&amp;amp;lt;0.05). No significant differences in HHS values were detected between the groups at 6 and 12 weeks postoperatively (p=0.655 and p=0.755, respectively). The group variable significantly contributed to VAS score, and age and gender variables significantly contributed to HHS value.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; A significant reduction of subjective pain levels and lower analgesic consumption was found in patients who received vitamin C, suggesting that it should be considered as an adjuvant agent for analgesia in patients with hip fracture.&amp;lt;/p&amp;gt;

Structural reversal of disc cupping measured in Bruch’s membrane opening-based OCT morphometry after PRESERFLO microshunt implantation for open-angle glaucoma

Background/ AimsTo analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) after implantation of a PRESERFLO® microshunt for surgical glaucoma management in adult glaucoma patients.MethodsRetrospective data analysis of 59 eyes of 59 participants undergoing implantation of a PRESERFLO microshunt between 2019 and 2022 at a tertiary center for glaucoma management. Surgical management included primary temporary occlusion of the glaucoma shunt to prevent early hypotony. Pre- and post-operative OCT examinations of the optic nerve head (ONH) and intraocular pressure (IOP) were assessed. Longitudinal change in morphometric spectral domain OCT parameters of the ONH was correlated to change in IOP.ResultsBMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first three months after surgery (BL = 171.15 ± 66.80 μm; FU = 180.78 ± 70.394 μm; p = 0.034). For the same postoperative period, the mean preoperative IOP of 24.97 ± 7.22mmHg was lowered after surgery to 13.70 ± 5.09 mmHg. Eighteen months after surgery, there was no significant change in BMO-MRW compared to baseline (BL = 169.83 ± 52.69 μm; FU = 164.98 ± 55.85 μm; p = 0.271), while mean IOP was 13.08 ± 4.48 mmHg. A decrease in IOP correlated significantly with a change in BMO-MRW (r = 0.453, p < 0.05) three months after surgery. Peripapillary RNFL thickness was unchanged in follow-up after three months (p > 0.16) and significantly decreased in later follow-up (p = 0.009).ConclusionPRESERFLO® microshunt implantation with primary temporary occlusion leads to a significant transient increase in BMO-MRW. This phenomenon is also known as structural reversal of disc cupping (SRDC). The effect seems to be less pronounced and of shorter duration when compared to previous data after trabeculectomy with comparable pre- and postoperative IOP levels.

Serum autoantibody-based biomarkers for prognosis in early-stage lung cancer patients with surgical resection

Background Lung cancer is the cancer with the highest morbidity and mortality in the world. With the increasing diagnosis rate of patients with early-stage lung cancer, surgery treatment becomes an option for more patients. However, there is a lack of effective indicators to assess the risk of recurrence after lung cancer surgery. Methods We collected levels of serum autoantibodies and evaluated their roles as biomarkers especially for postoperative recurrence of lung cancer. In vitro experiments including antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), and complement-dependent cytotoxicity (CDC) were performed to explore the functions of serum autoantibodies. Results Our study demonstrated that serum autoantibody-positive patients with early-stage lung cancer had a longer postoperative progression period. The levels of serum autoantibodies in patients with lung cancer were higher than that in patients with benign lung diseases. But all the serum autoantibodies had no difference between patients with stage I and II. In addition, the results of in vitro experiments indicated that serum autoantibodies can mediate immune responses and enhance anti-tumor effects. Conclusion This study proposed effective biomarkers for prognosis in lung cancer patients after surgery which is critical to reduce the recurrence.