Postoperative Inflammatory Response Research Articles

Comparison of the mid-term outcomes of laparoscopic and percutaneous nephroscopic laser unroofing for the treatment of single renal cyst: a single-center retrospective study.

Renal cysts are the most common benign disease of the kidneys, and their increasing size cause compression symptoms that require surgical intervention. In this study, we compared the safety, efficacy and prognosis of percutaneous nephroscopic laser unroofing (PNLU) with those of laparoscopic unroofing (LU) for simple renal cysts. Data from patients with single renal cysts who underwent PNLU or LU between Jan 2018 and Dec 2023 were collected and followed up thereafter. Baseline characteristics, perioperative events, blood test results and postoperative complications were compared. Recurrence-free survival (RFS) was also compared via survival analysis. Subgroup analyses were conducted in the PNLU group, including the 980nm laser and Holmium laser groups. A total of 75 patients were included, 35 of whom underwent PNLU and 40 of whom underwent LU. Compared with LU, PNLU requires only one surgical incision and is a shorter procedure, causes less blood loss, requires fewer urinary catheter days, is known for quicker drainage tube removal, requires a shorter postoperative hospital stay, has lower hospitalization costs, induces a weaker postoperative inflammatory response, and is associated with a lower incidence of abdominal distension. There was no significant difference in RFS between the PNLU and LU groups. In the subgroup analyses of PNLU, no significant differences were observed between the 980nm laser and Holmium laser groups. PNLU is safe, effective and cost-effective for single renal cysts and known for a low complication rate, and its mid-term prognosis is similar to that of laparoscopic surgery.

Laparoscopic hepatectomy using indocyanine green attenuates postoperative inflammatory response for hepatocellular carcinoma: A propensity score matching analysis.

Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons. To determine the benefits of indocyanine green (ICG) fluorescence imaging in patients with hepatocellular carcinoma (HCC) who underwent laparoscopic hepatectomy during and after surgery. We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital (Xiamen), Fudan University from June 2022 to June 2023. Whether using the ICG fluorescence imaging technique, we divided them into the ICG and non-ICG groups. To eliminate statistical bias, a 1:1 propensity score matching analysis was conducted. The comparison of perioperative outcomes, including inflammation-related markers and progression-free survival, was analyzed statistically. Intraoperatively, the ICG group exhibited lower blood loss, a shorter surgical time, lower hepatic inflow occlusion (HIO) frequency, and a shorter total HIO time. Postoperatively, the participation of ICG resulted in a shorter duration of hospitalization (6.5 vs 7.6 days, P = 0.03) and postoperative inflammatory response attenuation (lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day, P < 0.05). Although the differences were not significant, the levels of all inflammation-related markers were lower in the ICG group. The rates of postoperative complications and the survival analyses, including progression-free and overall survivals showed no significant difference between the groups. The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes, especially postoperative inflammatory response attenuation, and ultimately improve HCC patients' recovery after surgery.

P0454 Predictive value of postoperative CRP levels on endoscopic recurrence in Crohn’s disease patients undergoing Ileocolic resection

Abstract Background Patients with Crohn’s disease (CD) undergoing ileocolic resection (ICR) develop higher postoperative C-reactive protein (CRP) levels compared to patients undergoing surgery for colorectal cancer (CRC), suggesting an increased postoperative inflammatory response. (1,2) This study aims to identify whether postoperative CRP levels are associated with endoscopic recurrence in CD patients undergoing ICR. Methods CD patients (≥18 years) who underwent ICR between 2007-2022 at two referral centres (Amsterdam UMC and University Hospital Leuven) were included. CRP levels were measured postoperatively and endoscopy was performed within 12 months after ICR. Endoscopic recurrence (ER) was defined as modified Rutgeerts score ≥i2b. The primary outcome was the association between postoperative CRP levels and endoscopic recurrence. Secondary outcome was the added prognostic value of postoperative CRP levels for ER, compared to traditional risk factors (i.e., smoking, disease behaviour, prophylactic treatment, and perianal location. (3) Multivariable logistic regression and linear mixed models were used. Results A total of 610 patients were included (median age at surgery 31.5 years [IQR 24.0-43.3], 323 [53%] female). The majority of patients presented with stricturing (266 [44%]) or penetrating disease behaviour (229 [38%]) at time of surgery, and 159 patients (26%) were active smokers. Prophylactic therapy (&amp;lt; 8 weeks postoperative) was initiated in 97/606 (16%) of the patients. In total, 548 patients (90%) had an available endoscopy within one year postoperatively. ER was observed in 243/543 (38%) patients. Patients with ER had numerically higher CRP levels on postoperative day (POD) 2 to 5 compared to patients who did not develop ER, but this difference was most significant on POD 4 (mean, 97 vs 86; adjusted difference, 14% [1 to 26%]; P=0.041; Figure 1). After adjusting for traditional risk factors, CRP level on POD 4 remained an independent predictor of ER (P=0.040; Figure 2). Conclusion In CD patients undergoing ICR, high postoperative CRP levels on postoperative day 4 is independently associated with an increased risk of endoscopic recurrence within 12 months. In addition, patients with ER had numerically higher CRP levels on Postoperative day 2 to 5.

How do intraocular lens materials influence the outcome of cataract surgery?

This review summarizes the evidence on the effect of intraocular lens (IOL) material on the outcomes of cataract surgery, as well as on the surgical procedure itself. Differences in capsular biocompatibility between IOL materials lead to variations in capsular stability and posterior capsule opacification (PCO), while differences in uveal biocompatibility affect postoperative inflammatory response. Refractive outcomes are affected by both incision size and the rotational stability of toric IOLs. Small incision sizes favour hydrophilic IOLs. Rotational stability of hydrophobic and hydrophilic IOLs were comparable in recent studies. Visual outcomes are affected by chromatic aberrations, dysphotopsia, lens opacifications and PCO. Hydrophilic IOLs are associated with reduced chromatic dispersion. Hydrophobic IOL opacifications are caused by sub-surface glistenings, while hydrophilic IOL opacifications are due to surface calcifications. Some surgeries, including pars plana vitrectomy and lamellar corneal transplants, were shown to increase the risk of IOL calcifications, although the mechanism is still unknown. Hydrophilic IOLs have greater ease of manipulation, greater resistance to IOL damage, and higher uveal biocompatibility. Hydrophobic IOLs show better PCO prevention than hydrophilic IOLs, and should be preferred in highly myopic eyes where Nd:YAG capsulotomy might increase the risk of retinal detachment.

Clinicopathologic Parameters of Peritoneal Fluid as Predictors of Gastrointestinal Lesions, Complications, and Outcomes in Equine Colic Patients: A Retrospective Study.

Neutrophil characteristics in peritoneal fluid (PF) may aid in diagnosing and treating specific colic lesions and complications. The objective of this retrospective study was to evaluate quantitative PF leukocyte values, as well as PF total protein (TP) and lactate, for associations with diagnosis, morbidity, and mortality in horses with acute colic. Three hundred and forty-two horses that presented to one institution between January 2010-2020 for the evaluation of acute colic were included. The PF total nucleated cell count (TNCC), % and total neutrophil counts, total protein (TP), and lactate were analyzed for associations with lesion location and type, the development of postoperative reflux (POR) or systemic inflammatory response syndrome (SIRS), and survival to discharge via Kruskal-Wallis testing. Horses with strangulating lesions had higher PF % neutrophils, neutrophil count, and TNCC compared to non-strangulating lesions. The development of SIRS or POR was associated with higher PF TNCC, total neutrophil count, TP, and lactate. Horses that did not survive to discharge had increased PF % neutrophils, neutrophil count, TP, lactate, and ratio of PF-to-systemic TP than those that survived via univariable analysis. Identified associations between increased PF neutrophils and the development of POR and SIRS warrant further investigation to better understand their role in the pathogenesis of equine colic and potential as targets for therapeutic intervention.

Effect of Low-dose Ketamine on Inflammatory Markers, Perioperative Analgesia, and Chronic Pain in Patients Undergoing Laparoscopic Inguinal Hernia Surgery: A Prospective, Randomized, Double-blind, Comparative Study.

The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are indicators of postoperative inflammatory response. Low-dose ketamine has analgesic and anti-inflammatory properties. Inguinal hernia surgery is associated with a higher incidence of chronic pain. Sixty patients aged 18-60 years; American Society of Anesthesiologists status I and II who were scheduled for laparoscopic inguinal hernia surgery were included. After the induction of general anaesthesia, a ketamine 0.5 mg kg-1 bolus, followed by a 0.2 mg kg-1 h-1 infusion (group K) or saline bolus and infusion (group S) was administered until the end of the surgery. Blood samples were collected at various time intervals. Fentanyl requirement, hemodynamics, verbal analog scale (VAS), emergence delirium, recovery, postoperative nausea and vomiting, and chronic pain were recorded. Median (interquartile range) NLR was 4.63 times increased at 2 hours postoperatively from the baseline in group S [2.07 (1.72-2.79) to 7.91 (5.74-14.7)] as compared to 2.53 times increase in group K [1.85 (1.4-2.61) to 5.45 (2.89-7.61)] (P=0.02). The increase in median PLR from baseline to 2 hours postoperatively was greater in group S (2.98 times) than in group K (1.94 times) (P=0.02). The NLR and PLR were comparable on POD1 between the groups. Fentanyl requirement was significantly higher in group S compared to Group K both intraoperatively, (P=0.01) and two hours postoperatively (P=0.047). More patients had chronic pain and VAS scores in group S than in group K (13 vs 5, P=0.05). Low-dose ketamine reduces postoperative inflammatory response, decreases perioperative opioid requirement, and reduces incidence of chronic pain after laparoscopic inguinal hernia surgery with no significant side effects.

Comparative Study of Safety and Efficacy of α-n-Butyl-2-cyanoacrylate Glue versus Traditional Embolization Materials in the Treatment of Acute Renal Hemorrhage.

Aims/Background This study aims to evaluate the safety and efficacy of α-n-butyl-2-cyanoacrylate (NBCA) glue in comparison with traditional embolization materials for the treatment of acute renal hemorrhage. Methods A total of 105 patients with the acute renal hemorrhage who underwent superselective renal artery embolization were enrolled. The patients were divided into two groups based on the embolization materials used: the traditional group (43 cases, control group) and the medical glue group (62 cases, observation group). Demographic characteristics, medical history, preoperative and postoperative 24-hour blood counts, renal function, and other clinical data were collected. The safety and efficacy of the two treatment methods were then compared between the groups. Results No significant difference in efficacy was observed between the traditional group and the medical glue group (p > 0.05). However, significant differences were found between the two groups in terms of embolization vessel grade, systemic immune-inflammation index (SII) difference, estimated glomerular filtration rate (eGFR) difference, and combined eGFR difference (p < 0.05). The traditional group exhibited a higher postoperative inflammatory response and greater renal function damage compared to the medical glue group. The degree of vascular embolization also influenced the extent of postoperative inflammatory response and renal function damage in patients with acute renal hemorrhage. Conclusion Compared to traditional embolization materials, NBCA glue demonstrates a clear hemostatic effect in the treatment of patients with acute renal hemorrhage, while also leading to reduced postoperative inflammatory response and renal function damage. NBCA adhesive is both safe and effective for treating acute renal hemorrhage.

Inflammation-attenuating effect of carbon dioxide versus room-air environment in a rat laparotomy model.

The mechanism by which laparoscopic operations induce lower post-operative inflammatory response compared to open surgery was investigated with regard to the effect of the type of gas environment. Rats were subjected to midline laparotomy at either CO2 (group CO2) or room-air environment (group Air) or to anesthesia only (group Control) under atmospheric pressure conditions. At various timepoints after surgery (1, 3, 6, 24, or 48h), the expression of inflammation biomarkers interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and nuclear factor-κΒ (NFκΒ) were assessed immunohistochemically in tissue samples excised from the liver, intestine, and kidneys, accompanied by histopathologic analysis, and their levels were measured by ELISA in blood samples. Tissue expression of IL-6, TNFα, and NFκΒ was downregulated in the liver and intestine in group CO2 compared to group Air and in the kidneys in group Air compared to group CO2. However, no differences were noted among groups regarding the histopathologic score of organ tissues and the blood serum levels of inflammation biomarkers. Post-operative local inflammatory response was lower in intra-peritoneal organs of rats subjected to laparotomy at CO2 rather than room-air environment under atmospheric pressure conditions.

Efficacy analysis of tip-flexible suction access sheath during flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi.

This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi. The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro. The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts. TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2cm or greater, compared to T-UAS.

The Impact of ERAS and Multidisciplinary Teams on Perioperative Management in Colorectal Cancer.

The Enhanced Recovery After Surgery (ERAS) protocol, a comprehensive multimodal approach, aims to mitigate surgical stress, expedite recovery, and improve postoperative outcomes. Its implementation has notably advanced perioperative care in colorectal cancer surgeries. Integrating ERAS with multidisciplinary collaboration, involving surgery, anesthesia, nursing, and nutrition, may further enhance patient outcomes, making it a significant focus in clinical practice. This study assessed the effectiveness of integrating the ERAS model with multidisciplinary collaboration during the perioperative period in colorectal cancer patients. A total of 117 patients scheduled for elective surgery at Haiyan People's Hospital between August 2023 and April 2024 were randomly assigned to either a control group (n = 59), receiving traditional care, or an experimental group (n = 58), receiving ERAS-based multidisciplinary care. Key outcomes related to postoperative rehabilitation were evaluated. Patients in the ERAS group demonstrated significantly shorter hospital stays, quicker catheter removal, and earlier mobilization compared to the control group (P < 0.0001 for all). Additionally, the ERAS group exhibited reduced postoperative inflammatory responses, as indicated by significantly lower interleukin-6 levels on the first postoperative day (P = 0.0247). The quality of life was significantly higher in the ERAS group (P < 0.05). Furthermore, the ERAS group incurred lower total hospitalization expenses than the control group (P = 0.0011). These findings confirm the benefits of the ERAS protocol in enhancing postoperative recovery in colorectal cancer surgeries. The study highlights the importance of a multidisciplinary approach in optimizing patient outcomes and reducing the burden on hospital resources.

Hidden messages in fluids: A review of clinical and fundamental perspectives on post-lymph node dissection drains.

In recent years, there has been a growing interest in liquid biopsy due to its non-invasive diagnostic value. Postoperative drainage fluid (PDF) is the fluid exudate from the wound site following lymph node dissection. PDF is regarded as a medical waste with no specific clinical significance. Nevertheless, the liquid biopsy of PDF may enable the reuse of this fluid. PDF contains a variety of body fluids, including blood and lymph. PDF contains a variety of biological components, including cytokines, extracellular vesicles (EVs), proteins, nucleic acids, cells and bacteria. These components are indicative of the postoperative inflammatory response, the immune response and the therapeutic response. In this review, we examine the current state of research in the field of liquid biopsy in PDF, elucidating how the analysis of its components can assess the prognosis of patients after lymph node dissection, monitor real-time changes in patient status, and identify new biomarkers and potential therapeutic targets.

Application of Endovenous Laser Treatment Combined with Foam Sclerotherapy for the Minimally Invasive Treatment of Great Saphenous Vein Varicosity

Objective: To evaluate the efficacy of endovenous laser treatment (EVLT) combined with foam sclerotherapy (FS) in the treatment of great saphenous vein varicosity (GSVV). Methods: A total of 50 patients with GSVV, treated between March 2021 and March 2024, were selected and randomly divided into two groups using a random number table. The combination group (25 cases) underwent EVLT combined with FS, while the conventional group (25 cases) underwent EVLT alone. The total effective rate, complication rate, disease severity score, and serological indicators were compared between the two groups. Results: The total effective rate in the combination group was higher, and the complication rate was lower compared to the conventional group (P &lt; 0.05). One week after surgery, the disease severity score in the combination group was lower, coagulation function indicators were better, and inflammatory factor levels were lower compared to the conventional group (P &lt; 0.05). Conclusion: EVLT combined with FS can improve the clinical efficacy in GSVV patients, prevent postoperative complications, reduce disease severity, protect patients’ coagulation function, and alleviate postoperative inflammatory responses, showing significant advantages in combined surgery.

Effects of Different Ultrasound-Guided Nerve Block Modalities on Inflammatory Stress Response in Elderly Patients after Total Hip Arthroplasty.

This study aimed to evaluate the impact of different ultrasound-guided nerve blocks on the postoperative inflammatory and stress response in elderly patients undergoing total hip arthroplasty (THA), providing a theoretical foundation for clinical application. Elderly patients with THA who received ultrasound-guided nerve block combined with general anesthesia from June 2021 to June 2022 in the hospital were selected as a retrospective cohort study. Patients were divided into two groups based on the type of nerve block used. The observation group (n = 60) received ultrasound-guided pericapsular nerve group (PENG) block combined with femoral nerve block (FNB), while the control group (n = 60) received ultrasound-guided PENG block. The cortisol (Cor), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), visual analogue scale (VAS) scores, and pain medication consumption in both groups were compared. The observation group demonstrated significantly lower serum levels of Cor, TNF-α, and IL-6 at postoperative 1 day, 3 days and 7 days, as well as lower soluble protein-100β (S100β) levels at postoperative 1 day compared to the control group (p < 0.001). The VAS score in the observation group was significantly lower than that in the control group at postoperative 1 day, 3 days and 7 days (p < 0.001), with no significant difference in preoperative VAS score between the two groups (p > 0.05). Additionally, opioid consumption in the observation group was significantly lower than that in the control group at postoperative 48 h (p < 0.001). The combination of ultrasound-guided PENG block and FNB effectively reduces postoperative pain and the inflammatory response in elderly patients undergoing THA, facilitating early recovery.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

The Relationship Between Peri-Operative Systemic Inflammation and Survival in Patients With Abdominal Aortic Aneurysm

An association between preoperative markers of systemic inflammation and inferior mortality following abdominal aortic aneurysm (AAA) repair has been observed. The prognostic value of the postoperative inflammatory response remains unreported in patients with AAA. This study aimed to describe the association between the perioperative inflammatory response and mortality in patients undergoing endovascular aneurysm repair and open surgical repair (OSR) for infrarenal AAA. Consecutive patients undergoing either emergency (endovascular aneurysm repair or OSR) or elective (OSR) intervention for infrarenal AAA were retrospectively recruited from 3 centers. Preoperative systemic inflammation was assessed using the modified Glasgow Prognostic Score. Day 3 postoperative C-reactive protein (CRP) (≤300mg/L, >300mg/L) was chosen as the covariate of interest. The primary outcome was 30-day mortality in the emergency cohort and 12-month mortality in the elective cohort. There were 167 emergency cases (120 (72%) OSR) and 207 elective (207 (100%) OSR) cases, with a median (interquartile range) follow-up of 85 (52) months in the emergency cohort and 63 (57) months in the elective cohort. There were 56% versus 44% of patients in the emergency cohort day 3 CRP ≤300mg/l versus >300mg/L compared with 82% versus 18% of patients in the elective cohort (P<0.001). On univariate binary logistic regression analyses in the emergency cohort, open repair (P<0.05), preoperative modified Glasgow Prognostic Score 2 (P<0.05), postoperative mesenteric ischemia (P<0.01), and day 3 postoperative CRP >300mg/L (P<0.05) were associated with increased odds of 30-day mortality. On multivariate binary logistic regression analyses, only preoperative modified Glasgow Prognostic Score 2 (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.12-3.98, P<0.05) retained independent association with 30-day mortality. In the elective cohort, mean (95% CI) survival in the day 3 CRP ≤300mg/l versus >300mg/L was 112.0 (101.8-122.2) months versus 67.2 (54.1-80.2) months (P<0.001). On univariate binary logistic regression analyses in the elective cohort, age ≥75 (P<0.05), ischemic heart disease (P<0.05), and day 3 postoperative CRP >300mg/L (P<0.001) were associated with increased odds of 12-month mortality. On multivariate binary logistic regression analyses, both age ≥75 (OR: 5.15, 95% CI: 1.25-21.30, P<0.05) and day 3 postoperative CRP >300mg/L (OR: 15.68, 95% CI: 3.61-68.15, P<0.001) retained independent association with 12-month mortality. Preoperative and postoperative markers of systemic inflammation were independently associated with inferior survival following emergency and elective repair of AAA, respectively. Further investigation of the perioperative systemic inflammatory response is warranted in this patient group, with a particular focus on identifying targets for intervention.

Advantage of Postoperative Inflammatory Status after Laparoscopic Distal Pancreatectomy

Introduction: Laparoscopic distal pancreatectomy (LDP) is a safe and effective procedure; however, its impact on perioperative inflammatory reactions compared with open distal pancreatectomy (ODP) remains unclear. This study aimed to assess short-term outcomes following LDP and ODP regarding inflammatory reactions. Methods: This retrospective study of 77 consecutive patients who underwent distal pancreatectomy for low-grade malignancies between 2005 and 2022 compared white blood cell (WBC) count, C-reactive protein (CRP) level, serum albumin level, and CRP/albumin ratio (CAR) between LDP and ODP. Complications, especially postoperative pancreatic fistula (POPF), recovery program, and hospital stay period, were also compared. Results: POPF (17.1% vs. 38.7%, p = 0.039) and surgical morbidity (≥Clavien-Dindo grade III, 12.2% vs. 32.3%, p = 0.038) were significantly lower in LDP than in ODP, as for the difference in postoperative inflammatory response, including CRP and CAR, was just temporary. By multivariate analysis, CAR ≥6.94 on POD 3 was significant predictor of POPF (42.1% vs. 13.2%, odds ratio 4.828, p = 0.030). Conclusion: LDP has lower POPF and earlier postoperative recovery. CAR could be a predictor of POPF.

Gender differences in postoperative pain, sleep quality, and recovery outcomes in patients undergoing visual thoracoscopic surgery

ObjectiveThe purpose of our study was to investigate the effect of gender on postoperative pain, sleep quality, and recovery outcomes in patients undergoing VATS surgery under general anesthesia. MethodPerioperative peripheral blood inflammatory markers system inflammation Index (SII) was recorded for perioperative inflammatory response. The visual analog scale (VAS) was used to evaluate pain level. And the Athens Insomnia Scale (AIS) was evaluated on the night before surgery (sleep preop 1), the first night after surgery (sleep POD 1), and the third night after surgery (sleep POD 3) for postoperative sleep. ResultIn this prospective cohort study, 79 males and 79 females were consecutively included. Females had significantly higher pain score (both rest and cough pain) compared to the males at 3 h after the surgery (3.85 ± 1.2 vs. 3.16 ± 1.1) (rest) (p < 0.001) and 5.10 ± 1.3 vs. 4.46 ± 1.6 (coughing) (p = 0.006)). Patients in the male group had significantly lower AIS scores than those in the female group at Sleep POD 1 and Sleep POD 3 (p = 0.024 and p = 0.045). And in both groups, postoperative SII was increased and statistically significant compared to preoperative SII (p < 0.001, respectively). Women presented higher levels of SII on the first day after surgery, and the increase of postoperative SII in females groups was significantly higher than that in male group when compared to preoperative SII (1806.33 ± 1314.8 vs 1430.55 ± 958.4) (p = 0.042). ConclusionThese findings highlight the complex multidimensional nature of postoperative pain, nausea and vomiting, sleep quality and the potential contributory role of sex in shaping these outcomes. Women had worse sleep quality, higher postoperative inflammatory response level and pain level than men.

Photobiomodulation as a Potential Adjuvant Therapy to Improve Cochlear Implant Efficiency.

Objective: Photobiomodulation (PBM) is a noninvasive therapeutic modality with widespread applications for modulating various biological processes. Although the exact mechanisms of action remain uncertain, PBM promotes homeostasis through diverse pathways, including reducing inflammation and enhancing tissue recovery. Hearing loss is irreversible in mammals due to the limited regenerative capacity of cochlear hair cells. Cochlear implants offer a solution by electrically stimulating the auditory nerve, bypassing damaged hair cells in individuals with severe hearing loss. However, postoperative inflammatory responses and cochlear nerve fiber damage can compromise implant efficacy. Materials and Methods: We investigated current strategies to minimize secondary cochlear damage after cochlear implantation and evaluated the potential of PBM as an adjuvant therapeutic approach. Results: The auditory cell protective effects of PBM could significantly enhance the performance of EAS devices in individuals with residual hearing. Further, postoperative CI is accompanied by an inflammatory response characterized by the upregulation of specific cytokines. Conclusion: Considering the neuroregenerative potential of PBM, its application as a neuroprotective strategy warrants further validation.

Clinical outcomes of unicompartmental knee arthroplasty and total knee arthroplasty in the same patient.

Osteoarthritis has become the predominant manifestation of arthritic conditions on a worldwide scale and serves as a significant instigator of pain, impairment, and increasing socio-economic strain on a global level. The ongoing discourse on the choice between total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients suffering from anterior medial osteoarthritis continues to ignite scholarly controversy. Our objective was to assess and compare the clinical outcomes of UKA and TKA within the same patient, hereby offering a novel perspective on this topic. Fifty-seven individuals who underwent TKA on one knee and UKA on the other knee at the Department of Orthopaedics, First Hospital of Hebei Medical University between March 2019 and March 2024 were analysed for this retrospective study. We conducted a comprehensive examination and evaluation of perioperative laboratory assessments, radiological examinations, knee functionality, contentment levels, and postoperative complications within the two groups. Following surgical procedures, levels of hemoglobin, red blood cells, and albumin were found to be elevated in the UKA group when compared to the TKA group (hemoglobin: 121.2 ± 12.54 vs. 110.1 ± 13.21g/L; red blood cells: 4.0 ± 0.47 vs. 3.6 ± 0.42 *1012/L; albumin: 37.7 ± 5.66 vs. 35.3 ± 5.23g/L). There is a significant difference in the hip-knee-ankle angles between the postoperative UKA group and the TKA group (5.3 ± 3.46° vs. 4.1 ± 2.86°, p < 0.05). There existed no notable disparity in postoperative visual analog scale, knee society score, and forgotten joint score between the two groups. However, a remarkable variance was observed in postoperative range of motion between the two groups (116.4 ± 5.96° vs. 108.4 ± 5.32°). We found that UKA resulted in less physical strain, less postoperative inflammatory response, improved joint mobility, although with less effective lower limb force line correction compared to TKA. Many patients have shown a preference for UKA and express higher levels of satisfaction with the procedure.

Effect of acupuncture anesthesia on inflammatory response and cellular immunity in patients with osteoporotic fractures.

Osteoporotic vertebral compression fractures (OVCFs) occur frequently in the elderly, with percutaneous vertebroplasty (PVP) being the major clinical treatment at present. How to improve the patient's surgical cooperation while ensuring surgical safety is the focus of clinical research. This study explores the influence of acupuncture anesthesia (AA) on the safety, inflammatory response, and cellular immunity of OVCF patients undergoing PVP, which may provide a more reliable safety guarantee for future treatment of OVCFs. The results showed that patients using AA had lower postoperative Visual Analogue Scale (VAS) scores and incidence of postoperative adverse reactions, a smaller anesthetic dosage, but an extended duration of anesthesia; moreover, the postoperative inflammatory response was markedly alleviated and the stability of T lymphocyte subsets was obviously enhanced. Therefore, AA has high clinical application value in PKP treatment of OVCFs in the future.