Postsurgical Patients Research Articles

Impact of Face Mask-Wearing on Quality of Life in Post-Surgical Oral Cancer Patients: A Cross-Sectional Study

Background: Treatments for oral squamous cell carcinomas (OSCCs) often result in significant aesthetic and functional issues, impacting patients’ quality of life (QoL). The COVID-19 pandemic’s mask mandates may have provided psychosocial benefits by concealing facial disfigurements, potentially reducing stigma. This study aimed to assess the impact of mask-wearing on the QoL of patients surgically treated for OSCC. Methods: This single-center, cross-sectional study, conducted from June 2022 to December 2023, included patients who had completed their treatment and returned home before or during the mask-wearing mandate. They answered a questionnaire using a four-point Likert scale to evaluate the mask-wearing’s impact on QoL and the influence on it of physical appearance, tumor localization, radiotherapy, and treatment end date. Results: The questionnaire analysis found a high internal consistency among the questions (Cronbach’s alpha = 0.931). Considering 41 patients (median age 69, 63% male), wearing a mask significantly improved QoL, with a mean score of 1.66 compared to a score of 2.00 for patients not wearing it (p < 0.001). This improvement was particularly notable for appearance concerns, fear of perception by family or others, and sociability apprehension. The QoL, with or without mask use, was not significantly modified when considering physical appearance, tumor localization, radiotherapy, or end date of the treatment, as demonstrated by two-way ANOVA tests and multiple linear regression. Conclusions: Mask-wearing positively impacted QoL in OSCC patients, providing psychological relief from disfigurement and social stigma. Masks offer a simple, accessible solution to enhance QoL while awaiting a definitive prosthetic treatment, suggesting that their continued use could be beneficial in supportive care strategies.

Functional Lumen Imaging Probe Panometry Findings in Obese Patient Populations.

Few data are available on functional lumen imaging probe (FLIP) findings specifically in obese patients. We aimed to evaluate FLIP metrics in obese patients who had not undergone bariatric surgery and in those who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). We also sought correlations of FLIP abnormalities with esophageal symptoms and HRM findings. We identified obese patients who had FLIP performed during workups either for a first bariatric operation (surgery-naïve patients), or for surgical revision of SG and RYGB operations that resulted in inadequate weight loss. We recorded esophageal symptoms, HRM data, and FLIP metrics. We identified 228 eligible patients (87 surgery-naïve, 90 SG, 51 RYGB). Dysphagia and chest pain were frequent symptoms in all groups. Median EGJ diameter and EGJ-DI were similar in surgery-naïve and postsurgical patients, but subgroup analysis of symptomatic patients with no HRM diagnosis revealed reduced EGJ opening in 12%. Abnormal FLIP response patterns were common (69% surgery-naïve, 74% SG, 65% RYGB) with higher ACR rates in SG (46.7% vs. 29.9%, p = 0.026) and RYGB (41.2% vs. 29.9%, p = 0.189) and lower SRCR rates in SG (11.1% vs. 24.1%, p = 0.021) and RYGB (5.9% vs. 24.1%, p = 0.006) compared to surgically naïve patients. There were no significant associations between FLIP contractile response patterns and symptoms or HRM diagnoses. Dysphagia and chest pain are common in obese patients, and most obese patients (with or without bariatric surgery) have FLIP contractile response abnormalities that do not correlate with HRM findings. FLIP findings appear to be especially valuable in obese patients who have esophageal symptoms with no HRM diagnosis.

Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients. Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed. A systematic review and meta-analysis guided by the PRISMA protocol. CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales. Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes. Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings. Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy. This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Patient and public contributions were not required for this review.

Comparative Effects of GLP-1 Agonists, Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Diabetes Mellitus Outcomes.

The purpose of this review is to assess the effects of glucagon-like peptide-1 (GLP-1) agonists, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) on type 2 diabetes mellitus (T2DM) remission. This review explores the efficacy, safety, and durability of these surgical and medical modalities of diabetes management. Studies have shown that GLP-1 agonists achieve higher rates of T2DM remission compared to standard glucose-lowering medications and lifestyle changes. In addition to weight loss, bariatric surgery has been found to be highly effective in treating and inducing remission of T2DM. Studies suggest that post-surgical patients see enhanced glycemic control. Both surgical interventions and GLP1 agonists are effective in achieving T2DM remission. Long-term follow-up and randomized controlled trials comparing bariatric surgery and GLP-1 agonists are necessary to evaluate their relative effectiveness in T2DM control. Further research is also needed to assess the combined effects of these treatment modalities.

48-Year clinical experience and genetic analysis of pediatric primary hyperparathyroidism from a single center in China.

This study aims to investigate the clinical and genetic features and change of clinical spectrum of primary hyperparathyroidism (PHPT) in children and adolescents. The clinical and follow-up data of 74 pediatric patients (onset age ≤ 18 years) with PHPT during 1975-2022 were retrospectively analyzed. For comparison, patients were divided into four subgroups according to their time of diagnosis. Genetic analysis was conducted in 40 patients. Pediatric PHPT cases increased largely over time [34 cases (45.9%) in 2015-2022]. The rate of asymptomatic PHPT increased by time (14.7% in 2015-2022 vs. 0% before 2015), in accordance with routine screening of serum calcium becoming a more frequent reason for clinic visit (17.6% in 2015-2022 vs. 0% before 2015). Skeletal manifestation significantly decreased in recent years (64.7% in 2015-2022 vs. 100.0% in 1975-1994, P < 0.05). Sixty-seven patients (90.5%) of the whole cohort underwent parathyroidectomy. Atypical parathyroid adenoma and parathyroid carcinoma occurred in 13.4% and 4.5% of the surgical cases, respectively. Recurrence and persistence of PHPT were observed in 17.9% of postsurgical patients. Germline rare variations (RVs) of PHPT-related genes were found in 42.5% (17/40) of all cases with genetic testing. Compared with no-variation group, the variation group had higher incidence of multiple parathyroid lesions (42.8% vs. 4.3%, P = 0.014), and lower rate of benign lesions and higher rate of recurrence and persistence. Milder cases of Pediatric PHPT are coming to clinical attention probably due to routine lab testing. Genetic testing is recommended for pediatric PHPT patients.

Abstract B005: Investigating distinct methylation signatures characteristic of breast cancer subtypes in residual disease via cell free DNA methylation

Abstract Breast cancer is the most common type of cancer in females and recurrence increases over time, unlike many other cancers. Treatment for recurrent cancer is often the same as the primary with no additional biopsies taken. Current research suggests that subtype switching and tumor character changes frequently occur between primary and recurrent breast cancers. Therefore, it may be beneficial to patients to switch treatment based on these changes. Since physical biopsies are cumbersome and not always feasible, liquid biopsies open a way to monitor tumor changes less invasively and more comprehensively. It has been previously established that cell free DNA (cfDNA) shed into the bloodstream from dying cells can reflect cell type of origin via methylation pattern and rate of death via concentration of cfDNA. In this pilot study, we seek to look at the cfDNA of fifteen late stage pre-/ post-surgical breast cancer patients who also received radiation treatment. We will perform cfDNA extraction on the serum of these patients and both whole genome bisulfite sequencing (WGBS), which chemically converts unmethylated cytosine to uracil/thymine in the DNA and is the current gold-standard of methylation sequencing, and a newer method, enzymatic methylation sequencing (EM-seq), which enzymatically converts (TET2/APOBEC) unmethylated cytosine to uracil/thymine and potentially preserves more of the cfDNA. To validate any signatures found in the cfDNA of the breast cancer patients, we have begun the genomic DNA (gDNA) extraction and WGBS/ EM-seq protocols on a variety of breast cancer cell lines including: MCF10A, MCFDCIS, MCF7, T47D, BT474 MDA MB453, MDA MB436 and MDA MB231 (including in-lab brain, bone, and lung metastatic clones). Bioanalyzer traces are produced from the extracted cfDNA/gDNA and also for the final sequencing libraries. The success of the methylation conversion is evaluated after sequencing data is returned and conversion rates of the cytosine to uracil/thymine are compared to unmethylated DNA control (lambda) and methylated DNA control (pUC19). Once this sequencing data is obtained, we use an in-lab deconvolution algorithm to detect cell types of origin and intend to make the algorithm more robust for cancer cell types as well. We have currently produced breast cancer cell line methylation sequencing libraries and are in the process of producing the libraries for the patient samples. Our current data suggests that there are changes in the cfDNA general fragmentation patterns and cfDNA concentrations between pre-/post- surgery samples. Once our sequencing data is obtained for the patient samples, we will run our deconvolution algorithm. The potential of characterizing breast cancer subtype and progression signatures in cfDNA of late stage pre-/ post-surgical breast cancer patients can have significant impact on patient treatment options. Identifying these breast cancer signatures less invasively and, therefore, more frequently may allow for early and more targeted intervention to improve breast cancer patient outcomes. Citation Format: Amber Alley, Megan McNamara, Sidharth Jain, Anton Wellstein. Investigating distinct methylation signatures characteristic of breast cancer subtypes in residual disease via cell free DNA methylation [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B005.

Functional outcomes and healthcare utilization trends in postsurgical and nonsurgical patients following high-frequency (10 kHz) spinal cord stimulation therapy.

Chronic low back pain (CLBP) is the leading cause of disability in the United States and is associated with a steadily increasing burden of healthcare expenditures. Given this trend, it is essential to evaluate interventions aimed at reducing disability and optimizing healthcare utilization (HCU) in affected populations. This study investigates the impact of prior spinal surgery on functional outcomes and HCU patterns following high-frequency (10 kHz) spinal cord stimulation (SCS) therapy. This retrospective observational study included 160 subjects who underwent implantation of a 10 kHz SCS device. Participants were divided into surgical and non-surgical cohorts for comparative analysis. Pain relief was assessed using the Numeric Rating Scale (NRS), while disability levels were evaluated using the Oswestry Disability Index (ODI). HCU was examined through the frequency of emergency department (ED) visits, outpatient visits for interventional pain procedures, and opioid consumption measured in morphine milliequivalents (MME). No statistically significant differences were observed between the surgical and non-surgical groups regarding pain relief and disability outcomes. Additionally, ED visits and outpatient visits for interventional pain procedures did not show significant differences between the two cohorts. This study represents the first comparative analysis of pain, disability, and HCU trends between surgical and non-surgical populations following 10 kHz SCS therapy. The results suggest that prior spinal surgery may not substantially affect the efficacy of 10 kHz SCS therapy in terms of pain relief, disability reduction, or HCU patterns.

Effects of postoperative treatment with chemotherapy and cellular immunotherapy on patients with colorectal cancer.

The outcome of surgical treatment for colorectal cancer (CRC) remains unsatisfactory and warrants further exploration and optimization. To clarify the impact of chemotherapy plus cellular immunotherapy [dendritic cell-cytokine-induced killer (DC-CIK) cell immunotherapy] on patients after CRC surgery and to explore the mediating variables. A total cohort of 121 patients who underwent CRC surgery between January 2019 and April 2022 were selected. The sample comprised a control group of 55 patients who received the XELOX chemotherapy regimen and a research group of 66 patients who received XELOX + DC-CIK immunotherapy. We performed comparative analyses of the clinical and pathological data of the two groups, including efficacy (2-year disease-free survival [DFS] rate), the incidence of adverse events (diarrhea, myelosuppression, gastrointestinal reactions, and peripheral neuritis), serum levels of tumor markers [carcinoembryonic antigens and carbohydrate antigens (CA)19-9 and CA242], and T-cell subsets [cluster of differentiation (CD)3+, CD3+ CD4+, CD3+ CD8+, natural killer (NK), and NK T cells]. We also conducted preliminary univariate and multivariate analyses of the variables that affected the efficacy of the treatments. We found a significantly higher 2-year DFS rate of treatment efficacy in the research group than in the control group, with a statistically lower incidence of adverse events. Both groups showed a reduction in serum tumor markers after treatment but there was no marked intergroup difference. After treatment, the various T-cell subgroup indicators in the control group were significantly lower than those in the research group. The indices of T-cell subsets in the research group showed no significant change from preoperative levels. Univariate analysis revealed a significant correlation between TNM staging, tumor differentiation, and the rates of nonresponse to treatment in CRC patients after surgery. Multivariate results indicated that the treatment approach significantly affected the efficacy of postoperative CRC treatment. We concluded that XELOX + DC-CIK immunotherapy for postsurgical CRC patients offers reduced rates of treatment-induced adverse events, extended 2-year DFS, enhanced immunity, and increased physiological antitumor responses.

A Scoping Review of 'Smart' Dressings for Diagnosing Surgical Site Infection: A Focus on Arthroplasty.

Early diagnosis and treatment of surgical wound infection can be challenging. This is especially relevant in the management of periprosthetic joint infection: early detection is key to success and reducing morbidity, mortality and resource use. 'Smart' dressings have been developed to detect parameters suggestive of infection. This scoping review investigates the current status of the field, limited to devices tested in animal models and/or humans, with a focus on their application to arthroplasty. The literature was searched using MEDLINE/PubMed and Embase databases from 2000 to 2023. Original articles assessing external sensing methods for the detection of wound infection in animal models or human participants were included. Sixteen articles were eligible. The results were broadly divided by sensing method: colorimetric, electrochemical and fluorescence/photothermal responses. Six of the devices detected more than one parameter (multimodal), while the rest were unimodal. The most common parameters examined were temperature and pH. Most 'smart' dressings focused on diagnosing infection in chronic wounds, and none were tested in humans with wound infections. There is limited late-stage research into using dressing sensors to diagnose wound infection in post-surgical patients. Future research should explore this to enable inpatient and remote outpatient monitoring of post-operative wounds to detect wound infection.

Real-world usage pattern, effectiveness and safety of oral tramadol/dexketoprofen trometamol fixed-dose combination in moderate-to-severe acute pain in Asia: a prospective, multicentre, observational study

ObjectivesThis study aims to determine the usage pattern, effectiveness and safety of oral tramadol 75 mg and dexketoprofen trometamol 25 mg fixed-dose combination (TRAM/DKP FDC) in the short-term treatment of...

B-123 Prediction of Opioid Use Duration in Post-Surgical Orthopedic Patients Using CYP2D6 Inhibitor Index and Routine Laboratory Markers

Abstract Background Hydrocodone, the most commonly prescribed opioid in the U.S., is typically used for pain management following surgery and is a known potential drug of abuse with non-negligible risk of addiction. Significant variability in patients’ response to hydrocodone therapy have been reported, owing to both iatrogenic and endogenous sources. The objective of this study is to evaluate the feasibility of predicting post-discharge hydrocodone use in patients who have undergone orthopedic surgery using patient demographics, genotyping, concurrently prescribed medications, and routinely collected laboratory test results. Methods Targeted genotyping was performed on each patient with genes known to affect hydrocodone pharmacokinetics or pharmacodynamics, including CYP2D6, CYP3A4, CYP3A5, CYP2B6, COMT, OPRM1, and ABCB1. An inhibition index for CYP2D6 was calculated by ranking concurrently prescribed medications as weak, moderate, or strong inhibitors of enzyme activity. Pain index, average hydrocodone dose per day during hospital stay, and CYP2D6 estimated activity scores based on allele functionality were included as predictors. In addition, a retrospective chart review of electronic hospital records was performed where basic metabolic panel and complete blood count results were screened within 10 days of each patient's surgery date. Two types of classification and decision tree algorithms were tuned and validated as prediction models using 5-fold cross validation, including a ‘Fast and Frugal Decision Tree’ (FFTree) and an extreme gradient boosting machine (xgBoost). Clinical predictive features were ranked according to the Shapley Additive Explanations (SHAP) values using the xgBoost model. Results Out of 79 total patients with hydrocodone use duration information, 25 were categorized as “Short” and 54 categorized as “Long” using a 1-week threshold. FFTree model selected the top three features of CYP2D6 inhibition index, blood sodium level, and blood creatinine level and obtained a sensitivity and specificity of 0.80 and 0.76, respectively. The xgBoost model, using the same three features, achieved a sensitivity and specificity of 0.872 and 0.628, respectively, an AUROC of 0.814, PRAUC of 0.912, net benefit of 0.359, and was well-calibrated with a Brier score of 0.161. Consistent with previously published results, the predictive capacity of all genotypes analyzed were unremarkable and consistently ranked as the least important features by the xgBoost model SHAP values, due to their low predictive value. Conclusions Both the FFTree and xgBoost models were able to adequately classify the patients according to a 1-week stratification criteria with good to excellent classification performance. Patients with larger CYP2D6 inhibition index were more likely to be classified as “Long” duration. Sodium and creatinine level, which may reflect hydration status and renal function, and therefore hydromorphone elimination rate, were key predictors of post-discharge hydrocodone use duration when combined with the CYP2D6 inhibition index. Further refinement of the proposed models and validation of model robustness and stability using external cohorts is necessary. These results may have implications for providers when prescribing hydrocodone for pain management, where the ability to risk-stratify patients according to their predicted probability of developing opioid use disorder is of clinical importance.

Incidence of Subclinical Venous Thromboembolism after Pulmonary Resection for Lung Cancer

Abstract Background Deep venous thrombosis DVT, in post-surgical patients, is more common in lung cancer patients undergoing resection. The combination of malignancy, surgical trauma, chemotherapy, and smoking are all synergistic factors raising the risk. Most of the patients developing post-operative DVT are subclinical and asymptomatic. Subclinical DVT means presence of thrombus in deep veins of lower limb without any signs and symptoms. DVT can be prevented more successfully in its subclinical phase than that in its clinical phase. Aim The present study was undertaken to estimate the occurrence and associated risk factors of subclinical deep vein thrombosis at our institute after lung resection for lung cancer patients in the elective and urgent setting. Methods This is a prospective study of 150 patients who underwent different types of lung resection for lung cancer. Patients younger than 18 years old, symptoms of lower limb DVT and pregnant patients were excluded. Caprini risk score was assessed in all patients. All patients received prophylactic stockings and anticoagulant. On the 5th postoperative day, a duplex venous ultrasound of bilateral lower limbs was performed in every asymptomatic patient to look for presence of thrombus in the deep veins. Results Out of 150 patients enrolled in the study, we completed the study on 147 patients. According to the results of Doppler US, the patients were divided into 2 groups: group 1 (n = 143) post-lung resection and no DVT. Group 2 (n = 4) with post-lung resection subclinical DVT. 4 patients (2.721%) developed subclinical deep vein thrombosis. No patient developed postoperative clinical DVT. Incidence was maximum in the group with longer ICU stay (P-value = 0.04.). Among the various pathologies, incidence was more in patients who received preoperative chemotherapy (P-value = 0.001). One patient (25%) died in the group who developed subclinical DVT while no mortality was observed in the No DVT group. Conclusion It can be concluded that incidence of subclinical deep vein thrombosis is low in the post operative period among the patients undergoing lung resection for lung cancer. However, patients of old age, those with preoperative chemotherapy and those with longer periods of immobilization are at a higher risk to develop postoperative DVT despite anticoagulant prophylaxis. It might be justified to screen these high-risk groups to detect subclinical DVT to allow for post discharge prophylaxis.

Patient and healthcare practitioner evaluation of patient-reported outcomes in bariatric surgery - a modified Delphi study.

Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important. A modified Delphi survey was distributed to patients pre- and post-surgery, and to a variety of healthcare practitioners involved in bariatric care. Across two rounds, participants were asked to rate a variety of physical and psychosocial outcomes of bariatric surgery from 0 (Not Important) to 10 (Extremely Important). Outcomes rated 8-10 by at least 70% of participants were considered highly important (prioritised). The highest-rated outcomes were compared between the three groups as well as between medical and allied health practitioner subgroups. 20 pre-surgical patients, 95 post-surgical patients, and 28 healthcare practitioners completed both rounds of the questionnaire. There were 58 outcomes prioritised, with 21 outcomes (out of 90, 23.3%) prioritised by all three groups, 13 (14.4%) by two groups, and 24 (26.7%) prioritised by a single group or subgroup. Unanimously prioritised outcomes included 'Co-morbidities', 'General Physical Health', 'Overall Quality of Life' and 'Overall Mental Health'. Discordant outcomes included 'Fear of Weight Regain', 'Suicidal Thoughts', 'Addictive Behaviours', and 'Experience of Stigma or Discrimination'. While there was considerable agreement between stakeholder groups on many outcomes, there remain several outcomes with discordant importance valuations that must be considered. In particular, healthcare practitioners prioritised 20 outcomes that were not prioritised by patients, emphasising the range of priorities across stakeholder groups. Future work will consider these priorities to ensure resulting measures encompass all important outcomes and are beneficial and valid for end users.

Efficacy and safety of central parenteral nutrition with A 1:1 ratio of a N-3/N-6 polyunsaturated fatty acid in postsurgical patients with gastric cancer: A randomized controlled trial

Efficacy and safety of central parenteral nutrition with A 1:1 ratio of a N-3/N-6 polyunsaturated fatty acid in postsurgical patients with gastric cancer: A randomized controlled trial

Bridging the pain gap after cancer surgery - Evaluating the feasibility of transitional pain service to prevent persistent postsurgical pain - A systematic review and meta-analysis.

The lack of a dedicated pain service catering to the postsurgical period has resulted in the origination of the pain-period gap. This has led to a resurgence of transitional pain service (TPS). Our objective was to evaluate the feasibility of TPS in pain practice among postsurgical cancer patients and its prevention of persistent postsurgical pain (PPSP), culminating in chronic pain catastrophising. The protocol for this meta-analysis was registered in the International Prospective Register of Systematic Reviews (ID: CRD42023407190). This systematic review included articles involving all adult cancer patients undergoing cancer-related surgery experiencing pain, involving pharmacological, non-pharmacological and interventional pain modalities after an initial systematic pain assessment by pain care providers across diverse clinical specialities, targeting multimodal integrative pain management. Meta-analysis with meta-regression was conducted to analyse the feasibility of TPS with individual subgroup analysis and its relation to pain-related patient outcomes. Three hundred seventy-four articles were evaluated, of which 14 manuscripts were included in the meta-analysis. The lack of randomised controlled trials evaluating the efficacy of TPS in preventing PPSP and pain catastrophising led to the analysis of its feasibility by meta-regression. The estimate among study variances τ2 was determined and carried out along with multivariate subgroup analysis. A regression coefficient was attained to establish the correlation between the feasibility of TPS and its patient outcome measures and opioid-sparing. TPS interventions carried out by multidisciplinary teams incorporating bio-physical-psychological pain interventions have resulted in its successful implementation with improved pain-related patient outcomes mitigating the occurrence of PPSP.

Comparative efficacy of doxycycline and its analogues with autologous blood patch pleurodesis for persistent air leak following secondary spontaneous pneumothorax in adults-a systematic review.

The presence of free air in the pleural space of lungs is termed pneumothorax and in individuals with underlying lung disease, it is known as secondary spontaneous pneumothorax. The incidence of spontaneous pneumothorax is 16 to 18 per lakh population. The most common causes for secondary spontaneous pneumothorax are chronic obstructive pulmonary disease (COPD), tuberculosis (TB), human immunodeficiency virus (HIV), cystic fibrosis of lung, and history of smoking. The clinical signs and symptoms include acute dyspnea, thoracic pain and cough. Persistent air leaks are frequently seen in secondary spontaneous pneumothorax. The incidence of persistent air leaks in post-surgical patients varies from 8% to 43%. The aim of the study is to compare the efficacy of doxycycline, tetracycline, and minocycline to other pleurodesis agents in the cessation of air leaks and reducing the recurrence of pneumothorax in adults with persistent air leaks following secondary spontaneous pneumothorax. A systematic search from PubMed, Cochrane, Embase, Web of Science, and clinical trials.gov was performed. After screening, three studies were selected which includes 2 randomized controlled trials (RCTs) and 1 prospective study with a pooled sample size of 168. The mean age and standard deviation of the study participants was 50.57±13.23 years. The success rate of autologous blood patch pleurodesis (ABPP) was reported as 94.70% followed by doxycycline with 84.20%, talc with 84% and tetracycline 63%. The mean time of cessation of air leaks was lowest with doxycycline (11 and 36 hours) and ABPP (24 and 27 hours). Furthermore, ABPP is reported having fewer complications when compared with other agents. Among chemical pleurodesis agents, doxycycline is reported to be having higher success rate and less recurrences. However, it is found to be inferior when compared directly to ABPP.

Fasting in critical illness: the role of ketonuria — a retrospective observational study

BackgroundMetabolic acidosis is a frequent finding in patients admitted to the intensive care unit (ICU). It can be caused by prolonged fasting due to surgical procedures or by medical conditions that lead to starvation ketoacidosis (SKA). Early recognition and treatment of SKA could prevent several life-threatening complications, improving survival and reducing the ICU length of stay.MethodsWe retrospectively screened all medical records of patients admitted to the ICU (Maggiore Hospital, Bologna, North Italy) from May 2022 to April 2023. We included patients aged 18 years or older who presented ketonuria detected in the urine sample.ResultsWe analyzed 190 patients with ketonuria at ICU admission. Postsurgical patients showed lower levels of albumin and a higher rate of shock compared to medical patients. Ketonuric patients with shock had a lower body mass index (BMI) compared to patients without shock (24 versus 26 kg/m2, respectively). There were no differences within groups regarding mortality and ICU readmission rate. Medical patients had a significantly higher ICU length of stay.ConclusionsThis retrospective observational descriptive study showed that patients with ketonuria, hypoalbuminemia, and low BMI at ICU admission have high risk of hemodynamic instability and shock. Surgical patients compared to medical patients are exposed to a catabolic trigger that could worsen a state of malnutrition and induce anabolic resistance; elective and urgent surgical patients did not differ in terms of risk of shock and mortality, probably due to the activation of this catabolic pathway. Early recognition and treatment of starvation ketoacidosis and perioperative nutritional optimization could reduce incidence of hemodynamic and metabolic complications.

A - 30 Chiari Malformation Type I: the Powerful Impact of Participation in Computerized Working Memory Training on Mood and Self-Perception

Abstract Objective Chiari Malformation type I (CM-I), a disorder characterized by displaced cerebellar tonsils through the foramen magnum, is neuropsychologically complex and underrecognized. While decompressive neurosurgical intervention relieves physiological symptoms, cognitive and neuropsychiatric challenges may persist. Given the importance of attentional abilities and emotional functioning for post-operative quality of life for CM-I patients, exploring the effects of CogMed Computerized Working Memory Training (CCWMT) on aforementioned elements, specifically self-perception, is essential to the neurological surgery survivorship mission. Method Three CM-I patients diagnosed in adulthood were enrolled in CCWMT approximately three years post-operatively; each with self-reported decrements in attentional functioning following neurosurgical intervention with neurocognitive measures within normal limits and moderate levels of self-reported mood dysfunction and decline in self-perceived pre-surgical functional status. Comprehensive neuropsychological testing was completed pre and post CCWMT treatment, consisting of 25 sessions of progressively challenging working memory exercises completed within 5–12 weeks. Results There were no significant decrements in objective attentional-based measures pre-CCWMT treatment relative to baseline estimates and no significant changes pre to post CCWMT treatment. However, there were clinically significant decreases in self-reported depression. Further, post-treatment improvement in self-perception of functioning aligned with degree of improvement index within the CCWMT program. Conclusions Given the positive prognosis of post-surgical CM-I patients, clinical neuropsychological investigation can maximize a patient’s quality of life by extrapolating cognitive and emotional elements that interact as barriers to optimal outcomes. This case series underscores that effortful participation in intensive cognitive remediation may enhance mood and self-perception beyond objective cognitive enhancement, thereby supporting holistic aspects of a patient’s recovery.

Assessing adequacy of surgical extent in CRSwNP: The Completion of Surgery Index.

Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments. A Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre- and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality-of-life improvements. The CoSI assesses surgical extent on a scale of 0-100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT-22 scores improved at 6months postoperatively, with durable and consistent improvement at 24months (p<0.001). Preoperative CoSI scores in revision surgery patients were 49.4±26.0, improving to 91.0±8.1 postoperatively. SNOT-22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p=0.029). It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention.

Oral Protein Supplements Might Improve Nutritional Status and Quality of Life in Elderly Patients after Standard Pancreatic Resection.

Elderly patients who undergo pancreaticoduodenectomy (PPPD) or distal pancreatectomy (DP) experience not only a reduction in protein intake but also a decrease in protease secretion, leading to impaired protein digestion and absorption. This increases the risk of malnutrition and creates a dual burden of sarcopenia. This randomized, double-blind, placebo-controlled trial examined the impact of protein supplements on the nutritional status and quality of life (QoL) of elderly patients after PPPD and DP surgeries. For six weeks, the case group (CG; n = 23) consumed protein supplements containing 18 g of protein daily, while the placebo group (PG; n = 18) consumed a placebo with the same amount of carbohydrate. In elderly patients where protein digestion and intake were compromised, the CG showed significantly higher protein intake (77.3 ± 5.3 g vs. 56.7 ± 6.0 g, p = 0.049), improved QoL, better nutritional status, and faster walking speed compared to the PG. Protein intake was positively correlated with muscle mass and phase angle. Protein supplementation may not only increase protein intake but also improve clinical outcomes such as walking speed, nutritional status, and QoL in elderly post-surgical patients at high risk of sarcopenia. Further studies are needed to determine the optimal dosage and long-term effects.