Preoperative Group Research Articles

The association between preoperative lacunar infarcts and postoperative delirium in elderly patients undergoing major abdominal surgery: a prospective cohort study.

The primary goal was to investigate whether the presence of preoperative lacunar infarcts (LACI) was associated with postoperative delirium (POD) in elderly patients undergoing elective major abdominal surgery. A prospective cohort study. Patients aged ≥ 65years from a tertiary level A hospital in China. The POD was assessed once daily within the first postoperative 3days using the Confusion Assessment Method. Neurocognitive tests using the Mini-mental State Examination (MMSE) and the Beijing version of the Montreal Cognitive Assessment scales were carried out within 3days before surgery and 4-7days after surgery. Regional cerebral oxygen saturation (rScO2) was recorded in the operating room. Logistic regression analysis was used to evaluate the impact of preoperative LACI on POD and to explore the risk factors for POD. A total of 369 participants were analyzed, 161 in the preoperative LACI-positive group (P group), and 208 in the preoperative LACI-negative group (N group), respectively. The incidence of POD was 32.7% in our study. The incidence of POD was significantly higher in the P group than in the N group (39.1 vs 27.9%, risk ratio, 1.66; 95% CI 1.07-2.58; P = 0.022). Furthermore, the P group exhibited lower mean rScO2 values during the procedure (P < 0.001). In exploratory analysis, the advanced age (P = 0.005), sex (P = 0.038), and lower preoperative MMSE score (P = 0.019) were independent risk factors for POD in patients undergoing major abdominal surgery. Preoperative LACI was common, and constituted a risk factor for POD in older patients undergoing abdominal surgery. Despite the frequent subclinical nature, the preoperative LACI led to lower mean rScO2 during the procedure. These findings could help early identification of high-risk POD patients.

Protocol for a multicentre, prospective, open-label, randomised controlled trial to compare PROs and safety outcomes between preoperative and postmastectomy radiotherapy in locally advanced breast cancer patients with immediate reconstruction via a deep inferior epigastric perforator flap (CAPPELLA) in China

IntroductionDespite its therapeutic advantages, postmastectomy radiotherapy (PMRT) increases the risk of complications and often leads to poor cosmesis in women undergoing breast reconstruction. Preoperative radiotherapy followed by skin-sparing mastectomy and...

Analysis of Dynamic Mandibular Movement of Patients With Condylar Hyperplasia Treated With Orthognathic Surgery and Condylectomy.

To assess the dynamic mandibular movement of patients with condylar hyperplasia before and after simultaneous orthognathic surgery and condylectomy through an intraoral approach. Two groups of patients diagnosed with unilateral condylar hyperplasia were studied: the preoperative group consisted of 23 patients and the postoperative group consisted of 13 patients who had undergone simultaneous orthognathic surgery and condylectomy through an intraoral approach with follow-up for more than 1 year. The normal reference value was obtained from 11 individuals without oral and maxillofacial diseases. Three-dimensional mandibular movement trajectories and electromyography of masticatory muscles were recorded. Patients showed no limitation in mandibular border movement before surgery, but the average amplitude of electromyography of the lower head of lateral pterygoid muscle on the affected side was lower than normal reference value. After condylectomy, the maximum mouth opening decreased [32.00 (26.55, 36.20) mm], mandibular movement deviated to the affected side, and the maximum distance in protrusive movement of the mandibular incisal point and the movement to the normal side were both significantly lowered. Amplitude of electromyography of the lateral pterygoid muscle on the normal side increased in the postoperative group compared with the preoperative group. Patients with condylar hyperplasia had a restriction in protrusive and to the normal side movement, and mandibular movement deflected to the affected side after condylectomy, which indicates the necessity of postoperative individualized rehabilitation training.

Metabolomic Analysis of Patients With Patent Foramen Ovale and Migraine Using Liquid Chromatography-Mass Spectrometry Technology.

This study aims to examine the changes in metabolic profiles in patients with patent foramen ovale (PFO) and migraine, as well as in patients with isolated migraine, before and after surgical intervention using metabolomics. Patients were categorized into four groups: the simple migraine (SM) group, the PFO with migraine preoperative group (PRE), the PFO with migraine postoperative Day 3 group (POST_3d), and the PFO with migraine postoperative Day 30 group (POST_30d). Untargeted metabolomics using liquid chromatography-mass spectrometry (LC-MS) were employed to identify differential metabolites across these groups. Differential metabolites were identified, their clinical diagnostic value was assessed, and a correlation analysis was conducted to examine changes in metabolic pathways before and after surgery. The expression levels of metabolites such as linoleic acid, quinolinic acid, homophenylalanine, and amphetamine showed significant changes in patients with PFO and migraine following surgery. Notably, linoleic acid demonstrated strong diagnostic potential for this patient population. Trend analysis revealed that the levels of 3-phenylpropionic acid and caffeine decreased on postoperative Day 3 and subsequently increased by postoperative Day 30, whereas gallic acid continuously declined. Compared to the PRE group, differential metabolites in the SM group were primarily associated with α-linolenic acid metabolism, niacin and nicotinamide metabolism, sphingolipid signaling, and tyrosine metabolism. In contrast, differential metabolites in the POST_3d group were predominantly enriched in phenylalanine metabolism, niacin and nicotinamide metabolism, protein digestion and absorption, and caffeine metabolism. Linoleic acid may serve as a potential biomarker, and the activation of inflammation and oxidative stress-related pathways could contribute significantly to the development of complicated migraine in patients with PFO.

PREOPERATIVE HOSPITALIZATION AS A BRIDGING STRATEGY FOR WEIGHT LOSS IN PATIENTS WITH BODY MASS INDEX = 50 KG/M2 WHO ARE CANDIDATES FOR BARIATRIC SURGERY.

Preoperative hospitalization with the purpose to obtain more effective weight loss provides intensive care for patients who have a higher body mass index (BMI) and associated diseases that involve a greater risk of peri- and postoperative complications. It is a therapeutic strategy that can make it possible to overcome obstacles related to the difficulty of adhering to obesity treatment. To analyze the implementation of a preoperative hospitalization strategy for weight loss in patients eligible for bariatric surgery. Retrospective study that included 194 patients with a BMI=50 kg/m2. They were grouped according to preoperative preparation strategies: inpatient (n=32) and outpatient (n=162), who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2020. The groups were compared regarding preoperative weight loss before and after the strategies and postoperative up to two years after surgery. Most patients were female and there were significant differences in age group (an average of 42.94 years in the preoperative hospitalization strategy group and 37.73 in the outpatient strategy group). The mean BMI in the hospitalized group was 63.01±8.72 kg/m2, and in the outpatient group it was 54.95±4.31 kg/m2. There was a significant difference only between initial and preoperative weight in the hospitalized group. Furthermore, the difference between initial weight and last recorded weight up to two years after surgery was significant in each group. The occurrence of associated diseases was higher in the outpatient group. Patients following the preoperative hospitalization strategy experienced significant weight loss before surgery.

Preoperative versus postoperative radiotherapy for localized soft tissue sarcoma treated with curative intent in a French tertiary center “SARCLOC”

BackgroundSoft tissue sarcomas of the extremities (E-STS) are rare and heterogeneous. Treatment combines surgery with preoperative or postoperative radiotherapy (RT) for deep, large, or high-grade tumors. We evaluate the effectiveness and toxicity in E-STS patients treated at our institution from 2015 to 2021.Materials and methodsThis retrospective, single-center study, compared clinical and therapeutic characteristics, toxicities, and surgical complications by radiotherapy type. Local recurrence-free survival (LRFS), overall survival (OS), and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method.ResultsWe included 158 patients; 124 (78%) received preoperative RT. The two groups (preoperative RT vs. postoperative RT) differed significantly in terms of median tumor size (111 vs. 67.5 mm, p < 0.01), perivascular involvement (51% vs. 29%, p = 0.03), and bone contact (32% vs. 12%, p = 0.02), but not in grade (grade 2 or 3: 65% vs. 74%, p = 0.72). Median follow-up was 2.9 vs. 5.1 years. Two-year LRFS was 82% [95%CI: 74–88] for both groups; OS was 87% [95%CI: 80–92] vs. 88% [95%CI: 71–95]; and RFS was 72% [95%CI: 63–79] vs. 70% [95%CI: 52–83]. Postoperative complications were 53% vs. 35%, with wound disruption at 39% vs. 15% and infections at 29% vs. 6%. Grade 2 or higher dermatitis was 16% vs. 29%, and RT discontinuation rates were 4% vs. 12% for the two groups, respectively.ConclusionDespite poorer prognostic factors in the preoperative RT group, LRFS and OS were comparable to those in the postoperative RT group. Postoperative complications were more frequent with preoperative RT, and treatment discontinuation was more common postoperatively.

Routine preoperative blood group and save is unnecessary for adult emergency appendicectomies: A retrospective multicentre study.

Routine group and save (G&S) is commonly performed before appendicectomy despite limited evidence. This study aims to evaluate the necessity of preoperative G&S by determining perioperative blood transfusion rates. A multicentre retrospective observational study of adult patients who had emergency appendicectomy across four hospitals between August 2018 and November 2020. Data analysed included demographics, operative details, G&S, crossmatching and perioperative blood transfusion. 1105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26-52). 1012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) normal. 921 (83.3%) patients had preoperative G&S. 42 (3.8%) patients also had crossmatch. No patients required blood transfusion in 30 days post appendicectomy. The cost of G&S is estimated to be £40,164 in this cohort. The need for perioperative blood transfusion is rare in patients undergoing appendicectomy. It has a significant cost impact and can cause unnecessary delays. Our study suggests that a routine G&S policy is not necessary, and we suggest a more 'selective' G&S policy.

Efficacy of Preoperative Pericapsular Nerve Group Block in Patients with Hip Fracture and its Effect on the Success of Spinal Anaesthesia: A Retrospective Study.

We intended to research the efficacy of pericapsular nerve group (PENG) block performed with preoperative ultrasonography (USG) in patients who underwent hip fracture repair under spinal anaesthesia and whether it affects the success of spinal anaesthesia. The files of 100 patients were analysed, and 60 patients were enrolled in the study. The patients were assigned into two groups: Group P (n = 30) consisted of patients who underwent USG-guided PENG block before the start of surgery and the control group (Group C; n = 30) consisted of patients in whom tramadol infusion was initiated. All patients received 10 mg IV bolus tramadol as rescue analgesia when numeric rating scale (NRS)>3. From the files of the patients, before PENG block application, after PENG block application, during positioning before spinal anaesthesia, the NRS values at the time of the patient's discharge from the operating room and at 2nd, 4th, 12th and 24th hour NRS values, spinal anaesthesia duration and number of attempts, and perioperative total tramadol consumption were obtained. In group P, NRS values were found to be significantly lower after PENG block application, during positioning before spinal anaesthesia, and at the postoperative discharge, 2nd, 4th, 12th and 24th hours. In addition, group P had a lower duration of spinal anaesthesia, a lower number of spinal anaesthesia attempts and a lower total perioperative tramadol consumption. The results demonstrated that preoperative PENG block facilitated positioning for spinal anaesthesia, shortened the application time, increased the first-attempt success rate, decreased pain scores, and reduced the need for postoperative opioids.

Improvement of smile characteristics in dentofacial deformity patients following orthognathic surgery.

The purpose of this study was to investigate the effect of bimaxillary surgery on smile characteristics, including smile line, smile arc, smile index (SI), most posterior teeth displayed(MPTD), buccal corridor ratio (BCR), and smile symmetry. The study consisted of 87 patients with dentofacial deformity: Class II (30 patients), Class III (37 patients), and asymmetry (20 patients). Pearson's chi-squared test and ANOVA were used to analyze the differences in smile characteristics across the preoperative groups. Pearson's chi-square test and the paired-sample t-test were utilized to determine the differences in smile characteristics between the preoperative and postoperative periods. The results showed significant differences in lip thickness ratio (p=0.021∗), smile line (p=0.003∗∗), smile arc (p=0.000∗∗), MPTD (p=0.015∗), and BCR (p=0.000∗∗) among the preoperative groups. After orthognathic surgery, in the Class II group there was an increase in the proportion of smile line that transformed from high to average and low (p=0.001∗∗), an increase in the percentage of upper lip curvature that changed from downward to upward and straight (p=0.011∗), and an increase in both postoperative SI and BCR (p=0.007∗∗ and p=0.002∗∗, respectively), while MPTD decreased (p=0.031∗). For Class III, the postoperative change in upper lip curvature tended to be more upward and straight (p=0.002∗∗), the smile arc became more parallel and straight (p=0.000∗∗), postoperative SI and MPTD increased (p=0.000∗∗), while BCR decreased (p=0.000∗). Regarding asymmetry, both MPTD and BCS showed symmetry postoperatively (p=0.038, p=0.000∗∗). The findings of this study indicate that orthognathic surgery could enhance some smile characteristics.

Changes in the Structure, Function, and Fat Content of the Heart in Patients with Obesity After Bariatric Surgery-A Prospective Magnetic Resonance Imaging Study.

Changes in myocardial fat in addition to changes in cardiac structure and function have not been accurately evaluated in obese patients following surgery. Forty-four obese patients who underwent sleeve gastrectomy and completed preoperative and postoperative cardiac magnetic resonance imaging (CMR) before surgery and at 1, 3, and 6 months after surgery were enrolled, and their clinical and laboratory data were collected. The differences and correlations between clinical, laboratory, and CMR parameters between the preoperative and postoperative groups were analysed. The left ventricular mass (LVM), left ventricle cardiac output (LVCO), pericardial adipose tissue volume (PATV), and myocardial proton density fat fraction (M-PDFF) decreased after surgery (all P < 0.05). The left ventricle global longitudinal strain increased at 6 months after surgery (P = 0.004). A decrease in BMI was positively correlated with the LVCO (r = 0.58, P < 0.001) at 3months after surgery and was positively correlated with the LVM and PATV (r = 0.54, P < 0.05) at 6months after surgery. Six months after surgery, the changes in PATV were positively correlated with the changes in triglycerides (r = 0.61, P < 0.01). There was a moderately positive correlation between the decrease in the LVM and PATV (r = 0.54 ~ 0.71, P < 0.02) after surgery. After surgery, the cardiac structure and function of obese patients significantly improved, the PATV and M-PDFF decreased, and there was a correlation between the structure and function of the heart and several clinical and laboratory indicators.

Association between preoperative antifungal therapy and postoperative complications in patients with pulmonary aspergilloma: A national database study in Japan.

Postoperative complications of pulmonary resection in patients with pulmonary aspergilloma are common. Preoperative antifungal therapy is a perioperative management strategy to reduce postoperative complications; however, the benefit of the treatment remains controversial. A retrospective cohort study was conducted using data from the Diagnosis Procedure Combination database (July 2010-March 2021), a national inpatient database in Japan. Patients with pulmonary aspergilloma with or without chronic necrotizing pulmonary aspergillosis who underwent pulmonary resection were identified and divided into two groups based on whether they received preoperative antifungal therapy. Propensity-score overlap weighting was performed to compare the occurrence of composite postoperative complications and postoperative length of hospital stay between the two groups. We identified 98 patients with pulmonary aspergilloma who received preoperative antifungal therapy and 399 patients who did not. After propensity-score overlap weighting, the preoperative antifungal therapy group had a significantly lower proportion of composite postoperative complications than the non-preoperative antifungal therapy group (6.8% vs. 14.2%, P=.038). There was no significant difference in postoperative length of stay between the groups with and without preoperative antifungal therapy (median 14.6 vs. 15.8 days, P=.41). Preoperative antifungal therapy was associated with a reduction in postoperative complications in patients with pulmonary aspergilloma. Preoperative treatment with antifungals may be beneficial in reducing the risk of postoperative complications in patients with pulmonary aspergilloma undergoing pulmonary resection.

Circulating Tumor cells and multiple indicators combined to identify the risk of poorer prognosis in patients with resected non-small cell lung cancer

BackgroundSurgical resection is an important treatment option for patients with non-small cell lung cancer (NSCLC). However, recurrence and survival rates remain a cause of concern. To further improve prognosis, more studies have focused on liquid biopsy, which has significant value as a prognostic factor for defining the risk stratification of postoperative NSCLC patients. This study aimed to identify circulating tumor cells (CTCs) as biomarkers that indicate a poor prognosis, combined with multiple indicators to determine prognostic risks in advance and develop individualized treatment strategies.MethodsBetween November 2015 and August 2018, 65 radical resected patients with NSCLC were analyzed. Preoperative CTCs were collected, and follow-up lasted until August 2023. Overall survival (OS) and disease-free survival (DFS) were the primary outcomes.ResultsWith an 11 CTC unit threshold, the high preoperative CTC level group had worse OS and DFS than the low-level group, suggesting that preoperative CTC levels have prognostic value. Time-dependent receiver operating characteristic (ROC) curves also showed satisfactory predictive efficiency of CTCs. Univariate analysis revealed that preoperative CTC levels were significantly associated with increasing risks for OS and DFS. Moreover, we combined CTCs and multiple indicators to provide a reference for a group at high risk of adverse outcomes.ConclusionsCTCs serve as feasible biomarkers for predicting postoperative prognosis in NSCLC patients. The combination of hematological, radiological, and pathological features could be valuable tools to guide postoperative management and treatment decisions in these patients. A multimodal prognostic approach is important for the clinical evaluation of lung cancer.

Effect of scalp nerve block on postcraniotomy analgesia in children: a randomized, controlled trial

ObjectiveEffective postoperative pain management is critical for pediatric craniotomies. Scalp nerve block (SNB) interventions present a potential solution, yet their comparative benefits in preoperative and postoperative settings remain unclear. This study investigated the analgesic effects of SNB in pediatric craniotomy patients by comparing preoperative versus postoperative administration.MethodsThis randomized trial included 180 children (1–12 years) who underwent elective craniotomy and were assigned to the preoperative, postoperative, or nonblocking control group. The outcomes included cumulative sufentanil use, pain scores (1, 2, 4, 24, 48 h postoperation), rescue medicine utilization, postoperative complications (24, 48 h), and hospitalization length. The primary outcome was total sufentanil use within 24 h postsurgery.ResultsTotal sufentanil use (µg·kg− 1) in the postoperative block group was significantly lower than that in the nonblocking control group at 1 h (P < 0.001, 95% CI [-0.024 to -0.006]), 2 h (P < 0.001, 95% CI [-0.054 to -0.020]), 4 h (P < 0.001, 95% CI [-0.089 to -0.032]), 24 h (P < 0.001, 95% CI [-0.192 to -0.047]), and 48 h (P = 0.010, 95% CI [-0.208 to -0.022]) postoperation. Additionally, sufentanil use in the preoperative block group was significantly lower than that in the nonblocking control group at 1 h (P = 0.004, 95% CI [-0.021 to -0.003]), 2 h (P < 0.001, 95% CI [-0.043 to -0.010]), and 4 h (P = 0.002, 95% CI [-0.069 to -0.013]). Within 24 h postoperation, the use of sufentanil in the postoperative block group was significantly lower than that in the preoperative block group (P = 0.014, 95% CI [-0.157 to -0.013]).ConclusionCompared with preoperative SNB or nonblocking, postoperative SNB significantly reduces postoperative sufentanil use within 24 h for pediatric patients undergoing craniotomy, highlighting its potential as an effective analgesic intervention in this population.Trial registrationThe trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800017386) on 27/07/2018, under the title “A study of scalp nerve block for neurosurgical analgesia in children with craniotomy.”

A multivariate and retrospective analysis of the impact of intra-aortic balloon counterpulsation in Open-Heart surgery

Background The use of intraaortic balloon pump (IABP) effectively reduces left ventricular afterload and significantly increases coronary perfusion pressure by raising aortic diastolic pressure. This study examined the short and medium-term outcomes of 22,540 adult cardiac surgical patients requiring an IABP. Methods From 2009 to 2018, 1114 patients (4.94%) undergoing open-heart surgery at a single tertiary cardiac hospital received IABP support and were included in this retrospective study. They were categorized into pre-operative (Group A, n = 577), intra-operative (Group B, n = 475), and post-operative (Group C, n = 62) IABP insertion groups. Results Cardiogenic shock occurred in 11.2% of cases, mainly in Group A. Hemodynamic instability (38.8%) drove IABP use in Groups A and C, while difficulty weaning from CPB was the primary reason in Group C. The overall operative mortality rate was 10.9%, highest at 25.8% postoperatively. Multivariate analysis identified significant predictors of mortality: age (OR: 1.067, 95% CI: 1.041–1.094, p < 0.001), higher BMI (OR: 1.071, 95% CI: 1.017–1.128, p = 0.009), pulmonary hypertension (OR: 2.085, 95% CI: 1.302–3.341, p = 0.002), renal disease (OR: 2.780, 95% CI: 1.556–4.967, p < 0.001), and cardiogenic shock (OR: 3.684, 95% CI: 2.066–6.569, p < 0.001). Complications were more common in Group C, especially with renal disease. Average preoperative and postoperative stays were 4.0 ± 4.8 days and 15.2 ± 20.4 days, respectively, with no significant differences between groups. Conclusion IABP might offer safety for open-heart surgery, with longer hospital stays potentially associated with high-risk patients. Pre-operative IABP prophylaxis could be crucial in high-risk open-heart cases to reduce mortality.Clinical registration number: NHG DSRB Ref No# 2016/01070 and 2019/00397.

Do we need group and save for trans-urethral resection of bladder tumour and trans-urethral resection of the prostate procedures?

Background: Trans-urethral resection of the prostate (TURP) and trans-urethral resection of bladder tumour (TURBT) are urological procedures essential for treating benign prostatic hyperplasia (BPH) and non-muscle invasive bladder cancer, respectively, these procedures may result in post-operative bleeding. In our hospital, pre-operative blood group and save is a routine to enhance patient safety. This study aims to evaluate transfusion rates and the potential cost benefits of limiting routine blood group and save. Methods: We conducted a retrospective audit of patients undergoing TURP and TURBT between October 2018 and October 2020. Data was collected using theatre system records and blood bank information regarding transfusions. Results: Out of 233 patients (average age 74), 141 underwent TURBT, 89 underwent TURP, and 3 underwent both simultaneously. Historical group and save were found in 214 (91.84%) patients, and 162 (69.5%) had same-day group and save. Only 2 patients (0.85%) necessitated transfusions. Conclusions: The necessity for blood transfusion after TURP and TURBT is low, indicating that routine pre-operative group and save may not be essential for all patients. Tailoring this practice to high-risk individuals may reduce costs and relieve workloads. Enhanced surgical techniques and tools are likely contributors to these improved outcomes.

In vivo shoulder kinematic changes and rotator cuff healing after surgical repair of large-to-massive rotator cuff tears

BackgroundFew studies have investigated the correlation between shoulder kinematics and clinical outcomes in patients undergoing rotator cuff repair using dynamic analysis. This study assessed shoulder kinematics before and after surgical repair in patients with rotator cuff tears (RCTs) and determined the relationship among shoulder kinematics and between shoulder kinematics and clinical outcomes.MethodsTen patients with large-to-massive RCTs and 10 control participants were included. In vivo shoulder kinematics during scapular plane abduction were measured preoperatively and 1 year postoperatively using validated image-registration techniques and compared among the control, preoperative, and postoperative groups. Mixed models were used to compare the effects of the groups on shoulder kinematics, followed by Tukey’s honest significant difference test. Pearson’s correlation coefficient was used to identify the correlations among shoulder kinematics and between each kinematic and clinical outcome.ResultsThe scapula, tilted more anteriorly preoperatively, was not different from the control group postoperatively. Additionally, the change in scapular posterior tilt (PT) throughout dynamic abduction was 18.17° ± 3.59° in the postoperative group, greater than that in the control group (11.54° ± 2.29°; p = 0.0037). The postoperative change in PT significantly correlated with acromiohumeral distance (AHD) and rotator cuff integrity (Sugaya classification) (AHD: r = 0.71, p = 0.023; Sugaya classification: r = − 0.75, p = 0.013), but not preoperative change in PT. Functional score improved from preoperative to postoperative (p < 0.0001). Abduction angle and functional score significantly correlated with Sugaya classification (abduction angle: r = − 0.67, p = 0.034; functional score: r = − 0.70, p = 0.025) but not with shoulder kinematics. Mean superior translation of the humeral head and AHD throughout abduction changed from 1.77 ± 1.34 to 0.61 ± 1.37 and 1.44 ± 1.59 to 2.71 ± 2.27 mm, respectively, from preoperative to postoperative (both p < 0.0001).ConclusionsAfter the surgical repair of large-to-massive RCTs, glenohumeral stability normalized, and the more anteriorly tilted orientation of the scapula improved. Additionally, the preoperative increased scapular motion throughout dynamic abduction was further enhanced postoperatively. Interestingly, in postoperative patients, scapular motion toward PT during dynamic abduction correlated with minimum AHD and cuff healing.

Achieving Better Clinical Outcomes After Total Knee Arthroplasty in Knees with Valgus Deformity: The Role of Alignment Strategies.

Personalized alignment in total knee arthroplasty (TKA) has demonstrated good functional outcomes for knees with varus alignment. However, limited research has explicitly addressed optimal alignment strategies for valgus knees. The aims of the current study were to assess the impact of the postoperative knee alignment and of the degree of correction of knee alignment on functional outcomes and satisfaction in a population with preoperative valgus and to evaluate the complication and revision rates based on postoperative alignment. This retrospective study included primary posterior-stabilized TKA with a preoperative hip-knee-ankle (HKA) angle of ≥180°, with a minimum follow-up of 32 months. There were 460 knees included, divided into 3 groups: (1) preoperative neutral alignment (180° to 183°) (n = 162), (2) preoperative mild valgus (184° to 190°) (n = 204), and (3) preoperative severe valgus (>190°) (n = 94). A standardized surgical technique was employed with a goal of achieving neutral postoperative alignment. Data on radiographs, Knee Society Scores (KSS), range of motion, satisfaction, complications, and revisions were collected at the last follow-up. The mean follow-up was 74.3 ± 12.4 months. In the preoperative mild valgus group, 10.8% of patients had postoperative varus, 81.4% had postoperative neutral alignment, and 7.8% had postoperative valgus. In the preoperative severe valgus group, 4.3% had postoperative varus, 83.0% had postoperative neutral alignment, and 12.8% had postoperative valgus. In the preoperative mild valgus group, patients with postoperative neutral alignment had significantly higher satisfaction (p = 0.0004) and KSS function score (p = 0.031) than patients with postoperative valgus alignment. In the preoperative severe valgus group, patients with postoperative valgus alignment had significantly higher satisfaction (p = 0.035) and greater improvement of the KSS knee score (p = 0.014) than patients with postoperative neutral alignment. Functional outcomes were not impacted by the degree of HKA angle correction. There were significantly fewer complications (p = 0.022) and revisions (p = 0.007) in the preoperative mild valgus group when patients had a postoperative neutral alignment compared with a postoperative valgus alignment. For preoperative mild valgus, correction to neutral alignment achieved better outcomes and fewer complications than leaving residual valgus. For preoperative severe valgus, retaining residual valgus postoperatively ensured satisfactory functional outcomes without increased complications. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preoperative ultrasound-guided injection of nanocarbon for central lymph node dissection in patients with papillary thyroid carcinoma

To explore better methods for tracing central lymph nodes in patients with papillary thyroid carcinoma by comparing the differences in the numbers and staining rates of central lymph nodes as well as the degree of nanocarbon extravasation between the preoperative ultrasound-guided injection of nanocarbon particles and the intraoperative injection of nanocarbon particles. A total of 302 patients were randomly divided into a preoperative ultrasound-guided injection group and an intraoperative injection group. The number and degree of staining of the lymph nodes in each subgroup of central lymph nodes, including linea alba cervical lymph nodes, Delphian lymph nodes, and pretracheal and paratracheal lymph nodes, were recorded and analyzed. The extent of dye extravasation was reduced when nanocarbon was injected preoperatively. Significantly more linea alba cervical lymph nodes and pretracheal and paratracheal lymph nodes were detected in the preoperative injection group. Preoperative injection of nanocarbon can accelerate the staining and detection of central lymph nodes in patients with Hashimoto’s thyroiditis, clinically positive lymph nodes (cN1) and tumors with diameters > 1 cm. Preoperative ultrasound-guided injection of nanocarbon can reduce the likelihood of dye spillage and improve the staining rate as well as the detection rate of central lymph nodes.

A Randomized Study to Compare the Efficacy Between Intranasal and Intravenous Dexmedetomidine for the Removal of Foreign Bodies in the Esophagus at the Cricopharynx Level in Pediatric Patients.

Foreign body (coins, magnets, button batteries, and metallic foreign bodies) ingestion is common and causes significant morbidity and mortality in children aged six months to three years. Endoscopic removal of swallowed foreign substances is widely accepted, but sedation and general anesthesia may be required to alleviate pain and anxiety during the procedure. Dexmedetomidine is used as a sedative, hypnotic, anxiolytic, and analgesic. In this study, we aimed to investigate and compare the efficacy between the intranasal (IN) and intravenous (IV) routes for the administration of dexmedetomidineas an adjunct to propofol for the removal of foreign bodies in the esophagus at the cricopharynx level in pediatric patients. This prospective, double-blinded,randomized study was conducted on 80 patients of either sex andAmerican Society of Anaesthesiologists physical status(ASA PS) I and II aged one month to 12 years with a foreign body in the esophagus at thecricopharynx level undergoing endoscopic foreign body removal. Patients were randomly allocated into groups A and B, with 40 patients each. In the preoperative area group A, IN, 3 mcg/kg, was dripped equally in both nostrils (supine position). In Group B, IV, 3 mcg/kg, diluted in normal saline, was administered intravenously slowly over 10 minutes. The onset of sedation was assessed using the Ramsay Sedation Scale (RSS) every 10 minutes following dexmedetomidine administration, and when an RSS score of 3 or above was achieved, the patient was transferred to theoperation theater. In the operation room, patients were induced with injection propofol in a dose of 2 mg/kg or until the loss of verbal response.Parent separation scale scoring was used to evaluate the child's behavior on separation from parents as a tool to assess the anxiolytic property of dexmedetomidine. Perioperative pain using the Wong-Baker Faces pain rating scale, heart rate (HR), oxygen saturation (SpO2), ECG, and blood pressure (BP) were monitored before drug delivery till the end of theprocedure. Statistical analysis was done using SPSS version 24.0 (IBM Corp., Armonk, NY). The mean time (minutes) in shifting to operation theater (33.8 ± 5) was significantly higher in group A compared to group B (10.7 ± 2.1) (p = 0.001). The mean Ramsay Sedation Score was higher at 10 and 20 minutes in group B as compared to group A. Group B had significantly lower pain (2.2 ± 1.4) (p ≤ 0.001) at 10 minutes, while in group A, the pain score decreased slowly and took more time but remains lower (1.35 ± 0.94) for longer duration (120 minutes) in the postoperative period in comparison to Group B (1.94 ± 0.35) (p = 0.002). Group B had a sharp hemodynamic decrease, while group A had slow, persistent changes. IN administration of dexmedetomidine is a safer and more effective mode of sedation to remove a foreign body from the esophagus at the cricopharyngeal level in pediatric patients. It provides stable and sustained hemodynamic parameters and longer postoperative pain relief compared to IV dexmedetomidine.

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.