Preoperative Indicator Research Articles

The Association Between Preoperative Neutrophil-Lymphocyte Ratio and Febrile Urinary Tract Infection in Patients Treated by Percutaneous Nephrolithotomy.

This study aimed to assess the association between preoperative neutrophil-lymphocyte ratio (NLR) and febrile urinary tract infection (fUTI) in patients who underwent percutaneous nephrolithotomy (PCNL). The clinical data of patients who underwent PCNL at our hospital between March 2020 and May 2023 were retrospectively analyzed. According to whether fUTI occurs after operation, collected data were divided to the patients into fUTI and non-fUTI. Univariate analysis, relative operating characteristic (ROC) curves and multivariate logistic regression analysis were performed on the data. A total of 405 patients were enrolled in the study. The procedure was successfully performed in all patients, and the incidence of fUTI was 8.4% (34/405). Eight patients eventually developed sepsis, and the incidence of sepsis in fUTI patients was 23.5%. The result shows a significant correlation between NLR and fUTI (95% confidence interval [CI],1.21-1.83, Odds ratio [OR]=1.49, p<0.001). The predictive ability of NLR on the occurrence of fUTI was assessed by plotting relative operating characteristic (ROC) curves. The area under the curve (AUC) in the ROC curve for NLR was 0.718 according to the Youden index, and the best cut-off value of NLR was 2.71. Furthermore, logistic multiple regression model adjustment was carried out to further confirm the robustness of the relationship between NLR and fUTI. The results indicated robustness regardless of whether NLR was a continuous variable or a categorical variable. NLR can be used as a simple and effective preoperative indicator for the prediction of fUTI in patients undergoing PCNL.

Prognostic nutritional index predicts lateral lymph node metastasis and recurrence free survival in papillary thyroid carcinoma

BackgroundPreoperative hematological parameters are predictors of pathological features and recurrence-free survival (RFS) in various malignancies. However, comprehensive studies of preoperative indicators associated with papillary thyroid carcinoma (PTC) are scarce. The present study investigated the association between preoperative indicators and RFS in patients with PTC. Accordingly, we explored the clinical impact of the prognostic nutritional index (PNI) on lymph node metastasis and RFS in patients with PTC.MethodsA total of 619 PTC patients were retrospectively reviewed between Jan 2013 and Dec 2017. Laboratory values were measured and calculated. Receiver operating characteristic curves were generated to calculate the cutoff value. Univariate and multivariate analyses using the COX proportional hazard model were performed for RFS. The effects of PNI and age on RFS were investigated by the Kaplan-Meier method. Clinical characteristics and PNI were tested with the chi-square test. Univariate and multivariate logistic analyses were conducted to evaluate the predictive value of PNI for lymph node metastasis.ResultsIn the multivariate Cox analysis, age, PNI and lymph node metastasis were independent prognostic indicators for RFS. The Kaplan-Meier method showed that the lower PNI group and age older than 55 years group displayed poor RFS. A low preoperative PNI was remarkably correlated with age, sex, extrathyroidal invasion, T stage, N stage and TNM stage. PNI was the only preoperative hematological indicator for lateral lymph node metastasis.ConclusionsAmong the preoperative hematological indicators, PNI may serve as a promising and effective predictor for RFS and lateral lymph node metastasis in PTC patients.

A Morphological Study of Distal Femoral Varus Deformity.

Background In the management of medial compartment knee osteoarthritis via around-knee osteotomy (AKO) and total knee arthroplasty (TKA), evaluating the lateral distal femoral angle (LDFA) is crucial. This angle reflects the presence of distal femoral varus deformity. This study aims to explore the relationship between LDFA and lower extremity bone morphology and identify factors contributing to a high LDFA. Methods A retrospective analysis was conducted on 59 patients who underwent AKO or TKA at our hospital. Alignment of the lower extremity was assessed using X-rays, and bone morphology was investigated through computed tomography (CT) employing the ZedKnee® system(LEXI, Tokyo, Japan). Each measured parameter was analyzed. Results Our findings indicate a significant correlation between LDFA and several parameters, including age, femoral tibial angle (FTA), hip knee ankle angle (HKA), percentage of mechanical axis (% MA), femoral bowing angle, femoral tibial joint torsion, and the height of lateral and medial femoral condyles. A multiple-regression analysis determined that the most significant influences on LDFA were the heights of the femoral condyle, age, and HKA. Conclusion LDFA is significantly affected by the heights of the medial and lateral femoral condyles and tends to increase with age, possibly as a result of attrition of the medial femoral condyle. Given its significance, LDFA should be carefully considered as a preoperative indicator in AKO and TKA to guide surgical caution when LDFA is elevated.

Abdominal aortic calcification volume as a preoperative prognostic predictor for pancreatic cancer.

Atherosclerosis and cancer may progress through common pathological factors. This study was performed to investigate the association between the abdominal aortic calcification (AAC) volume and outcomes following surgical treatment for pancreatic cancer. The subjects of this retrospective study were 194 patients who underwent pancreatic cancer surgery between 2007 and 2020. The AAC volume was assessed through routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of the AAC volume on oncological outcomes. A higher AAC volume (≥ 312 mm3) was identified in 66 (34%) patients, who were significantly older and had a higher prevalence of diabetes and sarcopenia. Univariate analysis revealed several risk factors for overall survival (OS), including male sex, an AAC volume ≥ 312 mm3, elevated carbohydrate antigen 19-9, prolonged operation time, increased intraoperative bleeding, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy. Multivariate analysis identified an AAC volume ≥ 312 mm3, prolonged operation time, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy as independent OS risk factors. The OS rate was significantly lower in the high AAC group than in the low AAC group. The AAC volume may serve as a preoperative prognostic indicator for patients with pancreatic cancer.

Clinical and radiologic features in patients with the WHO grade I and II meningiomas

Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior. Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema. Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032). Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results.

Novel Preoperative Type IV Collagen to Predict the Risk of Hepatocellular Carcinoma in Patients with Hepatitis B Virus-Related Cirrhotic Portal Hypertension After Laparoscopic Splenectomy and Azygoportal Disconnection.

Although laparoscopic splenectomy and azygoportal disconnection (LSD) can significantly decrease portal vein pressure and even the incidence of hepatocellular carcinoma (HCC) in patients with cirrhotic portal hypertension (CPH), postoperative HCC inevitably occurs in certain patients. The purpose of this study was to seek a novel preoperative non-invasive predictive indicator to predict the occurrence of postoperative HCC. From April 2012 to April 2022, we collected clinical data of 178 hepatitis B virus (HBV)-related CPH patients. Based on inverse treatment probability weighting, candidate variables for predicting postoperative HCC were determined by means analysis. Then, a novel preoperative non-invasive prediction indicator (ie, type IV collagen-alpha fetoprotein-fibrosis-4 score [IVAF-FIB-4]) was established based on candidate variables, and its predictive ability was explored. Postoperative HCC occurred in 9 (5.1%) patients. Correlation analyses showed that the IVAF-FIB-4 had a significant positive correlation with HCC (r = 0.835, P < 0.001). IVAF-FIB-4 showed a high accuracy (the area under the receiver operating characteristic curve: 0.939, 95% confidence interval [CI]: 0.818-1.000; sensitivity: 88.9%; specificity: 93.5%). At the end of follow-up, the incidence density of HCC in patients with IVAF-FIB-4 (1) was significant higher than that in patients with IVAF-FIB-4 (0) (138.1/1000 vs 1.1/1000 person-years; rate ratio: 130.475, 95% CI: 16.318-1043.227). In logistic regression, IVAF-FIB-4 was an independent risk factor for HCC (odds ratio: 668.000, 95% CI: 53.895-8279.541; P < 0.001). IVAF-FIB-4 is a novel preoperative noninvasive predictive indicator for predicting postoperative HCC in HBV-related CPH patients after LSD, with satisfactory predictive ability.

Preoperative Three-Dimensional Morphological Tumor Features Predict Microvascular Invasion in Hepatocellular Carcinoma

The study was designed to evaluate microvascular invasion(MVI)using three-dimensional (3D) morphological indicators prior to surgery. This retrospective study included 156 patients with hepatocellular carcinoma (HCC) at our hospital from 2017 to 2018. Through thin-layer CT scanning and 3D reconstruction, the tumor surface inclination angles can be quantitatively analyzed to determine the surface irregularity rate (SIR), which serves as a comprehensive assessment method for tumor irregularity based on preoperative 3D morphological evaluation. Univariate and multivariate logistic regression analyses were employed to investigate the correlation with MVI. The SIR was related to MVI (OR: 10.667, P < 0.001). Multivariate logistic regression analysis showed that the SIR was an independent risk factor for MVI. The area under the receiver operating characteristic curve (ROC) of prediction model composed of the morphological indicator SIR was 0.831 (95% confidence interval: 0.759-0.895). The preoperative 3D morphological indicator SIR of a tumor is an accurate predictor of MVI, providing a valuable tool in clinical decision-making.

Correlation of Preoperative Radiological Factors with Histological Involvement of Thyroid Gland in Laryngeal Carcinomas.

Total laryngectomy is the primary treatment for locally advanced laryngeal carcinomas. However, routine thyroid removal (total or hemithyroidectomy) during this procedure is controversial, as the incidence of thyroid gland involvement varies and may lead to lifelong thyroid supplementation, increasing postoperative morbidity. The lack of a consensus on managing the thyroid gland in laryngeal carcinoma cases necessitates improved evaluation techniques, with radiology playing a crucial role in this aspect. Understanding the correlation between radiological factors and histopathological involvement of the thyroid gland can aid in formulating appropriate management strategies during total laryngectomy. To study the correlation of preoperative radiological factors with histopathological involvement of thyroid gland in laryngeal carcinomas. This was a retrospective study which included 57 patients who underwent total laryngectomy for squamous cell carcinoma of larynx. The pre-operative CT findings such as involvement of thyroid cartilage, cricoid cartilage, paraglottic space, anterior commissure, subglottis and thyroid gland along with transglottic extension of tumor were correlated with post-operative histopathological thyroid gland involvement.Cricoid cartilage erosion and thyroid gland involvement in CT scans individually exhibited positive likelihood ratios of 2.58 and 3.23, respectively, demonstrating a reasonable agreement with histopathological findings. The specificity of cricoid cartilage and thyroid gland involvement was also higher with values of 76.4% and 81%, respectively. Moreover, combining thyroid and cricoid cartilage erosion in CT scans as a predictive parameter for thyroid gland involvement resulted in a better likelihood ratio of 8.23 and a fair agreement with histopathological findings. We conclude that cricoid cartilage erosion and thyroid gland involvement in pre-operative CECT can be taken as a preoperative indicator for intraoperative decision on thyroidectomy.

Deep learning-based solid component measuring enabled interpretable prediction of tumor invasiveness for lung adenocarcinoma

BackgroundThe nature of the solid component of subsolid nodules (SSNs) can indicate tumor pathological invasiveness. However, preoperative solid component assessment still lacks a reference standard. MethodsIn this retrospective study, an AI algorithm was proposed for measuring the solid components ratio in SSNs, which was used to assess the diameter ratio (1D), area ratio (2D), and volume ratio (3D). The radiologist measured each SSN's consolidation to tumor ratio (CTR) twice, four weeks apart. The area under the receiver-operating characteristic (ROC) curve (AUC) was calculated for each method used to discriminate an Invasive Adenocarcinoma (IA) from a non-IA. The AUC and the time cost of each measurement were compared. Furthermore, we examined the consistency of measurements made by the radiologist on two separate occasions. ResultsA total of 379 patients (the primary dataset n = 278, the validation dataset n = 101) were included. In the primary dataset, compared to the manual approach (AUC: 0.697), the AI algorithm (AUC: 0.811) had better predictive performance (P =.0027) in measuring solid components ratio in 3D. Algorithm measurement in 3D had an AUC no inferior to 1D (AUC: 0.806) and 2D (AUC: 0.796). In the validation dataset, the AI 3D method also achieved superior diagnostic performance compared to the radiologist (AUC: 0.803 vs 0.682, P =.046). The two measurements of the CTR in the primary dataset, taken 4 weeks apart, have 7.9 % cases in poor consistency. The measurement time cost by the radiologist is about 60 times that of the AI algorithm (P <.001). ConclusionThe 3D measurement of solid components using AI, is an effective and objective approach to predict the pathological invasiveness of SSNs. It can be a preoperative interpretable indicator of pathological invasiveness in patients with lung adenocarcinoma.

Change in Maxillary Sinus Mucosal Thickness in Patients with Preoperative Maxillary Sinus Mucosal Thickening as Assessed by Otolaryngologists: A Retrospective Study.

Background and Objectives: Maxillary sinus pathologic conditions may increase the risk of complications during posterior maxillary sinus augmentation surgery. The purpose of this study was to evaluate the changes in participants with preoperative maxillary sinus mucosal thickening and to assess this factor as a preoperative risk indicator for sinusitis after maxillary dental implantation. Materials and Methods: We compared the preoperative and postoperative maxillary sinus mucosal thickness (MSMT), the distance between the maxillary sinus ostium and sinus floor (MOD), and the MSMT/MOD ratio. The participants were divided into three groups (sinus augmentation, bone grafting, and no grafting). Results: The mean preoperative MSMT was 4.3 ± 2.0 mm, and the mean MSMT/MOD ratio was 0.13 ± 0.05. No postoperative sinusitis was observed in these patients, including cases caused by anatomical variations. The mean postoperative MSMT was 4.5 ± 2.3 mm, and the mean postoperative MSMT/MOD ratio was 0.15 ± 0.06. There was no statistically significant difference between the groups at each time point (p > 0.05). Conclusions: The study found no significant change in MSMT at post-treatment evaluation, even when considering different subgroups. It underscores the importance of preoperative maxillary sinus radiographic assessments and collaboration between dentists and otolaryngologists for better outcomes in patients with preoperative maxillary sinus mucosal thickening.

Thyomental distance is a good difficult airway indicator: Truth or a misconception- A prospective observational study

Unanticipated difficult intubation can be a true challenge to any anaesthesiologist. The most widely used determinant till date in almost every airway study is Thyromental distance[TMD]. We aimed to determine if a TMD above the average values could indicate difficult intubation.70 patients were selected in this prospective observational study who require general anesthesia with endotracheal intubation for their respective surgeries. Patients who fulfilled the inclusion criteria were enrolled in the study and informed written consent was taken.Routine pre-anesthetic check up was done. Thyromental distance was measured [thyroid notch to the lower border of the mandibular mentum-head fully extended] using a rigid ruler. Intraoperatively: After following standard general anaesthesia protocol, patients were intubated by anesthesiologist with atleast 2 years of experience and blinded to the study. The ease (0-5) / Difficulty (&amp;#62;5) in intubation was assessed with Intubation difficulty scale(IDS). Data was analysed using SPSS Software 16. Data was expressed in terms of frequency and percentage. In a total of 70 patients, 18.6% of the patients had difficult intubation. It was observed that 50 patients had a TMD &amp;#62;=7.5 cm out of whom, 7 patients were difficult to intubate. 12 patients had TMD&amp;#60;6.5 cm out of which 6 patients had an IDS of &amp;#62;5 indicating difficult intubation. Sensitivity, specificity, PPV, NPV were calculated. Categorical Pearson chi square test was done for TMD&amp;#62;7.5 vs IDS and it showed a p value of 0.017 (p&amp;#60;0.05).We observed that a long TMD (TMD&amp;#62;=7.5cm) could be a difficult airway indicator just like a short TMD (TMD&amp;#60;=6.5). Therefore, our findings suggest that thyromental distance may not have a significant role as a standalone pre-operative indicator of a difficult airway and its reliability as a useful parameter in predicting difficult intubation is questionable.

Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants.

The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable. All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability. Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.

Serum and hair steroid profiles in patients with nonfunctioning pituitary adenoma undergoing surgery: A prospective observational study

Patients who undergo transsphenoidal surgery (TSS) experience perioperative hormonal changes, but there are few studies on the perioperative changes of serum and hair steroid profiles. This study investigated the perioperative changes in steroid metabolic signatures in patients with nonfunctioning pituitary adenoma (NFPA) who underwent transsphenoidal surgery (TSS). A total of 55 participants who underwent TSS for NFPA at a single center between July 2017 and October 2018 were enrolled. Fifteen serum steroids and their metabolic ratios were profiled using gas chromatography-mass spectrometry (GC-MS) before and 1 day, 1 week, and 3 months after TSS. Five steroids from hair samples collected 1 day and 3 months after TSS were also quantitatively compared. Serum cortisol and its A-ring reductive metabolites, as well as 6β-hydroxycortisol, increased dramatically 1 day after TSS and then gradually decreased. Seven serum steroids, including adrenal androgens and mineralocorticoids, and hair cortisone levels were significantly lower in patients with preoperative adrenocorticotropic hormone (ACTH) deficiency (N = 7) than in those without ACTH deficiency (N = 48). Serum levels of dehydroepiandrosterone (DHEA) levels 1 week after TSS predicted ACTH deficiency 3 months after TSS, with 100 % sensitivity and 86 % specificity. A significant positive correlation between the preoperative serum and hair DHEA levels (r = 0.356, P = 0.008) was observed. These findings suggest that the levels of DHEA in both the serum and hair could be an early marker of ACTH deficiency after TSS. In addition, hair cortisone may be a useful preoperative indicator of chronic ACTH deficiency.

Tumor metabolism derived from 18F-FDG PET/CT in predicting the macrotrabecular-massive subtype of hepatocellular carcinoma

The recently described pathological subtype of hepatocellular carcinoma (HCC), named macrotrabecular massive (MTM), is associated with an unfavorable prognosis. This study aimed to evaluate the potential for tumor metabolism obtained by β-2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) to be used as a preoperative imaging indicator for predicting MTM-HCCs. This study was designed to be cross-sectional. Patients who underwent preoperative 18F-FDG PET/CT and who had surgically-diagnosed HCC between June 2015 and June 2021 were retrospectively included. Tumor metabolism was determined by the tumor-to-normal liver standardized uptake value ratio (TLR) of the primary tumor as shown on 18F-FDG PET/CT. Clinical, pathological, and PET/CT characteristics were compared between non-MTM-HCCs and MTM-HCCs. Univariate analyses were used to screen the predictive factors of MTM-HCCs, then multivariate binary logistic regression analyses were performed. A regression-based diagnostic model was then established. Substantial necrosis was assessed to compare the predictive performance between traditional imaging and TLR measured on 18F-FDG PET/CT. The receiver operating characteristic (ROC) curve analyses and the DeLong test were used to assess the predictive performance. A total of 93 patients (mean age, 52.6±11.3 years; 81 male) with 36 MTM-HCCs were included. Multivariate binary logistic regression analyses identified higher platelet count [PLT; ≥118.5×103/µL; odds ratio (OR), 3.63; 95% confidence interval (CI), 1.13-12.87; P=0.035], higher aspartate transaminase (AST; ≥52 IU/L; OR, 4.15; 95% CI: 1.34-14.33; P=0.017), and larger TLR (≥2.2; OR, 5.55; 95% CI: 1.90-17.56; P=0.002) as independent predictors of MTM-HCCs. A TLR ≥2.2 helped to identify 72.2% of the MTM-HCCs with a specificity of 75.4%. The AUC of the regression-based diagnostic model for predicting MTM-HCCs was 0.835 (95% CI: 0.746-0.923), with a sensitivity of 80.6% and a specificity of 78.9%. Substantial necrosis enabled the identification of MTM-HCCs with 52.8% sensitivity and 87.7% specificity, with an AUC of 0.702 (95% CI: 0.588-0.817). There was no statistical difference between TLR and substantial necrosis in predicting MTM-HCCs using the DeLong test (P>0.05). Tumor metabolism determined by TLR on 18F-FDG PET/CT is a valuable imaging indicator for MTM-HCCs. Noninvasive prediction of this subtype can achieve good sensitivity and excellent predictive performance based on the regression model of AST, PLT, and TLR.

A Simple Prognostic Nomogram of Preoperative Indicator for Patients with Hepatectomy: A MIMIC-based Study

A Simple Prognostic Nomogram of Preoperative Indicator for Patients with Hepatectomy: A MIMIC-based Study

The utilization of platelet parameters as an adjunct indicator for the diagnosis of shoulder periprosthetic joint infection

BackgroundThe diagnosis of periprosthetic joint infection (PJI) of the shoulder remains challenging. Platelet-related serum values are associated with physiological states of infection. The purpose of this study is to determine whether absolute platelet count and mean platelet volume could aid in the diagnosis of shoulder PJI. MethodsA retrospective review of all patients undergoing revision shoulder arthroplasty at a single institution was performed. Likelihood of PJI was determined based on the International Consensus Meeting score. The ratio of absolute platelet count to mean platelet volume (PV) was calculated for each patient. This PV ratio was compared to erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels for making the diagnosis of shoulder PJI. ResultsFour hundred sixty cases of revision shoulder arthroplasty were identified. Of these, 80 (17.4%) were diagnosed as having a definitive or probable shoulder PJI. The PV ratio was significantly higher for patients with a diagnosed PJI (28.1 vs. 25.4, P = .004). Receiver operator characteristic curve analysis for the PV ratio determined the sensitivity for diagnosing PJI is 55.3% and the specificity is 62.9% with an area under the curve of 0.60 (95% confidence interval [CI]: 0.50-0.69). There was no significant difference between the area under the curve values for PV ratio, ESR (0.61; 95% CI: 0.5117-0.7042), or CRP (0.67; 95% CI: 0.5766-0.7641). On subgroup analysis, the PV ratio demonstrated a specificity of 73.7%, compared to 18.2% for ESR and 23.8% for CRP, at recognizing PJI attributed to Cutibacterium acnes. DiscussionThere is a clear association between an elevated PV ratio and patients with shoulder PJI. Although the PV ratio should not be used alone to make the diagnosis, our analysis demonstrates that this ratio performs similarly to the traditional serum biomarkers at recognizing shoulder PJI. ConclusionThe PV ratio may be used as an adjunct preoperative indicator in the evaluation of patients with potential shoulder PJIs.

Assessment of manual perioperative anesthesia record-keeping practice: A multicenter; descriptive cross-sectional study, Ethiopia, 2022

ObjectiveThis study aimed to assess the practice of manual perioperative anesthesia record-keeping in Debre Markos and Debre Berhan Comprehensive Specialized hospitals from May to June 2022. MethodsA descriptive study was undergone from May 1 to June 30, 2022 at two Hospitals that are under Amhara regional health bureau. To retrieve and analyze manual anesthesia record-keeping practice, a checklist was developed from manual perioperative anesthesia record sheet of study hospitals and the American society of anesthesiologists which comprises indicators with corresponding predefined components. The checklist comprised questions with three alternatives “complete” for full data recorded, “incomplete” for partial data recorded, and “No” for totally missed data. SPSS version 22 was used to analyze the data. ResultThe name of the anesthetist was recorded as our expectation which means 100% complete. The name of the surgeon was the second most frequently recorded preoperative related indicator with a completion rate of 98.4%. Other preoperative indicators like last food/drink, current/previous medications, alcoholic/cigarette hx, pregnancy, cardiovascular, other system, and laboratory also not recorded in an eligible way. The anesthesia record completion rate was below fifty percent in many intraoperative indicators. Conclusionand recommendation: Most of the perioperative anesthesia recording indicators were found poorly recorded or below the standards. Information about preoperative patient condition and identity, intraoperative drug administrations, monitoring related information, and postoperative orders regarding pain and fluid management are among inadequately/illegibly recorded indicators. We recommend different interventional strategies like training, refresher course on the importance of the anesthetic record, and regular feedback for anesthetists improves the practice of manual anesthesia record-keeping.

The efficacy of anatomic resection for hepatocellular carcinoma within Milan criteria: A retrospective single-institution case-matched study

IntroductionStill now, the efficacy of anatomic resection (AR) for hepatocellular carcinoma (HCC) is controversial. The aim of this study is to examine it in our cohort and detect an optimal indicator for AR. MethodsThe present study included 656 patients with primary HCC within Milan criteria who underwent hepatectomy from 2000 to 2019. Our cohort was divided into AR (n = 378) and non-anatomic resection (NAR) (n = 278) groups, and 1:1 propensity score matching (PSM) was performed to minimize the effect of potential confounders. Recurrence-free survival (RFS), overall survival (OS), and a preoperative indicator for AR were examined. Results210 patients from each group were well-matched, and preoperative confounding factors were balanced between the two groups. There was no significant difference in RFS and OS between the two groups before (RFS; HR = 0.89 P = 0.25, OS; HR = 1.08 P = 0.64) and after PSM (RFS; HR = 0.93 P = 0.60, OS; HR = 1.07 P = 0.75). Subgroup analysis showed that the survival improvement effect of AR was observed in cases with a fucosylated fraction of alfa-fetoprotein (AFP-L3) > 10% and poorly differentiation (P for interaction <0.05). Moreover, the logistic regression analysis showed that preoperative AFP-L3 > 10% was an independent predictor for poorly differentiation (OR = 2.58, P = 0.03). ConclusionThe efficacy of AR for patients with primary HCC within Milan criteria was not shown. But it was suggested that AFP-L3 > 10% might be a preoperative indicator of AR for HCC within Milan criteria.

MRI for evaluation of preoperative chemotherapy in osteosarcoma

IntroductionOur study aims to highlight the role of Magnetic Resonance Imaging (MRI) in monitoring the therapeutic response after neoadjuvant chemotherapy in osteosarcoma of the long bones. MethodsIn this retrospective study, data from the Orthopaedics and Internal Medicine Department of Istanbul University Cerrahpasa Hospital was used. We selected the study cohort from our departmental database of patients with biopsy-proven osteosarcoma initially treated with preoperative chemotherapy at Istanbul University Cerrahpasa Hospital from 2010 to 2017. MRI images of 21 patients (male/female ratio: 2.5 with a mean age of 22) were analysed before and after neoadjuvant chemotherapy. The histological response to chemotherapy was graded according to The Huvos classification. Computed volumetry was performed to determine the size of the intramedullary component, largest enhancing component, and tumour volume. P < 0.05 was considered to denote a significant difference. ResultsThe mean tumour volume before chemotherapy was 409 cm3. After chemotherapy, however, the tumor volume increased to 701 cm3 (p = 0.10). The mean intramedullary component size of the tumours before chemotherapy was 10.5 cm3 while after chemotherapy was 11.2 cm3 (p = 0.06). The mean largest enhancing component size was 3.09 cm3 and after chemotherapy, decreased to 2.34 cm3 (p = 0.01). Neoadjuvant chemotherapy significantly changed the tumour composition. Tumour volume and intramedullary component size measurements failed to demonstrate a significant correlation and could not be used as a prognostic factor for tumour response to preoperative chemotherapy. We suggest that the largest enhancing component of a tumour can be a potential prognostic marker for assessing the tumour response. ConclusionMRI can help predict histological necrosis after the administration of preoperative chemotherapy to osteosarcoma via measuring the largest enhancing component. Hence, it is a promising preoperative indicator of response to neoadjuvant chemotherapy. However, tumour volume and intramedullary component size measurement are not effective predictors of histological necrosis. The increased volume and intramedullary component of the tumour were attributed to the increased central necrotic component of the tumour after chemotherapy. Implications for practiceIn this study, we showed that MRI can help predict histological necrosis and thus, prognosis after the administration of preoperative chemotherapy to osteosarcoma via the measurement of the largest enhancing component of the tumour. This is significant because histological necrosis is currently the gold standard method for assessing the treatment response. However, this requires an invasive procedure, and a non-invasive method would be beneficial. Assessing the treatment response through imaging after the completion of the initial chemotherapy will also help determine the final surgical approach and thus predict survival.

Re: Editorial Comment from Dr Babu to PlateObjective Scoring Tool: A new preoperative indicator of penile curvature degree in children with distal hypospadias.

Re: Editorial Comment from Dr Babu to PlateObjective Scoring Tool: A new preoperative indicator of penile curvature degree in children with distal hypospadias.