Preoperative Measurements Research Articles

Objective analysis of orbital rim fracture CT images using curve and area measurement.

The orbital bone presents a closed curve, and fracture results in disfigurement. An image analysis procedure was developed to examine before and after corrective surgery. An ellipse and circumscribed contour embodied the closed curve. Three-dimensional (3D) computed tomography (CT) images were collected from 25 patients. Orbital rim data were generated, and binary images were created to facilitate closed curve analysis. Various indices, including the solidity value (closed curve area/convex hull area) and ellipse distance (discrepancy between the closed curve and the ellipse traversing the curve), were utilized. The ratios of various indices-including the number of vertices, solidity value, and ellipse distance-between the affected and unaffected sides showed postoperative values that were closer to 1, which would indicate perfect symmetry, than the preoperative measurements (P < 0.05). The solidity value increased, while both the ellipse distance and curvature values decreased, reflecting the transformation of bends into smooth contours following reduction surgery (P < 0.05). Significant correlations were observed between 1-solidity, ellipse distance, and curvature using the Pearson correlation test (P < 0.05). This study validated postoperative changes in various indices and established correlations among multiple values, specifically solidity, ellipse distance, and curvature. Employing multiple indices with mutual complements has provided objective information confidently.

Assessment of measurement variability across automated biometry devices

Purpose: To evaluate measurement variability between different readily available automated biometric devices for the purposes of improving surgeon decision making for phakic intraocular lens (IOL) sizing. Setting: Private practice (Houston, TX, USA) Design: Prospective, single center, bilateral, non-randomized, open-label, observational study. Methods: This study included healthy eyes, with no prior eye surgery, and with a spherical equivalent of at least -1.00D. Orbscan II was compared to Argos, Atlas 9000, caliper, IOLMaster 500, IOLMaster 700, iTrace, Lenstar LS900, Pentacam HR, and Pentacam AXL Wave. Preoperative measurements included white to white (WTW), anterior chamber depth (ACD), and central corneal thickness (CCT). Linear mixed effect models were created to determine adjustment factor between the Orbscan II and other devices for WTW, ACD, and CCT measurements. Results: A total of 204 subjects (408 eyes) completed the study. All mean WTW measurements were significantly different compared to the Orbscan II (p &lt; 0.01), except for Pentacam AXL Wave. All mean ACD and CCT measurements were significantly different compared to the Orbscan II (p &lt; 0.01). Adjustment factors for WTW ranged from -0.65 mm to 0.24 mm. Adjustment factors for ACD ranged from -0.21 mm to -0.16 mm. Adjustment factors for CCT ranged from 19.9 µm to -36.0 µm. Conclusions: The biometers tested were not interchangeable with the Orbscan II. Adjustment factors for WTW and ACD may compensate for differences between devices and adapt ICL sizing recommendations.

Feasibility of continuous physical activity monitoring: first-month recovery markers following joint replacement surgery

Background The role of physical activity (PA) monitoring during the recovery after orthopaedic surgeries is unclear. This study aimed to explore early changes in the pattern and level of PA following orthopedic surgeries. Methods This observational feasibility study included 11 hip replacement patients (four females) with a mean age of 66 years and five knee replacement patients (four females) with a mean age of 65 years. A PA tracker was used to collect the patients’ daily PA data, including duration of various activity categories, steps taken, and activity intensity count. The PA tracker recorded data from two weeks prior to surgery until four weeks after the surgery. Ratios of PA parameters for each of the first four weeks following surgery were calculated in relation to preoperative measurements. Results Compared to preoperative measurements, during the first four weeks after the surgery, the time spent in a recumbent position decreased from 112% to 106%, while continuous walking time and activity intensity count increased from 27% to 77% and from 35% to 73%, respectively. Step counts increased from 18% to 67%, and sit-to-stands rose from 65% to 93%. No significant changes were found in sitting, standing, sporadic walk time, and sporadic steps. Conclusion Continuously measuring PA using wearable sensors was feasible in orthopedic patients during the perioperative period. Continuous step count, walking time, activity intensity count showed noticeable changes and stable patterns demonstrating their potential for remote monitoring of patients during the early postoperative period.

Predictors of Post-operative ABG Changes to Pre-operative Levels in Kidney Transplant Patients, a Cross-Sectional Study

Background: Kidney transplant is the treatment of choice for chronic renal failure (CRF), significantly improving patient outcomes. Fluid administration during surgery can lead to the accumulation of acid ions and electrolytes, inducing pH changes from the pre-operative to post-operative period, which may compromise transplant success. The impact of acid-base balance changes on transplant outcomes is crucial, yet research on predictors and arterial blood gas (ABG) changes post-kidney transplant is limited. Understanding ABG changes can enhance perioperative management, early detection of complications, and long-term graft function, thereby optimizing patient care and increasing transplant success rates. Objectives: To assess ABG changes before and after kidney transplant and identify predictors of post-operative acidosis in patients with renal failure through cross-sectional studies. Methods: In a retrospective cohort study, we included 97 patients who had undergone kidney transplant. During surgery, patients received crystalloid fluids, with 49 receiving only normal saline and 48 receiving only Ringer's lactate. Data collection involved the insertion of an arterial line after anesthesia induction, and the first ABG sample was obtained as a pre-operative measure. A post-operative measure was taken at the end of the surgery. Ethical considerations were followed throughout the study. Statistical analysis included paired t-test or Wilcoxon signed-rank test to compare pre- and post-operative ABG measures, with a significance level set at a P-value less than 0.05. Results: Total of 97 patients, which 65 (69.4%) were male and 32 (30.6%) were female and mean age was 38.6 ± 12.2. Variables significantly associated with post-op acidosis were fluid administered (OR: 3.25, 95% CI: 1.45 - 4.58), post-op central venous pressure (CVP) (OR: 2.31, 95% CI: 1.23 - 2.62, p &lt; 0.05), post-op base excess (BE) (OR: 2.16, 95% CI: 1.50 - 2.95, P &lt; 0.05). HCO₃ (P = 0.010), BE (P = 0.002), pH (P = 0.023) were significantly lower in the normal saline group compared to the Ringer's group. Post-op pH and BE was also associated with increased post-op CVP. Post-op acidosis and post-op CVP were significantly associated with post-op BE. Conclusions: Post-operative ABG changes, including decreases in pH and HCO3, are key indicators of transplant outcomes, reflecting graft function and patient stability. These findings highlight the critical need for prompt management of ABG abnormalities to optimize transplant success and minimize complications, making vigilant monitoring a vital part of post-transplant care.

Compensatory thoracic curve correction in lumbar anterior vertebral body tether (VBT) versus lumbar posterior spinal fusion (PSF).

Anterior vertebral body tethering (VBT) is a non-fusion surgical option for skeletally immature patients with idiopathic scoliosis. Prior studies demonstrated compensatory correction of the thoracic curve after lumbar posterior spinal fusion (PSF); however, no studies have examined thoracic curve correction after lumbar VBT. Patients with Lenke 5 + 6 lumbar scoliosis who underwent VBT and at least 2years' follow-up were compared to matched lumbar PSF patients. Groups were compared for major lumbar (L) and compensatory thoracic (T) curve correction, coronal/sagittal balance, and complications. 24 AVBT and 24 PSF patients were matched 1:1 for skeletal maturity and curve flexibility. There were no significant differences between VBT and PSF for average pre-operative or 2year post-operative major L or compensatory T curves. Average final L curve correction was 50% VBT and 60% PSF (p = 0.08); average T curve correction was 17% VBT and 20% PSF (p = 0.18). Compared to pre-operative flexibility radiographs, the final post-op thoracic curves were 6° (VBT) and 5° (PSF) larger. PSF had better coronal balance by average of 17mm (p < 0.0001). There were seven (24%) reoperations in the VBT group: two overcorrections relaxed, two T adding-on (extended to T by PSF-1, VBT-1), one broken tether converted to PSF. There was one (4%) reoperation in the PSF group (10-year post-op extension). Compensatory thoracic correction was achieved to a similar degree for lumbar VBT and PSF patients. There was little change in thoracic curve magnitude over time, and, on average, the correction did not reach the pre-operative flexibility curve measurement. There was better coronal balance by PSF, and a higher rate of re-operation in VBT patients. III.

Three-dimensional evaluation of maxillofacial symmetry improvement following orthognathic surgery in patients with asymmetrical jaw deformities.

The aim of this study was to clarify the three-dimensional changes in maxillofacial morphology following orthognathic surgery using 3D-CT in patients with asymmetrical jaw deformities. The subjects were 30 patients with asymmetrical jaw deformities. Three-dimensional images taken preoperatively and 6months postoperatively were re-aligned using image processing software with the horizontal plane, coronal plane, and midsagittal plane as reference axes. Thirty-nine measurements including 28 distances, nine angles, and two volumes were recorded, and differences between preoperative and postoperative measurements and percentage differences between paired measurements on the deviated and unevolved sides were calculated. Translational and rotational movements of the maxillary dentition and mandibular body and the mandibular ramus internally rotating contributed to improved symmetry of the maxillofacial morphology, but the degree and proportion of these changes varied from case to case and mild asymmetry remained even after surgery. 3D-CT analysis of maxillofacial morphology is essential to accurately evaluate the asymmetry of hard and soft tissue morphology in the maxillofacial region and the degree of improvement after orthognathic surgery, and the tooth movement during preoperative orthodontic treatment should be determined taking into account the movement of the upper and lower jaws during orthognathic surgery.

Ramp lesions of the medial meniscus are associated with greater preoperative anterior knee laxity in anterior cruciate ligament injury.

To assess the incidence of ramp lesions in anterior cruciate ligament (ACL) injuries and to compare preoperative knee laxity between the patients with and without ramp lesions by using an electromagnetic measurement system (EMS). Two hundred six patients who underwent primary ACL reconstruction with preoperative EMS measurements were retrospectively enrolled in the present study. The diagnoses of the ramp lesions were made by arthroscopic inspections. The patients with ramp lesions and no other meniscal lesions were allocated to 'ramp group', and the patients without any meniscal lesions were allocated to 'control group'. Before ACL reconstruction under general anaesthesia, the side-to-side difference (SSD) in anterior tibial translation (ATT) during Lachman test (mm) and tibial acceleration (m/s2) of posterior tibial reduction during the pivot-shift test was measured using the EMS. The SSD in tibial internal/external rotation angle (°) at 30, 60 and 90 were further measured using the EMS. The SSD in ATT using KT-2000 was also measured. Knee laxity measurements were compared between two groups using unpaired Student's t test. Ramp lesions were observed in 30 patients (14.7%). Subsequently, 17 patients were allocated to 'ramp group' and 77 patients to 'control group', and there were no statistical differences with regard to background demographics. ATT-SSD during Lachman test was significantly greater in 'ramp group' (9.1 [95% confidence interval, CI: 5.7-12.5] mm vs. 6.2 [95% CI: 5.1-7.3] mm, p = 0.037). However, SSD in ATT with KT-2000, tibial acceleration during pivot-shift test, and SSD in tibial rotational angles were not significantly different between the two groups. Presence of ramp lesion was associated with increased anterior knee laxity during Lachman test, suggesting ramp lesions may need to be addressed at the time of ACL reconstruction. IV.

The Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental Health T-Score: An Independent Predictor of Immediate Post-Surgical Outcomes Following Elective Total Knee Arthroplasty

The Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental Health T-Score: An Independent Predictor of Immediate Post-Surgical Outcomes Following Elective Total Knee Arthroplasty

Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

PurposeTo investigate the influence of the timing of ACL reconstruction (ACLR) on patient-reported outcomes, comparing those with and without concomitant medial collateral ligament (MCL) injury. MethodsThis study included patients who underwent ACLR between September 2015 and October 2020. Inclusion criteria required patients to have preoperative and postoperative patient-reported outcome measures (PROMs) and a follow-up period of at least 2 years. Patients who sustained a grade 2 or 3 MCL injury with an ACL tear were compared to patients with no MCL injury as a control. All patients underwent ACL reconstruction using either bone-tendon-bone (BTB) autograft or BTB Allograft. Patient-reported outcomes (International Knee Documentation Committee (IKDC), Lysholm, and Knee Osteoarthritis and Score (KOOS)) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted. ResultsA total of 253 eligible patients with 2-year outcomes were enrolled. Combined ACL/MCL injury had lower IKDC (β=-6.1 vs β=-8.3, p=0.003), KOOS QOL (β=-9.3 vs β=-11, p=0.004), and KOOS Sport (β=-12 vs β=-13 , p=0.08) if performed after 6 weeks from index injury. Isolated ACL injuries showed lower KOOS ADL (β=-2.4, p=0.045) if surgery performed between 3-6 months. For combined ACL/MCL injury, autograft (compared to allograft) was found to have worse IKDC (β=-11 (-18, -4.2), p=0.002), Lysholm (β=-9.2 (-15, -3.1), p=0.004), KOOS QOL(β=-11 (-20, -1.6), p=0.023), KOOS Pain (β=-5.1 (-10, -0.03), p=0.049), KOOS Symptoms (β=-7.6 (-10, -0.03), p=0.02), and KOOS Sports (β=-21 (-32, -10), p=<0.001). ConclusionPatients undergoing ACL reconstruction with a grade 2 or 3 MCL injury have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts. Level of EvidenceLevel III Retrospective Cohort Study

Active Machine Learning for Pre-procedural Prediction of Time-Varying Boundary Condition After Fontan Procedure Using Generative Adversarial Networks.

The Fontan procedure is the definitive palliation for pediatric patients born with single ventricles. Surgical planning for the Fontan procedure has emerged as a promising vehicle toward optimizing outcomes, where pre-operative measurements are used prospectively as post-operative boundary conditions for simulation. Nevertheless, actual post-operative measurements can be very different from pre-operative states, which raises questions for the accuracy of surgical planning. The goal of this study is to apply machine leaning techniques to describing pre-operative and post-operative vena caval flow conditions in Fontan patients in order to develop predictions of post-operative boundary conditions to be used in surgical planning. Based on a virtual cohort synthesized by lumped-parameter models, we proposed a novel diversity-aware generative adversarial active learning framework to successfully train predictive deep neural networks on very limited amount of cases that are generally faced by cardiovascular studies. Results of 14 groups of experiments uniquely combining different data query strategies, metrics, and data augmentation options with generative adversarial networks demonstrated that the highest overall prediction accuracy and coefficient of determination were exhibited by the proposed method. This framework serves as a first step toward deep learning for cardiovascular flow prediction/regression with reduced labeling requirements and augmented learning space.

CT imaging analysis of the C7 pedicle and lateral mass in children aged 0–14 years

Background and objectiveThere is currently a lack of anatomical research on the C7 pedicle and lateral mass in children aged 0–14 years, and experience with pediatric lower cervical spine surgeries remains limited. This study aims to investigate the anatomical structure of the C7 pedicle and lateral mass in a large pediatric sample to understand their growth patterns, providing imaging and anatomical references for pediatric lower cervical spine surgeries and the design of pediatric C7 screws. MethodsWe measured 12 parameters, including the width, length, height, and angles of the C7 pedicle and lateral mass in children aged 0–14 years. The t-test was used to analyze bilateral and gender differences, and least squares regression was applied for curve fitting analysis. ResultsThe size parameters of the C7 pedicle and lateral mass generally increased with age, while angular parameters fluctuated within specific ranges. The average values for each parameter between ages 0–14 were as follows: D1: 2.78–5.28 mm, D2: 18.15–30.54 mm, D3: 2.44–6.01 mm, angle A: 38.05–44.48°; D4: 6.81–10.94 mm, D5: 5.37–11.23 mm, D6: 8.07–13.28 mm, D7: 1.94–4.88 mm, D8: 5.67–9.39 mm, angle C: 18.50–28.80°, angle D: 43.23–52.01°, angle E: 33.74–44.96°. Bilateral analysis showed no significant differences for most parameters across most age groups, with differences mainly observed in angle A, angle C, D6, and D8. Gender differences were primarily noted in length parameters across different age groups, especially in the 3–4, 6–7, 9–11, and 13–14 age groups. Regression analysis indicated that most parameters followed cubic function curves, while a few followed power or quadratic function curves. ConclusionThis study provides detailed CT imaging anatomy of the C7 pedicle and lateral mass in children aged 0–14 years. Preoperative thin-slice CT scans and careful measurements of key parameters are essential for pediatric lower cervical spine surgeries. The findings offer valuable imaging and anatomical references for pediatric posterior cervical fixation surgery and screw design.

Preoperative echocardiography and anesthetic drugs as predictors of post-induction hypotension during general anesthesia: a prospective observational study

Post-induction hypotension (PIH) during general anesthesia is a serious concern due to its high incidence and association with adverse postoperative outcomes and prognosis. We prospectively enrolled consecutive 1,603 patients scheduled for non-cardiac and cardiac surgery under general anesthesia. The primary outcome was defined as the lowest mean blood pressure from induction of general anesthesia to the start of surgery: post-induction blood pressure (PIB). Multivariable regression analysis was used to investigate the relationships between PIB and preoperative echocardiographic measurements, types and doses of anesthetic agents, and preoperative comorbidities and oral medication. Left ventricle regional wall motion abnormality (RWMA) and lower estimated glomerular filtration rate significantly associated lower PIB. Factors significantly associated with higher PIB were high BMI, beta blockers, high pre-induction mean blood pressure, and starting induction in the afternoon. Sevoflurane and prophylactic norepinephrine use were associated with higher PIB as anesthetic interventions. Significant interactions were found between sevoflurane and RWMA (P for interaction: 0.01). This is the first study to demonstrate the feasibility of intervening in the selection of anesthetic agents based on echocardiographic findings and to recommend the use of sevoflurane and prophylactic norepinephrine for the prevention of PIH, especially in patients with RWMA.

A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)

BackgroundTo evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.MethodsThis was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.ResultsThere were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.ConclusionsLess surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.

Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction

Background: The anterior cruciate ligament (ACL) is commonly injured in the knee joint, necessitating surgical reconstruction where quadrupled hamstring tendon autografts are frequently utilized for their favourable outcomes. Predicting the appropriate dimensions of these grafts is essential for surgical success. This study aims to investigate whether simple anthropometric measurements-height, weight, body mass index (BMI), thigh length, and circumference-can predict the length and diameter of quadrupled hamstring tendons used in ACL reconstruction. Methods: This cross-sectional study included 45 patients undergoing ACL reconstruction with quadrupled hamstring autografts at department of orthopaedics, Renai Medicity Kerala, India. Preoperative anthropometric measurements were correlated with intraop graft dimensions using Pearson correlation and SPSS statistical software (version 22). Results: Taller patients exhibited a positive correlation with graft diameter (p=0.028). Height and thigh length correlated positively with both gracilis and semitendinosus tendon lengths (p&lt;0.001). Thigh circumference correlated positively with semitendinosus length (p=0.005), while weight, BMI, and other measures did not significantly correlate with graft dimensions. Conclusions: Anthropometric measurements, particularly height and thigh length, serve as valuable predictors for hamstring graft dimensions in ACL reconstruction. These findings may assist surgeons in selecting appropriate grafts and optimizing surgical outcomes.

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture

BackgroundThere are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.MethodsAccording to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.ResultsMason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11–26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.ConclusionDifferent types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.

Prediction of visual outcomes using virtual implantation of a trifocal intraocular lens in presbyopic lens exchange patients.

To assess the reliability of a novel virtual IOL implantation device to predict the outcomes of a trifocal IOL. Clinical sites in Spain and Germany. Prospective multicenter study. Preoperative measurements obtained by the virtual implantation of AT LISA tri 839MP IOL (Carl Zeiss Meditec AG, Jena, Germany) with VirtIOL device (10Lens S.L.U., Terrassa, Spain) were compared to postoperative (month 3) outcomes following the IOL implantation. Evaluated metrics were defocus curve, contrast sensitivity (both in photopic conditions), and visual phenomena (visual angle size of burst and annular pattern) in mesopic conditions. The study included 45 presbyopic non-cataract patients (mean age 56.16±5.03 years). VirtIOL device reasonably predicted the shape of the defocus curve, especially in the intermediate vision range, but underestimated postoperative visual acuities mainly at the defocus range between +1.0D and -3.5D. The difference between predicted and achieved visual acuity was -0.11±0.13 logMAR (p<0.001) for 0.0D defocus and -0.16±0.15D logMAR (p<0.001) for -2.50D defocus. The shape of the contrast sensitivity curve was almost identical for predicted and achieved measurements, but the device underestimated the values by ≈0.3 logCS units for each spatial frequency. Visual phenomena were similar between the predicted and achieved outcome (predicted vs. achieved: burst pattern 2.65±0.97° vs. 2.74°±0.95°, p=0.63; annular pattern: 0.88±0.42° vs. 0.93±0.49°, p=0.59). The device reasonably predicted the pattern of measured variables. Visual acuity/contrast sensitivity reduction might be attributed to viewing the objects through a more complex optical system and would need to be accounted for in clinical studies.

The application of basic SMAS rhytidectomy and comprehensive SMAS rhytidectomy.

Rhytidectomy has made great progress in the past 50 years, especially after the proposition of the concept of superficial musculoaponeurotic system (SMAS). Our previous research had classified SMAS rhytidectomy into basic SMAS rhytidectomy (B-SMAS) and comprehensive SMAS rhytidectomy (C-SMAS) according to whether the treatment of SMAS aponeurosis is combined with retaining ligament, fat pad, mimetic muscles, etc. The purpose of this paper is to compare the outcomes of the 2 methods. Through multicenter collaborative research, 21 cases of B-SMAS and 18 cases of C-SMAS were collected. Photographs were taken pre- and post-operation for each patient, and the facial width of the lateral canthus level (upper face), the alar base level (middle face), and the oral commissure level (lower face) were measured. We compared the statistics of upper, middle, and lower face pre- and post-B-SMAS and C-SMAS to assess the ramifications of each operation. We used preoperative measurements minus corresponding postoperative measurements of specific operation to assess which position would acquire superior improvements. We also recruited 3 professional plastic clinicians to rate the ramifications of specific positions and approaches after pre- and post-photo comparing. Through comprehensive analyzing, we compared the improvements between B-SMAS and C-SMAS to assess which method is more beneficial concerning facial rejuvenation. Both B-SMAS and C-SMAS would acquire optimal changing concerning facial width in middle and lower face after operation (P < .05). Two methods all harvested better width changing effects in middle and lower face than upper face (P < .05). However, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). Both B-SMAS and C-SMAS are beneficial to facial rejuvenation. The effects in middle and lower face are better than upper face. In addition, C-SMAS may be more effective than B-SMAS.

Moving towards a core measures set for patient safety in perioperative care: An e-Delphi consensus study.

A Core Measures Set (CMS) is an agreed standardized group of measures that should be assessed and reported in research for a specific condition or clinical area. This study undertook the development of a CMS for Patient Safety through a two-round, web-based Delphi consensus approach, in the context of the "Improving quality and patient SAFEty in surgical care through STandardisation and harmonization of perioperative care in Europe" (SAFEST) project-a collaborative, patient-centered and evidence-based European Union-funded project that aims to generate action-oriented evidence in perioperative care. We developed an Initial List of Measures via an umbrella review following the deployment of an e-Delphi method with an inclusive panel of experts to prioritize measures towards a consensualized Final List of Measures. All measures were rigorously assessed for both importance and feasibility. After the two rounds of the e-Delphi consensus method we observed 13 preoperative measures (40.6% of the initial number), 24 intraoperative measures (66.7%), 25 postoperative measures (20.3%) and 23 mixed period measures (41.1%) met consensus criteria for both importance and feasibility. Higher scores were detected in importance ratings compared to feasibility across all groups of measures. Importantly, numeric averages regarding pain-related measures differed in the assessment of patients when compared to that of Healthcare Professionals (HCPs). This work not only informs future SAFEST iterations but also sets a precedent for research into valid, patient-centered, and action-oriented perioperative safety measures.

Assessment of the relationship between central venous pressure waveform and the severity of tricuspid valve regurgitation using data science

Purpose The relationship between the height of the V wave in the central venous pressure (CVP) waveform and the severity of tricuspid regurgitation (TR) is well known. Their diagnostic ability is unconfirmed. This study explored CVP waveform variations with TR. Methods All patients who underwent preoperative echocardiography and CVP waveform measurements before surgery at our institution were included. Indices were created to capture each feature of the CVP waveform. The median value for each case was obtained and statistically analyzed according to the severity of TR. A deep learning technique, Transformer, was used to handle the complex features of CVP waveforms. Results This study included 436 cases. The values for C wave – Y descent, X descent – Y descent, and V wave – Y descent differed significantly in the Jonckheere–Terpstra test (p = 0.0018, 0.027, and 0.077, respectively). The area under the receiver operating characteristic (ROC) curve (AUC) for X descent – Y descent in two groups, none to moderate TR and severe TR, was 0.83 (95% confidence interval (CI) [0.68, 0.98]). For Transformer, the accuracy of the validation dataset was 0.97. Conclusions The shape of the CVP waveform varied with the severity of TR in a large dataset.

Assessment of intraocular lens tilt and decentration after femtosecond laser-assisted and conventional cataract surgery at 12 months and beyond

PurposeTo compare long-term intraocular lens (IOL) decentration and tilt following femtosecond laser-assisted cataract surgery (FLACS) and conventional surgery using swept-source anterior segment ocular coherence tomography (SS-ASOCT).MethodsIn this retrospective cross-sectional study, all patients underwent FLACS or conventional cataract surgery. Those with a minimum of 12-months follow-up since surgery were included. Patients with surgical complications were excluded. Demographics, preoperative ocular measurements (axial length, anterior chamber depth), and postoperative measurements [corrected distance visual acuity (CDVA), autorefraction, keratometry, IOL type] were collected. Postoperative IOL tilt and decentration were compared using SS-ASOCT between patients with FLACS and conventional cataract surgery. Subgroup analysis was conducted to analyze tilt and decentration by haptic type (single-piece vs. three-piece).ResultsA total of 188 eyes were included [110 (58.5%) in the FLACS group and 78 (41.5%) in the conventional group]. No differences were observed between the FLACS and conventional groups regarding preoperative parameters. FLACS resulted in less IOL decentration compared to conventional cataract surgery (170 μm vs. 240 μm, p = 0.002). No statistically significant differences were observed between the FLACS and conventional groups in the magnitude and axis of IOL tilt. Both groups had a trend of IOL tilt toward the inferotemporal aspects. Moreover, no difference regarding postoperative CDVA, spherical equivalent, and keratometric astigmatism was observed.ConclusionsFLACS resulted in significantly better long-term IOL centration than conventional surgery with manual capsulotomy. No significant difference in IOL tilt or postoperative CDVA was observed between FLACS and conventional cataract surgery.