Preservation Group Research Articles

Comparative biocompatibility and antimicrobial studies of sorbic acid derivates

Nowadays, the sorbates are the third largest group of antimicrobial preservatives in food and pharmaceutical industries, following the parabens and benzoates whose safety is questioned by recent publications. A disadvantage of sorbates is their pH dependence, as their antimicrobial effect is greatly reduced in alkaline environment. The main, widely used sorbate derivatives are sorbic acid and potassium sorbate, no sorbic acid esters are involved in current industrial application. We aimed to test whether the esters of sorbic acid are capable to extend the antimicrobial spectrum of the original molecule while maintaining its advantageous biocompatibility profile. A comparative biocompatibility study of different derivatives (sorbic acid, potassium sorbate, isopropyl sorbate and ethyl sorbate) was carried out. In vitro cell viability assays of MTT (2-(4,5-dimethyl-2-thiazolyl)-3,5-diphenyl-2H-tetrazolium bromide), Neutral Red (3-amino-7-dimethylamino-2-methylphenazine hydrochloride) and flow cytometry with propidium iodide and annexin were performed on Caco-2 cells. In case of in vivo toxicity study, G. mellonella larvae were injected with different concentrations of the test compounds. Time-kill tests were executed on reference strains of C. albicans, E. coli, and S. aureus. According to the MTT-assay, the IC50 values were the following: ethyl sorbate, sorbic acid <0.045% w/w, isopropyl sorbate 0.32% w/w, potassium sorbate >0.75% w/w, while Neutral Red values were >0.75% w/w for the esters and potassium sorbate and 0.66% w/w for sorbic acid. Flow cytometry results indicated the higher cell damage in case of isopropyl sorbate. However, the cytotoxic results of isopropyl sorbate, in vivo toxicity study on G. mellonella larvae did not show significant mortality. It was found, that the antimicrobial properties of isopropyl sorbate were outstanding compared to sorbic acid and potassium sorbate. These results indicate, that the use of sorbate esters can be advantageous, hence, further toxicity studies are needed to prove their safety.

Importance of pulmonary valve morphology for pulmonary valve preservation in tetralogy of Fallot surgery: comparison of the echocardiographic parameters.

BackgroundThe decision to use transannular patching (TAP) during tetralogy of Fallot (TOF) repair depends on the pulmonary valve annulus size; the z score of the pulmonary annulus is the most commonly used predictor. However, definitive results are not obtained with z scores as different z score data sets are used for different parameters.PurposeThis study aimed to identify the echocardiographic and other key factors that warranted a change in the surgical method during TOF surgery.MethodsSixty-two patients were enrolled and divided into a pulmonary valve (PV) preservation group and a TAP group. Their medical records were reviewed.ResultsThe z score for PV annulus (PVA), ratio of the PVA to aortic annulus size, and ratio of PVA to descending aorta (DAO) size were significantly different between the PV preservation and TAP groups (-1.72±1.52 vs. -3.07±1.94, P=0.004; 0.62±0.12 vs. 0.50±0.14, P=0.002; and 1.32±0.32 vs. 1.07±0.36, P= 0.008, respectively). For TAP repair, the PVA z score had a sensitivity of 65.4% and specificity of 73.1%, ratio of PVA to aortic annulus size had a sensitivity of 73.1% and specificity of 65.4%, and ratio of PVA to DAO size had a sensitivity of 69.2% and specificity of 57.7%. The TAP group showed more monocuspid PVs (P=0.011), while the PV preservation group showed more tricuspid PVs (P=0.027). Commissurotomy was more frequently performed in the PV preservation group than in the TAP group (P=0.001). Of patients with commissurotomy, 58% showed a PV z score<-2.ConclusionAlthough various echocardiographic parameters may serve as predictors for determining surgical methods for TOF patients, the PV morphology and tissue characteristics should also be considered.

PSS10 PRESERVATIVE-FREE VERSUS PRESERVED GLAUCOMA EYE DROPS AND OCCURRENCE OF GLAUCOMA SURGERY. A RETROSPECTIVE COHORT STUDY BASED ON THE FRENCH NATIONAL HEALTH INSURANCE INFORMATION SYSTEM, 2008-2016

Preservatives contained in glaucoma eye drops have been shown to have a deleterious impact on the ocular surface. This study aimed to assess the influence of preservatives on the occurrence of further glaucoma surgery among patients with glaucoma or ocular hypertension in France. This retrospective cohort study consisted of an analysis of data from a French medical-administrative database (Échantillon Généraliste des Bénéficiaires (EGB)). The study concerned all patients who first received glaucoma eye drops treatments in the EGB database between 2008 and 2016 and received at least 3 months of treatment claim within the first year of follow-up. Three groups were created according to the level of preservative consumption during the whole follow-up: “0% preservatives”, “mixed” and “100% preservatives”. The risk of glaucoma surgery was estimated according to preservative exposure group in Cox multivariate models. The adjustment variables were age, sex, number of glaucoma eye drops classes, use of systemic anti-hypertensive treatment, and duration of exposure to intraocular pressure (IOP)-lowering agents. The sample consisted of 12,454 patients firstly treated for glaucoma or ocular hypertension between January 2008 and December 2015. The median (interquartile range) follow-up was 4.1 (1.7-6.1) years. A total of 231 (1.9%) patients underwent glaucoma surgery during follow-up. On multivariable analysis, the risk of glaucoma surgery was increased for the “100% preservative” group (HR=7.97 [95% CI, 3.07-20.67]) and for the “mixed” group (hazard ratio [HR] = 3.94 [95% CI, 1.54-10.05]) when compared with the 0% preservatives group. We found an association between exposure to glaucoma eye drops preservatives and the occurrence of further glaucoma surgery. In real life, these results support the use of preservative-free glaucoma eye drops among a large sample of patients in a long-term basis.

Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.

ObjectiveThis study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.MethodsThis retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.ResultsThis study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.ConclusionPlacental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.

Comprehersive warming nursing measures in perioperative period of neonates

Objective To explore the application effect of warming nursing measures in perioperative period of neonates. Methods From January 2017 to December 2018, 56 neonates who underwent surgery in the Operating Room of Foshan Women and Children Hospital were selected as the study subjects. According to the different thermal protection measures during operation, they were divided into normal temperature group (n=28) and heat preservation group (n=28) . The number of hypothermia, the changes of intraoperative temperature, and the complications of postoperative chills and anxiety were compared between the two groups. Results The number of hypothermia in the normal temperature group was higher than that in the heat preservation group, the difference between the two groups was statistically significant (P<0.05) . The body temperature of the children in the heat preservation group was higher than that of the control group at each time point during operation, and the differences were statistically significant (P<0.05) . The number of anxiety and chills in the heat preservation group was lower than that in the normal temperature group, and the difference between the two groups on the number of chills was statistically significant (P<0.05) . Conclusions The use of external liquid heating, electric blanket heating combined with local warming and surgical instrument pre-warming treatment in the operation process is a effective nursing measure to prevent neonatal hypothermia, which can effectively reduce the occurrence of complications. Key words: Infant, newborn; Perioperative nursing; Hypothermia; Comprehensive nursing

The effects of triptolide on the cellular activity of cryopreserved rat sciatic nerves and nerve regeneration after allotransplantation

Purpose: To investigate the effects of triptolide (T10) on the cellular activity of cryopreserved rat sciatic nerves and nerve regeneration after allotransplantation.Materials and methods: After the optimal T10 concentration was determine, sciatic nerve fragments from Sprague-Dawley (SD) rats were randomly divided into 5 groups: the fresh nerve group (group A), the Dulbecco’s modified Eagle’s medium (DMEM)-preservation group (group B), the T10-preservation group (group C), the T10-pretreatment, DMEM-preservation group (group D), and the T10-pretreatment, T10-preservation group (group E). The nerves in the preservation groups were preserved at 4 °C for 4 w. Then, either cryopreserved or fresh nerves were used to repair 10-mm sciatic nerve defects in Wistar rats (group A′, group B′, group C′, group D′, and group E′, which correspond to the nerve groups described above); in addition, one fresh homologous transplantation group (group F′) was established.Results: Nerve growth factor (NGF) was expressed at significantly higher levels in the groups treated with the T10 solution at 37 °C. After rat sciatic nerves were cryopreserved for 4 w, group E had increased numbers of live nerve cells and increased levels of biological activity (P < 0.001) and reduced levels of immunogenicity (P < 0.001) when compared with those for the other groups. Sixteen weeks after transplantation, recipient nerve regeneration in group E′ was increased compared with that in groups A′, B′, C′, and D′ (P < 0.05).Conclusions: The application of T10 in vitro induced the expression of neurotrophic factors in rat sciatic nerves, increased the biological activity of cryopreserved nerves, reduced immunogenicity, and promoted recipient nerve regeneration after allotransplantation.

Impact of Gait Speed on the Obesity Paradox in Older Patients With Cardiovascular Disease

PurposeThe purpose of this study was to determine whether gait speed affects the obesity paradox in older patients with cardiovascular disease. MethodsThe study population consisted of 2224 patients ≥60 years old with cardiovascular disease admitted to hospital between May 1, 2006, and January 31, 2018. Body mass index (BMI) and gait speed before hospital discharge were determined, and patients were divided into two groups: slow and preserved gait speed (≤0.8 and >0.8 m/s, respectively), according to the algorithm for sarcopenia diagnosis. The slow and preserved gait speed groups were also further subdivided according to BMI: <18.5 kg/m2, 18.5–24.9 kg/m2, and BMI ≥25.0 kg/m2. The study endpoint was all-cause mortality. ResultsThe study population (male: 66.7%) had a mean age of 73.1 ± 7.6 years. Over a median follow-up period of 1.69 years (interquartile range 0.67–3.67 years), 283 patients died. Higher BMI was associated with favorable prognosis in the group with preserved gait speed but not in the group with slow gait speed after adjusting for other prognostic factors. Adding BMI to the clinical model significantly increased the area under the receiver operating characteristic curve in the group with preserved gait speed (0.744 vs 0.726, P = 0.028) but not in the group with slow gait speed (0.716 vs 0.716, P = 0.789). ConclusionsHigher BMI was consistently associated with favorable prognosis in patients with cardiovascular disease and preserved gait speed but not in those with slow gait speed. These findings indicated that physical frailty influences the obesity paradox in older patients with cardiovascular disease.

Internal carotid artery occlusion may affect long-term quality of life in patients with high-flow carotid cavernous fistulas

To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly (P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant (P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant (P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.

Surgeon Ability to Appropriately Address the Calcified Cartilage Layer: An In Vitro Study of Arthroscopic and Open Techniques

Background: Microfracture is a commonly utilized cartilage restoration technique for articular cartilage defects. While the removal of the calcified cartilage layer (CCL) has been shown to be critical with in vivo models, little is known with regard to surgeon reliability to adequately perform the technique. Purpose: To evaluate surgeon reliability in removing the CCL utilizing open and arthroscopic techniques. Study Design: Controlled laboratory study. Methods: Eleven cadaveric knees were utilized to create four 12-mm diameter defects in the anterior and posterior medial femoral condyles. Eleven fellowship-trained surgeons were asked to perform the following procedures: remove the CCL open, retain the CCL open, remove the CCL arthroscopically, and retain the CCL arthroscopically. Samples underwent histologic staining and analysis with 3-dimensional micro–computed tomography. The latter was used to calculate the percentage of the CCL that was removed or retained across the entire defect. Results: When surgeons were asked to retain the CCL arthroscopically, 48% ± 41% (mean ± SD) remained. When surgeons were asked to remove the CCL arthroscopically, 24% ± 35% remained. There was no statistical difference between these groups (P > .05). When the CCL was retained during open preparation, 60% ± 39% remained. During attempts to remove the CCL in an open manner, 19% ± 28% remained. There was a significant difference in the amount of CCL remaining between the open removal and open retaining groups (P = .03). There were no significant differences in the percentage of CCL remaining between the open and arthroscopic preservation groups and between the open and arthroscopic removal groups. Conclusion/Clinical Relevance: This study highlights the significant variability in surgeon ability to reliably retain or remove the CCL. However, there appears to be improved ability of surgeons to more reliably remove or retain the CCL in an open fashion as compared with the arthroscopic approach.

Reduced Network Dynamics on Functional MRI Signals Cognitive Impairment in Multiple Sclerosis.

Background Previous studies have demonstrated extensive functional network disturbances in patients with multiple sclerosis (MS), showing a less efficient brain network. Recent studies indicate that the dynamic properties of the brain network show a strong correlation with cognitive function. Purpose To investigate network dynamics on functional MRI in cognitively impaired patients with MS. Materials and Methods In secondary analysis of prospectively acquired data, with imaging performed between 2008 and 2012, differences in regional functional network dynamics (ie, eigenvector centrality dynamics) between cognitively impaired and cognitively preserved participants with MS were investigated. Functional network dynamics were computed on images from functional MRI (3 T) by using a sliding-window approach. Cognitively impaired and preserved groups were compared by using a clusterwise permutation-based method. Results The study included 96 healthy control subjects and 332 participants with MS (including 226 women and 106 men; median age, 48.1 years ± 11.0). Among the 332 participants with MS, 87 were cognitively impaired and 180 had preserved cognitive function; mildly impaired patients (n = 65) were excluded. The cognitively impaired group included a higher proportion of men compared with the cognitively preserved group (35 of 87 [40%] vs 48 of 180 [27%], respectively; P = .02) and had a higher mean age (51.1 years vs 46.3 years, respectively; P < .01). The clusterwise permutation-based comparison at P less than .05 showed reduced centrality dynamics in default-mode, frontoparietal, and visual network regions on functional MRI in cognitively impaired participants versus cognitively preserved participants. A subsequent correlation and hierarchical clustering analysis revealed that the default-mode and visual networks normally demonstrate negatively correlated fluctuations in functional importance (r = -0.23 in healthy control subjects), with an almost complete loss of this negative correlation in cognitively impaired participants compared with cognitively preserved participants (r = -0.04 vs r = -0.14; corrected P = .02). Conclusion As shown on functional MRI, cognitively impaired patients with multiple sclerosis not only demonstrate reduced dynamics in default-mode, frontoparietal, and visual networks, but also show a loss of interplay between default-mode and visual networks. © RSNA, 2019 Online supplemental material is available for this article. See also the article by Eijlers et al and the editorial by Zivadinov and Dwyer in this issue.

Preservation of the Arachnoid Membrane During Encephaloduroarteriosynangiosis Reduces Postoperative Complications without Undermining the Surgical Outcome in Pediatric Moyamoya Disease

Encephaloduroarteriosynangiosis (EDAS) is a commonly used indirect revascularization operation method to treat pediatric patients with Moyamoya disease (MMD). Arachnoid dissection frequently has been performed during the EDAS operation to promote better revascularization. However, no studies have yet proven its surgical benefits. In this study, we investigated the impact of arachnoid preservation on the surgical outcome and postoperative complication by comparing pediatric patients with MMD who had the arachnoid membrane preserved during EDAS operation with those who had it dissected. This was a retrospective cohort study based on a single surgeon's experience at a single institution. A total of 206 pediatric patients with MMD who underwent EDAS operation at Seoul National University Children's Hospital were recruited for the study. We compared the surgical outcome and the postoperation complication rate of these 2 groups. Furthermore, risk factors for postoperative complication were analyzed. The overall clinical outcome (P= 0.342) and the extent of revascularization of middle cerebral artery territories (P= 0.736) were not different between the arachnoid dissection group and the arachnoid preservation group. However, the postoperative infarction/hemorrhage rate was significantly greater in the arachnoid dissection group (P= 0.005). Arachnoid dissection (P= 0.011) and young age (<3 years old, P= 0.012) were significantly associated with increased risk of postoperative complications. Arachnoid preservation may help to reduce postoperative complications without decreasing the surgical outcome of EDAS. Furthermore, factors such as the patient's age should be taken into account when treating pediatric patients with MMD.

Long-term quality of life and sensory impact of great auricular nerve preservation in parotid surgery as measured with the Parotidectomy Outcome Inventory-8.

This study aimed to evaluate sensory dysfunction resulting from great auricular nerve (GAN) sacrifice versus preservation in parotid surgery for benign lesions and its imact on long-term health-related quality of life (QOL). Retrospective. Participants were divided into two groups (GAN and non-GAN), and both short-term (two postoperative weeks) and long-term (at least 5years) QOL were assessed. The second item of the Parotidectomy Outcome Inventory-8 (POI-8) was used to analyse postoperative sensory loss. All items of the POI-8 questionnaire were used to determine health-related QOL.We used t test for dependent samples and Mann-Whitney U-test to compare patient groups PARTICIPANTS: A total of 137 patients (65 male and 72 female) enrolled in this study. Average age at the time of surgery was 53years (±12.8). The GAN preservation group had significantly better sensation than the GAN sacrifice in short term (2.8 vs 2.1; P=0.017). Both groups experienced improved sensation in the long term, and there was a trend towards better QOL in the GAN-preservation group. However, the difference in sensation was not statistically significant (1.7 vs 1.3; P=0.145). Health-related QOL also increased in the long term (compared to short term) for both groups (7.6±6.2 to 12±7.6; P<0.0001) postoperatively. GAN preservation did not significantly improve sensation in long term, nor did it increase health-related QOL postoperatively. Although GAN preservation was easily feasible, it only improved sensation in short term. We report a negative result: GAN preservation did not significantly improve sensation in long-term, nor did it increase health-related QOL postoperatively when compared to GAN sacrifice.

Transaortic valvular replacement prognosis according to aortic stenosis category

Transcatheter aortic valve replacement (TAVR) has revolutionized the prognosis of patients with severe aortic stenosis. Four categories of aortic stenosis can be defined depending on left ventricular ejection fraction (EF), mean transvalvular gradient and stoke volume index. Whether aortic stenosis category influence prognosis after TAVR regarding functional improvement and mortality. In total, 263 TAVR patients with a complete baseline echocardiography and one year follow-up, were retrospectively classified into four categories: high gradient ( n = 211); low-flow, low-gradient aortic stenosis with reduced EF ( n = 21); low-flow, low-gradient aortic stenosis with preserved EF ( n = 8) and normal-flow, low-gradient aortic stenosis with preserved EF ( n = 23). At 12 months follow-up, 39 deaths occurred (14.8%): 25 in the high gradient group (11.8%), 9 in the low-gradient, low-flow, reduced EF group (43%), 1 in the low-gradient, low-flow, preserved EF group (12.5%), 4 in the low-gradient, normal flow group (17.4%). In a multivariate model, one-year all-cause mortality was higher in low-gradient, low-flow, reduced EF group ( P < 0.0001) than in others (HR = 3.86; 95% CI 1.83–8.14; P = 0.0004). Patients with low-gradient, low-flow, reduced EF had less improvement in terms of dyspnea one month after the procedure with more patients in the NYHA 4 stage in this group ( P = 0.003). A complete echocardiography is necessary to evaluate aortic stenosis, its severity and its type before TAVR. Patients with low-gradient, low-flow reduced EF had a higher mortality rate one year after TAVR and remained more symptomatic one month after the procedure.

Usefulness of a Pretreatment CT-Based Modified RENAL Nephrometry Score in Predicting Renal Function After Cryotherapy for T1a Renal Mass.

We investigated the usefulness of the modified RENAL nephrometry (mRN) scoring system for predicting post-cryotherapy renal function in patients with T1a renal mass. A total of 75 patients with a T1a renal mass were enrolled. The mRN score was determined based on the tumor size, the tumor's exophytic/endophytic properties, the tumor's nearness to the collecting system, and the anterior/posterior location of the kidney. The change in the estimated glomerular filtration rate (ΔeGFR) was calculated as follows: ΔeGFR = 100 × ([pretreatment eGFR - eGFR at 6months after cryotherapy]/pretreatment eGFR). Based on the ΔeGFR results, we classified the patients into two groups: a preserved renal function group (ΔeGFR < 10%) and an impaired renal function group (ΔeGFR ≥ 10%). We then analyzed the relationships between the mRN score and ΔeGFR and between the mRN score and the chronic kidney disease (CKD) stage. The mean ΔeGFR for all patients was 5.5%. The mRN scores of the preserved renal function group (5.8 ± 0.3) were significantly lower than those of the impaired group (7.4 ± 0.3) (p < 0.001). When the mRN score cutoff value was set at 7 points, the mRN had 67.7% sensitivity, 72.7% specificity, 61.8% positive predictive value (PPV), 76.1% negative predictive value (NPV), and 70.7% accuracy for predicting impaired renal function. For predicting a deterioration of CKD stage, the mRN had 92.9% sensitivity, 67.2% specificity, 39.4% PPV, 97.6% NPV, and 72% accuracy. Our newly proposed modified RENAL nephrometry score was suggested to be useful for predicting renal function after renal cryotherapy.

Effect of Prophylactic Ilioinguinal Neurectomy on Postoperative Groin Pain Following Lichenstein Hernioplasty.

To compare mean postoperative pain post-Lichenstein open hernioplasty with and without ilioinguinal neurectomy at six months. Randomised controlled trail. Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, from August 2014 to February 2015. Adult male patients with unilateral reducible inguinal hernia, who consented to the study between the age range of 18-80 years, were included. Recurrent, irreducible or strangulated, or large inguinal-scrotal hernia and those with previous abdominal incision, impaired cognition, peripheral neuropathy, limited mobility and females were excluded. Patients were equally randomised to nerve-preservation and excision groups. Mann-Whitney U-test was applied to find out difference in inguinodynia at 1 and 6 months. There was significant difference in pain at 1 month in the nerve-preservation group (Md=6.00, IQR=4, n=90) and nerve excision group (Md=3.50, IQR=4, n=90), U=2308.00, z=-5.017, p<.001 and at 6 months in the nerve preservation group (Md=2.00, IQR=1, n=90) and nerve-excision group (Md=0.00, IQR=1, n=90), U=3001.00, z=-3.470, p=0.001. Prophylactic ilioinguinal neurectomy significantly reduces groin pain at 6 month as compared to nerve preservation group following Lichenstein hernioplasty.

Comparison of parathyroid hormone levels between orthotopic preservation of parathyroid gland and immediate active autotransplantation

Objective To compare the effects of in situ parathyroid preservation during total thyroidectomy and immediate active parathyroid transplantation (parathyroid tissue homogenate injection) on the level of parathyroid hormone (PTH) and serum calcium in patients after thyroidectomy. Methods The clinical data of 74 patients undergoing total thyroidectomy were analyzed. The patients were divided into two groups: in situ preservation group (control group) and immediate active autotransplantation group (experimental group) according to the different managements of parathyroid gland during operation. The levels of serum Ca2+ and PTH on day 1, 3, 5, 7 and 30 after operation in the two groups were analyzed. Results There was no significant difference in PTH between the experimental group and the control group (46.2±17.3), (50.6±15.7) pg/ml, before operation (P>0.05). There was no significant difference in serum calcium between the experimental group and the control group (2.21±0.12), (2.17±0.10) mmol/L, before operation (P>0.05). The PTH of the control group was (19.8±7.6), (22.4±9.4), (18.8±8.5) pg/ml, on the 1st 3rd and 5th day after operation, and the PTH, of the experimental group was significantly higher than that of the experimental group (11.7±5.5), (12.6±7.9), (13.5±8.7) pg/ml, had significant difference (P 0.05). The levels of PTH [(16.5±7.5) pg/ml] and serum calcium [(1.85±0.17) mmol/L] in the control group were significantly lower than those in the experimental group [(22.3±8.4) pg/ml and (2.02±0.18) mmol/L], on the 30th day after operation. The difference was statistically significant (P<0.05). Conclusion Immediate active autotransplantation of multiple parathyroid gland is helpful to reduce the hypoparathyroid function after total thyroidectomy, and the injection of parathyroid tissue homogenate is easier to carry out and the effect is better. Key words: Total thyroidectomy; Parathyroid gland autotransplantation; Parathyroid hormone

Elective ilio-inguinal neurectomy for prevention of chronic pain after inguinal hernia meshplasty

Background: This study has been carried out on 60 patients of inguinal hernia (either direct or indirect) from February 2016 to August 2017 who were admitted in the surgical ward of Index Medical College Hospital & Research Centre, Indore (M.P.). All patients were admitted through outpatient department. Method: The patients were divided into two groups: Group I and Group II. Each group consisted of 30 patients. Only male patients were included in the study. Surgery was organized within the hospital structure in the same way as other elective patients admitted in general surgical ward. Patient was fully explained about the procedure and its complications and was included in the study only after his written consent. Written explicit consent was taken in patients own language for group I patients. Result: The mean age of patients in nerve excision group (I) was 51.6 ± 18.1 years whereas in nerve preservation group (II) it was 50.3 ± 11.6 years. All the patients in both the groups were male. Patients suffering from pain were relatively much higher at 1 month irrespective of preservation or division of nerve. At 3 months after surgery both the groups had equal number of patients (2) with pain and continued resolution of pain symptom was thus noted. Conclusion: There is considerable evidence in world literature that supports the contention that in inguinal Hernia Meshplasty Neurectomy is associated with decreased incidence of pain after open hernia surgery. Keeping in mind the results emerging from the present study it may be suggested that routine identification and elective excision of the ilioinguinal nerve may be reasonable option without any significant added morbidity to prevent the chronic; pain in inguinal hernia repair with mesh. But a larger prospective randomized study is still required to confirm the benefit benefits of routine ilioinguinal neurectomy while doing open inguinal hernia repair with mesh.

Utero-ovarian preservation and overall survival of young women with early-stage borderline ovarian tumors.

To examine survival of women who had uterine and ovarian preservation during surgical treatment for early-stage borderline ovarian tumors (BOTs). The Surveillance, Epidemiology, and End Results Program was used to identify women aged < 50years with stage I BOTs who underwent ovarian conservation at surgical treatment between 1988 and 2003. Survival outcomes were examined based on the use of concurrent hysterectomy at surgery. Among 6379 cases of BOT, there were 1065 women who had utero-ovarian preservation at surgery, and there were 52 women who had hysterectomy with ovarian preservation alone. Women who had uterine preservation were more likely to be single and diagnosed in recent years (both, P < 0.05). On univariable analysis, women who had utero-ovarian preservation had cause-specific survival similar to those who had ovarian preservation alone without uterine preservation (10-year rates: 99.2% versus 98.1%, P = 0.42); however, overall survival was higher in the utero-ovarian preservation group compared to the hysterectomy group (95.8% versus 87.6%, P < 0.001). On multivariable analysis, utero-ovarian preservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.35, 95% confidence interval 0.15-0.79, P = 0.012). Cardiovascular disease mortality was lower in the utero-ovarian preservation group compared to the hysterectomy group, but it did not reach statistical significance (20-year cumulative rate, 0.8% versus 3.0%, P = 0.29). Our study suggests that utero-ovarian preservation for young women with early-stage BOTs may be associated with improved overall survival compared to ovarian preservation alone without affecting BOT-related survival outcome.

Ex-vivo perfusion as a successful strategy for reduction of ischemia-reperfusion injury in prolonged muscle flap preservation – A gene expression study

IntroductionWith the introduction of vascularized composite allotransplantation (VCA) as new surgical technique, the need arose for strategies that could safely prolong graft preservation. Ex-vivo machine perfusion is a promising technique and is currently applied in solid organ transplantation. There is still limited evidence in the field of VCA and free flap transplantation. This gene expression study aimed to assess the degree of ischemia-reperfusion (IR) injury after preservation and replantation of free muscle flaps in a porcine model. Materials and methodsA microarray analysis was first conducted on muscle flaps preserved by ex-vivo perfusion versus cold storage, to select genes of interest for further investigation. The expression of these selected genes was then examined in a muscle flap replantation model after 18 hour ex-vivo perfusion (n = 14) using qRT-PCR. Two preservation solutions were compared to static cold storage: University of Wisconsin-mp (n = 5) and Histidine-Tryptophan-Ketoglutarate solution (n = 5). ResultsA selection of 8 genes was made based on micro-array results: Tumor necrosis factor receptor superfamily member 10-A like, Regulator of G-protein signaling 2, Nuclear factor kappa beta inhibitor zeta, Interleukin-1 beta, Fibroblast growth factor 6 and DNA damage-inducible transcript 4, Hypoxia-inducible factor 1-alpha and Caspase-3. The muscle flap replantation experiment compared their expression patterns before and after preservation and replantation and showed overall comparable gene expression between the preservation groups. ConclusionsThe expression of genes related to ischemia, apoptosis and inflammation was comparable between the ex-vivo perfusion and static cold storage groups. These results suggest that ex-vivo perfusion might be a promising technique for 18 hour muscle preservation in terms of decreasing ischemia-reperfusion injury.

The Effect of Prostaglandin E1 on Pulmonoplegia before and after Ex Vivo Lung Perfusion

Purpose The lungs on ex vivo lung perfusion (EVLP) are kept under suboptimal condition in terms of graft preservation and their status can be compromised against cold ischemia (CI) after EVLP. Prostaglandin E1 (PG) is routinely used for pulmonoplegia against CI in clinical practice, however not used after EVLP. In this study, we investigated the effect of PG on graft preservation for the lungs before and after EVLP. Methods Lewis rats lungs were procured with cold Perfadex and were assigned for 4 different preservation groups: 1) 8h CI, 2) 8h CI with PG, 3) 2h EVLP + 6h CI and 4) 2h EVLP + 6h CI with PG. Lungs in group 3 and 4 were subjected to normothermic EVLP for 2h then kept under 4°C for 6h. PG (30 μg) was intravenously administered into grafts at graft procurement for group 2 and those at 2h EVLP for group 4. After preservation, left lungs in all groups were transplanted orthotopically using cuff technique in syngeneic rats and evaluated 2h after reperfusion. Results The lungs treated with PG on procurement showed better graft function after transplant following 8h CI than those without PG. Also, less inflammation and less endothelial barrier damage were found in PG treated lung tissue than control. However, the lungs treated with PG after EVLP showed worse posttransplant graft quality compared to those with no treatment after EVLP, although there was no difference in EVLP data. Further analysis showed PG depleted energy in the tissue after EVLP. Conclusion Lungs can obtain CI tolerance via a PG-induced protection mechanism that appears to be supported by cellular energy production. Importantly, PG may be unsuitable for post-EVLP pulmonoplegia due to disrupted cellular metabolic environment.