Choice Of Procedure Research Articles

Early Detection of the Pathogenetic Variants of Homologous Recombination Repair Genes in Prostate Cancer: Critical Analysis and Experimental Design

It has been shown that the pathogenic variants (PVs) of the DNA Damage Response (DDR) genes, whether of a germinal or somatic nature, represent a predictive biomarker of high sensitivity to treatment with inhibitors of the enzyme poly-ADP-ribose polymerase (PARP) in patients with hormone-resistant metastatic prostate cancer (HRPCa). Moreover, the detection of PVs of the Homologous Recombination Repair (HRR) genes in PCa patients can help to define the patient’s prognosis and the choice of the therapeutic procedure. Among men with metastatic PCa, the frequency of PVs in HRR genes ranges from 11% to 33%, which is a significantly higher rate compared to non-metastatic PCa, where the incidence is between 5% and 10%. Next-Generation Sequencing (NGS) results were more commonly obtained from newly acquired somatic samples compared to archived samples (prostate biopsy or prostatectomy). We developed an experimental multidisciplinary prospective study in patients with a new diagnosis of high-risk PCa at biopsy. The aim was to evaluate the presence of PVs of different HRR genes in patients with the first diagnosis of PCa in relation to a metastatic or non-metastatic stage, tumor aggressiveness, and early risk of progression. Among 43 initial tumor samples from 22 patients, 25 samples from 12 patients were selected for library preparation based on their DNA concentration and quality. After the NGS, 14 different DNA variants were prioritized. Oncogenetic and likely oncogenetic variants were found in the ATM, BRCA1, PTEN, KMT2D, and CDH1 genes. Moreover, variants of uncertain significance were found in ATM, DDR2, FANCA, FOXA1, PLCB4, PTCH1, and RB1.

A decade of AGO QS-Mamma – Adherence to the Recommendations of The AGO Breast Committee for Diagnosis and Treatment in EBC in Routine Therapy in Germany

Introduction: The cure for Early Breast Cancer (EBC) is increasing over the last decades due to the improvement of diagnosis and therapy. Individualization of cancer treatment in EBC requires constant optimization by implementing current guidelines. The AGO (working group gynecologic oncology) QS-Mamma initiative, a quality assurance program (QS) of the AGO Breast Committee, was introduced to provide insight in guideline adherence in real world practice in Germany. We evaluated 10 years of QS-Mamma data to identify gaps and trends implementing those guidelines. Methods: QS-Mamma is a retrospective sample survey providing a representative overview of the treatment landscape for the treatment of breast cancer in Germany. The last six cohorts were analyzed over a period of ten years. Across all cohorts, an average of 264 centers documented a total of n=4,577 patients with EBC. Results: Testing for BRCA mutations in triple-negative patients increased significantly. Breast conserving surgery has been standard of care since the start of data collection; choice of surgical procedure depends primarily on tumor size and nodal status according to the patient´s preference, if possible. Axillary intervention has shifted towards SLNE or targeted axillary procedures in patients with negative preoperative nodal staging. Neoadjuvant systemic therapy (NAST) in operable EBC is established. Anthracycline administration in the adjuvant setting decreases. We noted an uptake on using platinum-containing CTx in TNBC, corresponding to AGO recommendations. Dual HER2 blockade is established in HER2 positive EBC with increased risk of relapse. Changes in guidelines are reflected in real-world data. Conclusion: Guideline adherence in breast cancer care is high and new treatments and diagnostic options are implemented promptly. Finally, escalation and de-escalation of treatment is depending on individual tumor characteristics resulting in the individual risk of recurrence. Guidelines should be flanked by real-world evidence to ensure and survey their impact.

Global trends in surgical approach to neonatal brachial plexus palsy: a systematic review.

We analyzed trends in age at surgery and surgical approach over time and geography. We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus. Regression analysis of age at surgery 1985-2020 showed that age at BPBI surgery is rising (p < 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) (p < 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months (p < 0.05). The incidence of NTwoRE is increasing time. Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.

Cataract surgery combined with glaucoma surgery.

This review evaluates the surgical management of glaucoma in patients undergoing cataract surgery. Combining both procedures present challenges in balancing intraocular pressure (IOP) control, minimizing postoperative complications, and achieving optimal refractive outcomes. Recent studies highlight the effectiveness of combined glaucoma and cataract surgeries, with traditional filtering surgeries and MIGS showing significant IOP reduction. The abundance of long-term studies shows that MIGS can offer an effective and safer alternative when carefully tailored to meet the specific needs of each patient. Combining glaucoma and cataract surgery is a promising approach for patients with coexisting conditions. While traditional surgeries offer robust IOP reduction, MIGS procedures offer better safety profiles with fewer complications and more predictable refractive results. Surgeons must carefully consider the timing and choice of procedures, with further research required to develop standardized treatment algorithms.

Primary tracheo-bronchial adenoid cystic carcinoma: A surgical series with literature review.

Tracheo-bronchial adenoid cystic carcinoma (TBACC) is a rare disease. Its treatment is mainly surgical. We herein describe the clinical and para-clinical varieties of TBACC as well as their surgical treatment and prognosis. We conducted a retrospective study of eight patients operated on between 1994 and 2022 and whose definitive pathological examination concluded with primary TBACC. There were three men and five women with an average age of 44 years. The bronchoscopy found a budding formation reducing the tracheal lumen at the cervical (two cases), middle (two case) and distal trachea and carina (four cases). Bronchial anastomosis resection and sleeve pneumonectomy were the most common procedures. Surgical resections R0 were achieved in five patients. Surgery followed by adjuvant radiotherapy was performed in two patients with incomplete surgical resection R1. The overall survival for all patients with primary ACC was 72% at 5 years. TBACC is a rare and low-to-moderate grade malignant tumour. The choice of the surgical procedure and the appropriate approach is challenging to obtain a promising prognosis.

Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement with Concomitant Valve Disease.

The etiology of increased risk for reoperation after transcatheter aortic valve replacement (TAVR) versus prior surgical aortic valve replacement (SAVR) is poorly understood. This study evaluated the impact of concomitant mitral and tricuspid valve disease on associated risk of TAVR explant. Patients undergoing aortic valve replacement after prior SAVR or TAVR were extracted from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2021). Patients were stratified by TAVR explant status and presence of severe concomitant valve disease for analyses. Risk adjustment was performed using multivariable logistic regression. Interaction terms were utilized to evaluate differential risk of concomitant valve disease for TAVR explant versus redo-SAVR. Of 24,097 redo aortic valve replacement patients, 877 (3.6%) underwent TAVR explant. TAVR explant patients had higher rates of concomitant severe valve disease (17% vs 14%, p<0.001). Patients with severe concomitant valve disease had worse operative mortality after TAVR explant (26.2% vs 14.6%, p<0.001) and redo-SAVR (12.3% vs 6.9%, p<0.001). TAVR explant was independently associated with higher mortality (ORadj 1.3 [1.0-1.6], p=0.030). Severe mitral regurgitation (ORadj 1.2 [1.0-1.6], p=0.017), mitral stenosis (ORadj 2.0 [1.5-2.7, p<0.001), and tricuspid regurgitation (ORadj 1.6 [1.3-1.9], p<0.001) were all associated with mortality, although these factors were not associated with disproportionately higher risk during TAVR explant (p>0.05). TAVR explant cases have a higher burden of severe concomitant valve disease than redo-SAVR cases. Heart teams should consider these findings when discussing initial procedure choices for patients with multi-valve disease given their extreme risk at time of TAVR explant.

National Trends in Lumbar Degenerative Spondylolisthesis With Stenosis Treated With Fusion Versus Decompression.

The purpose of this study is to describe utilization, demographics, complications, and revisions for patients with degenerative spondylolisthesis (DS) with stenosis undergoing decompression or decompression with fusion in the United States. A national insurance database was used to identify patients who underwent either decompression and fusion or decompression alone for management of DS from 2010-2022. Utilization trends, demographics, and complications for each procedure were compared. A total of 162,878 patients were identified, of which 78,043 patients underwent combined single-level lumbar decompression and fusion and 84,835 underwent single-level lumbar decompression alone. Between 2010-2021, lumbar decompression and fusion became the predominant surgical intervention for DS in 2016 and continued to account for more than half of all procedures during the remainder of the study period. Factors such as age, sex, comorbidities, geographic region, and physician specialty training were associated with procedure choice. Decompression with fusion was associated with a lower risk of revision surgery up to 5 years postoperatively and an overall lower incidence of 30-day complications. Decompression with fusion has become the most common treatment for lumbar DS over the past decade despite a lack of compelling evidence supporting its use compared to decompression alone. A variety of patient and surgeon-specific factors is associated with procedure choice. After accounting for cofounders, we identified treatment-specific complications that may be valuable when counseling patients.

Problems of translation of Orthodox non-equivalent lexis to English

Cultural elements and systems often do not match up between two cultures which use different languages, which represents one of the main problems in the domain of translation. This paper is focused on the problems in translating non-equivalent lexicon specific to the Eastern Orthodox Church. The paper presents an overview and a detailed explanation of translation procedures used in dealing with this issue. The author begins with the non-equivalent words in Serbian, as the source language, since it is the language of the community which has been for many centuries back predominantly Eastern Orthodox and thus possesses an appropriate language “apparatus”, and observes their translation equivalents in English, as the target language. The research will show that the choice of the translation procedures is often not exclusively a matter of language. The good translator must not only have a good knowledge of the target language, but also must be familiar with the specific features of the religion and culture of the given society and the source language. Besides, we will point out that the target audience is also an important factor that must be observed in the process of translation.

Assessing the risk factors for surgical site infections after anal reconstruction surgery in patients with anorectal malformations: a retrospective analysis.

This study aimed to identify surgical site infection (SSI) risk factors after anal reconstruction surgery in patients with anorectal malformations (ARMs). This retrospective analysis from January 2013 to December 2022, including all pediatric surgical facilities in Hokkaido, Japan, examined consecutive patients with ARMs, excluding cloacal cases, regarding perioperative and SSI factors during their initial anal reconstruction surgeries. This study involved 157 cases of major clinical groups and 7 cases of rare/regional variants, among whom 4% developed SSIs. SSIs occurrence varied by type and was primarily observed from the neo-anus to the perineal region. Organ/space SSIs occurred in rectourethral fistula (prostatic/bulbar) and perineal (cutaneous) fistula type. Surgical procedures were abdominal sacroperineal rectoplasty, posterior sagittal anorectoplasty, laparoscopic-assisted anorectal pull-through, cutback anoplasty, and Pott's anoplasty, varied based on the ARM type and facility. In perineal (cutaneous) fistula, vestibular fistula, and anal stenosis cases, a significant association was observed between perianal muscle division and SSIs in patients aged > 4months (p = 0.04). No significant SSI factors were found in other ARM types. The choice of procedure as an interventional perioperative factor is suggested to be associated with SSIs. These findings may contribute to making informed decisions regarding surgical procedures in such cases.

Results of carotid stenting in patients with contralateral internal carotid artery occlusion: a retrospective single-center analysis and 22 years of experience.

Patients with contralateral carotid artery occlusion (CCO) represent a subgroup of patients at risk for revascularization procedures. The choice of appropriate revascularization procedure (carotid endarterectomy (CEA) or carotid artery stenting (CAS)) in these patients is controversial. The aim of this study is to share the results of clinical and radiological follow-up after CAS in these patients and to contribute to the literature by evaluating the efficacy and safety of stenting. In our study, the clinical and radiological data of 145 patients with CCO and 145 age-gender-matched patients without CCO who underwent elective CAS in the interventional neuroradiology clinic between 2001 and 2023 were retrospectively analyzed. A comparison was made between short- and long-term outcomes between the two groups. The overall technical success rate of CAS was 99.7% and the 30-day all-cause mortality rate was 1.4%. There was no statistically significant difference between the two groups in terms of early-term (intra-procedural thromboembolic events, post-procedural symptomatic hyperperfusion, intraparenchymal hemorrhage, major and minor ischemic stroke, early-term mortality rate) and long-term (intimal hyperplasia, residual stenosis, major and minor ischemic stroke and long-term all-cause mortality rate) (p > 0.05). In our experience, it was concluded that CAS performed by an experienced interventional neuroradiology team in patients with CCO does not pose an additional risk. Since CCO poses a risk for CAE, CAS may be a more acceptable treatment modality in these patients due to less perioperative risk. However, further research is required to support our findings.

Current surgical treatment of uterine isthmocele: an update of existing literature.

The prevalence of uterine isthmocele, also known as a uterine niche, has risen in parallel with increasing cesarean section (CS) rates, affecting approximately 60% of women depending on their history of cesarean deliveries. This condition, now categorized as cesarean scar disorder (CSD) by the "Delphi consensus," is characterized by one primary or two secondary symptoms. Diagnosis can be made through transvaginal ultrasound, sonohysterography, hysteroscopy, or magnetic resonance imaging (MRI). Management of isthmocele may involve pharmacological or surgical interventions. This review aims to provide a thorough analysis of the surgical management options, focusing on postoperative symptom relief, intraoperative and postoperative complications, length of hospital stay, and impact on secondary infertility. PubMed was comprehensively searched for observational studies from inception to 07.08.2024. Surgical treatments include hysteroscopic resection, laparoscopic procedures, and vaginal approaches, all of which offer comparable symptom relief. However, the vaginal approach is associated with a longer hospital stay. The robotic-assisted approach shows promising results but lacks extensive data. Among surgical options, hysteroscopic treatment has the fewest complications but is generally avoided when residual myometrial thickness (RMT) is less than 3mm. While many CSDs remain asymptomatic, and some women with uterine isthmocele may not wish to conceive, symptomatic patients or those desiring to conceive may benefit from surgical intervention. The choice of procedure should be based on individual patient characteristics, particularly RMT, to define the most appropriate surgical approach.

Simultaneous Traumatic Fractures of the Atlas and Axis: Presentation, Management, and Outcomes from a Series of 103 Consecutive Patients.

Simultaneous fractures of C1 and C2 are increasingly common, but contemporary series are limited in their evaluation. All patients with traumatic fractures of both C1 and C2 admitted to an academic trauma center from 2012 to 2022 were retrospectively analyzed. Multivariable regression was used to identify characteristics relevant to management and outcomes. 103 patients were identified, most of whom (52.4%) were age ≥80 years, suffered ground-level falls (80.6%), and had minor associated injuries (median Injury Severity Score 1), but had a 28.2% 1-year mortality rate. Landells Type 1 fractures were the most common C1 fracture (50.5%), and dens fractures were the most common C2 fracture (74.8%). Most patients did not undergo MRI, but ligamentous injury was seen in 54.8% of those who did. Fourteen patients (13.6%) had surgery upfront, and 7 (6.8%) had surgery after a trial of nonoperative management. Selection for upfront surgery was associated with neurologic deficits (p=0.010) and age (p=0.026). Dens fracture patients tended to have C2 as their lower instrumented vertebra (p=0.0902), and hangman's fracture patients tended to have C3 as theirs (p=0.0714). Upfront surgery decreased the odds of bony nonunion (p=0.0281). 91.7% of patients with bony nonunion with flexion-extension films had fibrous nonunion. Simultaneous atlantoaxial fractures commonly occur in elderly patients after ground level falls with minor associated injuries. Surgical selection is driven by neurologic deficits and age, and C2 fracture type may influence procedure choice. Surgery decreases the odds of bony nonunion, and fibrous nonunion is common in its absence.

Enhanced lion swarm optimization and elliptic curve cryptography scheme for secure cluster head selection and malware detection in IoT-WSN

Wireless Sensor Networks present a significant issue for data routing because of the potential use of obtaining data from far locations with greater energy efficiency. Networks have become essential to modern concepts of the Internet of Things. The primary foundation for supporting diverse service-centric applications has continued to be the sensor node activity of both sensing phenomena in their local environs and relaying their results to centralized Base Stations. Malware detection and inadequate Cluster Heads node selection are issues with the current technology, resulting in a drastic decrease in the total Internet of Things-based performance of sensor networks. The paper proposes an Enhanced Lion Swarm Optimization (ELSO) and Elliptic Curve Cryptography (ECC) scheme for secure cluster head selection and malware detection in IoT-based Wireless Sensor Networks (WSNs). The paper includes network models, choice of Cluster Head (CH) and attack detection procedures. The proposed method chooses the Cluster Head with the best fitness function values, increasing data transmission speeds and energy efficiencies. Minimum Hop Detection has been implemented to provide the best routing paths against attack nodes. Security level for quick data transmissions via the Internet of Things using Wireless Sensor Networks strengthen sinkhole attacks and black hole nodes, which are successfully removed using this method. The proposed method integrates the use of Lion Swarm Optimization and Elliptic Curve Cryptography (ECC) enhances network security by ensuring secure data transmission and preventing unauthorized access, which is particularly important in IoT-WSN environments. The proposed method achieves less End delay, increased throughput of 93%, lower energy utilization of 4%, increased network lifetime of up to 96%, Packet Delivery Ratio of up to 98% and 97% of malicious node detection efficiently compared to existing methods.

Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer

IntroductionDefects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60. MethodsA retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure. ResultsFrom 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% versus 4.2%, P < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% versus 25%, P < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% versus 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45). ConclusionsThese findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.

A Dilemma for Proceduralist Theories of Democracy: Elected Delegates or Elected Monarchs?

Abstract Emphasizing the intrinsic value of formal political equality, a prominent strand of democratic theory—proceduralism—sharply disassociates democracy from substantive justice. This paper elucidates a resultant dilemma: that proceduralism is either underinclusive in its exclusion of robust forms of representative democracy or overinclusive in its inclusion of elective dictatorship. I show how the horns of this dilemma respectively derive from different conceptions of political equality: the standard view, which foregrounds the choice of legislative text itself, and an alternative view, drawn from Robert Dahl’s model of “procedural democracy,” which privileges the choice of procedure by which to resolve disagreement over the choice of text. Conceiving of democracy in terms of political equality alone leads to a rigid characterization of the elected legislature either as an institution whose structure is entirely open or as a mechanism for enacting citizens’ wishes that denies legislators their intuitive input.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P &lt; 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P &lt; 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P &lt; 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

Tracking and Navigation Technologies for Image-Guided Trans-Arterial Interventions

Trans-arterial interventions are an increasingly utilized approach for diagnosing and treating a wide range of pathologies, providing superior patient outcomes compared to traditional open surgical methods. Recent advancements in tracking and navigation technologies have significantly refined these interventions, enhancing procedural precision and success. Advanced imaging modalities, such as fluoroscopy, cone beam computed tomography (CBCT), and intravascular ultrasound (IVUS), are frequently used strategies offering critical real-time guidance. Although fluoroscopy remains the primary choice for many procedures, advancements in CBCT and IVUS have enabled the delivery of detailed volumetric and intravascular imaging while reducing radiation exposure. Aiming to enhance imaging capabilities further, image fusion and augmented reality technologies show substantial potential for integrating multiple datasets into cohesive models, improving instrument tracking and spatial orientation during interventions. Innovations in navigation systems, including electromagnetic, fiberoptic, and robotic navigation, provide additional tracking capabilities for enhanced intra-arterial navigation. This article will review the current advancements in imaging, tracking, navigation, and image fusion technologies and explore their utility in enhancing trans-arterial interventions.

MORTALIDADE NO PERÍODO GESTACIONAL POR COMPLICAÇÕES ANESTÉSICAS: NÚMEROS NACIONAIS DOS ÚLTIMOS 10 ANOS

Brazil stands out globally for the number of cesarean sections performed annually, with figures far exceeding the recommendations of the WHO – World Health Organization. Cesarean delivery requires appropriate anesthetic blockade, with various techniques possible, the most common being spinal anesthesia and, less frequently, general anesthesia techniques. Both regional and general anesthesia techniques have advanced significantly in recent years but are not free from complications, which are associated with both maternal history and the anesthetic procedure itself. Maternal morbidity and mortality during the gestational period is a public health issue, which is also linked to the appropriate choice of delivery method and necessary anesthesia procedure. Therefore, the aim of this study is to examine the national number of maternal deaths related to anesthetic procedures over the past 10 years – from 2014 to 2023 – and to compare national data with international data, based on the most recent scientific literature.

Surgical strategy for metastatic spinal tumors based on Spine Instability Neoplastic Score and patient-reported outcomes: JASA multicenter prospective study.

Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0-6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0-9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient's background and the plan for postoperative adjuvant therapy.

Treatment patterns of childhood glaucoma in the United States: Analysis of IRIS® Registry (Intelligent Research in Sight)

PurposeTo investigate treatment patterns of childhood glaucoma in the United States. DesignRetrospective clinical cohort study SubjectsPatients under 18 years of age with a diagnosis code for glaucoma between January 1, 2013, and December 31, 2020, in the IRIS® Registry (Intelligent Research in Sight). MethodsPatient demographic information and clinical characteristics were extracted. A Cox regression model was used to determine predictors of undergoing incisional glaucoma surgery. Main Outcome MeasuresThe primary outcomes were the percentage of childhood glaucoma eyes that underwent glaucoma-related procedures and those receiving intraocular pressure (IOP)-lowering medications. Our secondary outcomes were hazard ratios (HRs) of demographic and clinical factors for undergoing incisional surgeries. ResultsA total of 5017 eyes of 3069 patients were included in this study. Based on billing codes, 208 eyes (4.1%) had primary congenital glaucoma (PCG), 1911 eyes (38.1%) had juvenile open-angle glaucoma (JOAG), 999 eyes (19.9%) had glaucoma following cataract surgery (GFCS), and 1646 (32.8%) had secondary glaucoma other than GFCS. Out of 5017 eyes with childhood glaucoma, 808 eyes (16.1%) underwent glaucoma-related procedures, and 4698 eyes (93.6%) received antiglaucoma medications. Angle surgery was the most common first-recorded procedure for PCG, and tube shunt surgery for GFCS and secondary glaucoma. Laser trabeculoplasty was mainly performed for JOAG by non-glaucoma subspecialists. Factors associated with higher likelihood of incisional surgeries were PCG (vs. JOAG, HR 5.40, 95% confidence interval [CI] 1.55–18.84, p = 0.008), increase in IOP (HR 1.06 per mmHg, CI 1.05–1.08, p<0.001), and index date at age < one year (vs. ages 11–15 years, HR 6.08, CI 1.51 – 24.44, p = 0.011). Being cared for by a non-glaucoma subspecialist was associated with a lower likelihood of undergoing incisional surgery (HR: 0.32 (95%CI: 0.23 – 0.44, p<0.001). ConclusionsWe found that 1 in 6 childhood glaucoma eyes underwent glaucoma-related procedures, and nearly all received antiglaucoma medications. The choice of first-recorded procedure differed across age and diagnosis. Type of glaucoma, baseline IOP, age, and type of treating subspecialist were predictors for undergoing incisional glaucoma surgery.