Reduce Blood Loss Research Articles

Comparison of Mean Postoperative Hemoglobin Concentrations in Patients Undergoing Total Knee Arthroplasty With Intravenous Versus Intraarticular Administration of Tranexamic Acid.

Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid(TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXAadministered IVvs IAafter TKA. To assess the effectiveness of intraarticular TXA against intravenous administration. The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution"straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant. There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA. This study demonstrates that IAadministration of TXAis more effective in maintaining higher postoperative hemoglobin concentrations compared to IVTXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.

Improving C1 Pedicle Screw Placement for Atlantoaxial Instability with Ultrasonic Bone Burr Assistance

This study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability (AAI) treatment, compared to the conventional high-speed drill (HSD) technique. A retrospective analysis was conducted on patients undergoing posterior screw-rod fixation for AAI between December 2017 and July 2023. The patients were divided into two groups based on the tools used for screw placement: UBB and HSD. Data on surgical duration, estimated blood loss, spinal cord and arterial injury incidence, screw placement accuracy, neurological status measured by the Japanese Orthopedic Association (JOA) score and fusion rates, were collected and analyzed. 13 patients received C1 pedicle screw placement via UBB facilitation, while 8 were treated using the HSD approach. The UBB group showed a significant reduction in blood loss and operation time compared to the HSD group (P=0.002 and P<0.001, respectively). No spinal cord or arterial injuries occurred in either group. Optimal screw placement was confirmed in all UBB cases versus 87.5% in the HSD group (P=0.139). Both groups demonstrated significant improvements in JOA scores with no inter-group difference. The fusion rate was 100% in the UBB group and 87.5% in the HSD group, not statistically different (P=0.381). UBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.

Oxytocin with calcium vs oxytocin for induction of labor in women with term premature rupture of membranes: a randomized controlled trial

BackgroundIntravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean section, but this regimen has not been compared in vaginal labor induction. ObjectiveTo determine the efficacy of oxytocin combined with calcium versus oxytocin alone for inducing labor among women with term premature rupture of membranes (PROM). Study designThis single-blind, randomized control trial was conducted between October 2022 and May 2023 in a tertiary university hospital. Patients diagnosed with PROM were randomly allocated into two groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n = 210), whereas the control group received only oxytocin infusion (n = 218). The primary outcome was successful vaginal deliveries within 24 hours of labor induction. Secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications. ResultsBaseline characteristics, including maternal age, BMI, Bishop score before labor induction, were comparable between groups. The rate of vaginal delivery within 24 hours of labor induction was statistically higher in the intervention group (79.52% vs. 70.64%; P = 0.04). Participants in intervention group experienced a shortened interval between induction and delivery (10.48 h vs. 11.25h; P = 0.037), and demonstrated a higher success rate in induction of labor assessed by the onset of active phase (93.80% vs. 87.61%; P = 0.04) without increasing the cesarean rate. Reduced hemorrhage was presented in the intervention group (242.5ml vs. 255.0ml; P = 0.0015) while the maternal and neonatal outcomes were comparable between groups. ConclusionThe co-administration of calcium and oxytocin in labor induction among pregnancies with PROM was more efficient and safer than oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes.

Comparative analysis of early versus late surgical intervention for lumbosacral hemivertebra: a minimum 2-year follow-up retrospective study

BACKGROUND CONTEXTLumbosacral hemivertebra (LSHV) is a complex and unique congenital spinal deformity characterized by early severe trunk imbalance and progressive compensatory curve. Previous studies have proved the efficiency of posterior LSHV resection. However, the optimal timing for surgical intervention of LSHV still remains controversial. Few studies compare the surgical outcomes in patients of different age groups. PURPOSETo evaluate the influence of posterior-only LSHV resection surgery timing on clinical and radiographic results. STUDY DESIGNRetrospective analysis. PATIENT SAMPLEWe retrospectively analyzed 58 LSHV patients undergoing posterior-only LSHV resection with short-segment fusion at our institution between 2010 and 2020, with a mean follow-up of 7.5 years. OUTCOME MEASUREThe following data were observed for all cases: patient demographics, clinical outcomes measured by operating time, intraoperative blood loss, complications, and Health-Related Quality of Life, radiographic parameters included Cobb angles, trunk shift and sagittal spinal parameters. METHODSFrom 2010 to 2020, a consecutive series of 58 LSHV patients treated by posterior LSHV resection with short segmental fusion were investigated retrospectively, with a 7.5-year average follow-up period. Patients were stratified into 2 groups based on the timing of surgery: Group E (≤6 years old, representing the early-surgery) and Group L (>6 years old, representing the late-surgery). Radiographic assessments included pre- and postoperative measurements of main scoliosis, compensatory scoliosis, trunk shift, and sagittal balance parameters. Operative data, perioperative complications and SRS-22 questionnaires were also collected. RESULTSCompared to Group L, Group E exhibited a lower intraoperative blood loss (p<.001), higher final main curve correction rate (p=.037), smaller post-op compensatory curve (p=.031), higher sagittal vertical axis correction rates at immediate post-op (p=.045) and last follow-up (p=.027), and lower implant failure complications incidence (p=.006). CONCLUSIONThis study suggested that early surgical intervention in LSHV patients can achieve better correction outcomes, while reducing blood loss and postoperative complications in a large-scale cohort.

Prophylactic Effect of Misoprostol Versus Tranexamic Acid in Conjunction with Oxytocin in Reduction of Post­Partum Hemorrhage After LSCS: A Prospective Randomized Study

AIM : The aim of this study is to compare the prophylactic efficacy of sublingual misoprostol (800 μg) versus IV tranexamic acid (1gm), each administered in conjunction with oxytocin, in reducing blood loss during LSCS METHOD: Hospital based prospective randomised study over a period of one year. The women undergoing LSCS who met the inclusion criteria were included. Total 182 patients were included and divided into three groups- control group, miso group and TXA group and comparison done by calculating the amount of blood in gauze used (approx.10cc) and the amount in the suction catheter, comparing pre and post-op Hb, and additional uterotonic agent used. RESULTS : Among 3 groups, Group C (oxytocin + TXA) had noticeably less blood loss with a mean of 395.57 ± 143.02, compared to Group A(oxytocin only) with a mean of 502.00 ± 112.17, and Group B(oxytocin + miso) with a mean of 470.49 ± 110.38 which was statistically significant with a p-value of less than 0.001. In Group A, 60.0% needed additional uterotonic agents, whereas In Group B,39.3% needed additional agents,and In Group C, 32.8% needed additional uterotonic agents, but 67.2% didn't. Group A only 16.7% had PPH,In Group B only 9.8% saw PPH, while in Group C only 6.6% of cases had PPH. CONCLUSION : Combining oxytocin with Misoprostol or Tranexamic acid might be more effective in reducing occurrences of PPH than using oxytocin alone.

Editorial: Craniosynostosis

In this edition of Archives of Pediatric Neurosurgery, which is entirely dedicated to craniosynostosis, we are pleased to present the foremost evidence on the foundations, concepts, diagnosis, and treatment modalities of this condition, based on well-designed studies in this field. Craniosynostosis is a rare congenital condition caused by the premature fusion of one or more skull sutures, leading to deformities in head shape, intracranial hypertension, and potentially negative impacts on neuropsychological development. Medical students, neurosurgery residents, young neurosurgeons, and even more experienced neurosurgeons should be aware of the various aspects of this condition to enhance early detection, improve treatment recommendations, and ultimately, the patient's quality of life. Currently, advancements in fields such as genetics, neurosciences, and surgical techniques have resulted in reduced blood loss, shorter hospital stays, and improved cosmetic and neuropsychological outcomes. Therefore, we aim to disseminate valuable information on the state-of-the-art research in craniosynostosis to stimulate the development and consolidation of evidence based approaches and guide pediatric neurosurgeons in their decision-making.

The Use of Tranexamic Acid for Primary Prophylaxis of Heterotopic Ossification Following Total Hip Arthroplasty

BackgroundHeterotopic ossification (HO) is a relatively common complication after total hip arthroplasty (THA) and can range from a radiographic observation only to severely disabling and requiring revision surgery. Prophylaxis is recommended for high-risk patients, though the ideal method and targeted population are open to debate. Tranexamic acid (TXA) is a medication increasingly being used to reduce blood loss associated with orthopaedic surgeries, including THA. MethodsA retrospective review of 357 patients undergoing THA from November 2020 through December 2023 was conducted. The patients were grouped based on whether they received intravenous TXA perioperatively or not, and their propensity score matched 2:1 TXA to no TXA on age, body mass index, sex, Charlson Comorbidity Index, and perioperative celecoxib use. Univariate and multivariate analyses were performed. ResultsAfter propensity score matching, the only significant differences between groups were American Society of Anesthesiologists (ASA) scores and preoperative celecoxib use between groups, as the TXA group had fewer patients who had an ASA of 3 or more (38.9 versus 58.5%, P < 0.001) and more patients who had taken celecoxib preoperatively (16.3 versus 5.9%, P = 0.010). Perioperatively, patients were more likely to undergo THA using the anterior approach (74.5 versus 57.6%, P = 0.002) and were more likely to receive postoperative celecoxib prescriptions (44.8 versus 31.4%, P = 0.021), but there was no difference in other nonsteroidal anti-inflammatory drug (NSAID) usage postoperatively. Postoperatively, patients who received TXA had a lower rate of HO on the last postoperative x-ray (20.1 versus 33.9%, P = 0.007). Multivariable logistic regression, to assess predictors of HO, found that patients who had TXA were 42% less likely to have visible HO (OR [odds ratio] = 0.58, P = 0.047), while holding surgical approach, American Society of Anesthesiologists score, preoperative and postoperative celecoxib use, and postoperative other nonsteroidal anti-inflammatory drug use constant. ConclusionsThe use of TXA in patients undergoing primary THA results in a decreased likelihood ofHO formation on postoperative x-rays.

Prediction of transfusion risk after total knee arthroplasty: use of a machine learning algorithm

IntroductionTotal knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count. HypothesisBased on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty. Material and methodsThis retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance. ResultsOf the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921 - 1], sensitivity of 94.4% [95% CI 91.2 - 97.6], and specificity of 85.4% [95% CI 80.6 - 90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com. ConclusionThe risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient. Level of evidenceII; diagnostic study

Can minimally invasive transforaminal lumbar interbody fusion achieve a better clinical and radiological outcome than traditional open technique in isthmic spondylolisthesis?

BackgroundSpondylolisthesis is a prevalent condition in the lumbar spine that can cause low back pain, leg pain, neurogenic claudication, and impact health-related quality of life in symptomatic individuals.Aimto assess the results of minimally invasive TLIF (MIS-TLIF) versus open-TLIF and the impact of correcting spino-pelvic parameters on the Health-Related Quality of Life (HRQoL) in patients with low-grade isthmic spondylolisthesis. The primary objective was to compare the effectiveness of both methods in correcting spinopelvic parameters. The secondary objectives involved comparing clinical improvement, operating time, blood loss, complications, and postoperative hospital stays between the two procedures.Patients and methodsSeventy-two patients with low-grade isthmic spondylolisthesis were enrolled in this retrospective cohort-control study, with a minimum follow-up period of 18 months. Disability was assessed using the Oswestry Disability Index (ODI), while back and leg discomfort were rated using the Visual Analogue Scale (VAS) for each patient. The measurements comprised the sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and Meyerding slip grades. We measured lumbar lordosis (LL), and segmental lordosis.ResultsThe seventy-two patients were 60 female and 12 males. There was no statistically significant difference in the duration of operation between the two groups. In the MIS group, there was a notable reduction in blood loss, higher radiation exposure, and a shorter hospital stay (P < 0.001). The back VAS showed more favorable outcomes in the MIS-TLIF, while the leg VAS showed better results in the Open-TLIF in the early outcome. Both procedures significantly reduced leg and back pain VAS scores and ODI, with no notable difference between the two groups at the final follow-up. Post-surgery, the pelvic incidence (PI) and lumbar lordosis (LL) matched properly in all patients, showing a rise in LL and sacral slope along with a decrease in pelvic tilt.ConclusionBoth open-TLIF and MIS-TLIF are effective methods for correcting spino-pelvic parameters and improving HRQoL in patients with low-grade isthmic spondylolisthesis. The rapid improvement in back pain experienced by these patients favored the use of MIS-TLIF. However, the cost-effectiveness of this approach must be carefully evaluated.

Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review.

Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.

The mitochondrial division inhibitor Mdivi-1 protected organ function and extended the treatment window in rats with uncontrolled haemorrhagic shock.

To elucidate whether the application of the mitochondrial division inhibitor Mdivi-1 can protect organ function and prolong the treatment window for traumatic hemorrhagic shock. Before definitive haemostasis treatment, Mdivi-1 (0.25 mg/kg, 0.5 mg/kg and 1 mg/kg) was administered to uncontrolled haemorrhagic shock (UHS) model rats. Lactate Ringer's solution plus hydroxyethyl starch (130/0.4) was used as a control. The effects of Mdivi-1 on blood loss, fluid demand, survival time, vital organ function, myocardial mitochondrial structure, and mitochondrial function of the heart, liver, kidney and intestine, and oxidative stress at 1 hour after hypotensive resuscitation (50-60 mmHg) were investigated. In addition, we investigated the effect of varying doses of Mdivi-1 on the maintenance time of hypotensive resuscitation without definitive haemostasis and the beneficial effect of Mdivi-1 after prolonging the duration of hypotensive resuscitation to 2 hours. Compared to conventional resuscitative fluid, Mdivi-1 significantly reduced blood loss and fluid demand, improved important organ functions during hypotensive resuscitation, improved animal survival and reduced the incidence of early death. Mdivi-1 significantly alleviated oxidative stress injury, reduced mitochondrial damage and restored myocardial mitochondrial structure and mitochondrial function of the heart, liver, kidney and intestine. In addition, Mdivi-1 increased the maintenance time of hypotensive resuscitation and improved rat survival after the duration of hypotensive resuscitation was prolonged to 2 h. Mdivi-1 significantly prolonged the treatment window for traumatic hemorrhagic shock to 2 hours in UHS model rats. The underlying mechanism may be that Mdivi-1 inhibits excessive mitochondrial fission and oxidative stress and improves the structure and function of mitochondria.

Tranexamic Acid Administration During Liver Transplantation Is Not Associated With Lower Blood Loss or With Reduced Utilization of Red Blood Cell Transfusion.

Current clinical guidelines recommend antifibrinolytic treatment for liver transplantation to reduce blood loss and transfusion utilization. However, the clinical relevance of fibrinolysis during liver transplantation is questionable, a benefit of tranexamic acid (TXA) in this context is not supported by sufficient evidence, and adverse effects are also conceivable. Therefore, we tested the hypothesis that use of TXA is associated with reduced blood loss. We performed a retrospective cohort study on patients who underwent liver transplantation between 2004 and 2017 at Heidelberg University Hospital, Heidelberg, Germany. Univariable and multivariable linear regression analyses were used to determine the association between TXA administration and the primary end point intraoperative blood loss and the secondary end point intra- and postoperative red blood cell (RBC) transfusions. For further secondary outcome analyses, the time to the first occurrence of a composite end point of hepatic artery thrombosis, portal vein thrombosis, and thrombosis of the inferior vena cava were analyzed using a univariable and multivariable Cox proportional hazards model. Data from 779 transplantations were included in the final analysis. The median intraoperative blood loss was 3000 mL (1600-5500 mL). Intraoperative TXA administration occurred in 262 patients (33.6%) with an average dose of 1.4 ± 0.7 g and was not associated with intraoperative blood loss (regression coefficient B, -0.020 [-0.051 to 0.012], P = .226) or any of the secondary end points (intraoperative RBC transfusion; regression coefficient B, 0.023 [-0.006 to 0.053], P = .116), postoperative RBC transfusion (regression coefficient B, 0.007 [-0.032 to 0.046], P = .717), and occurrence of thrombosis (hazard ratio [HR], 1.110 [0.903-1.365], P = .321). Our data do not support the use of TXA during liver transplantation. Physicians should exercise caution and consider individual factors when deciding whether or not to administer TXA.

Evaluation of the use of tranexamic acid in the postoperative period in patients with scoliosis undergoing posterior fusion.

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.

A thermal cross-linking approach to developing a reinforced elastic chitosan cryogel for hemostatic management of heavy bleeding

Uncontrolled hemorrhage stands as the primary cause of potentially preventable deaths following traumatic injuries in both civilian and military populations. Addressing this critical medical need requires the development of a hemostatic material with rapid hemostatic performance and biosafety. This work describes the engineering of a chitosan-based cryogel construct using thermo-assisted cross-linking with α-ketoglutaric acid after freeze-drying. The resulting cryogel exhibited a highly interconnected macro-porous structure with low thermal conductivity, exceptional mechanical properties, and great fluid absorption capacity. Notably, assessments using rabbit whole blood in vitro, as well as rat liver volume defect and femoral artery injury models simulating severe bleeding, showed the remarkable hemostatic performance of the chitosan cryogel. Among the cryogel variants with different chitosan molecular weights, the 150 kDa one demonstrated superior hemostatic efficacy, reducing blood loss and hemostasis time by approximately 73 % and 63 % in the hepatic model, and by around 60 % and 68 %, in the femoral artery model. Additionally, comprehensive in vitro and in vivo evaluations underscored the good biocompatibility of the chitosan cryogel. Taken together, these results strongly indicate that the designed chitosan cryogel configuration holds significant potential as a safe and rapid hemostatic material for managing severe hemorrhage.

Robot-assisted partial nephrectomy: Is it the future of kidney surgery? A comparison of nephron-sparing techniques in partial nephrectomy

Technological advancements are significantly transforming various medical fields, including urology. The increasing adoption of minimally invasive surgical techniques and robotic assistance is particularly impactful. Three partial nephrectomy techniques are investigated: open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Among these, robot-assisted partial nephrectomy is considered to be superior due to shorter warm ischemia time, reduced blood loss, better early renal functional preservation, and shorter hospital stays. The zero-ischemia partial nephrectomy concept aims to improve postoperative kidney function outcomes. The integration of robotic technology and advancements in artificial intelligence and surgical training systems are expected to further enhance surgical techniques. Artificial intelligence, particularly when combined with computer vision algorithms, shows potential for creating precise and automated three-dimensional models for surgical planning in complex robot-assisted partial nephrectomy procedures, potentially leading to better patient outcomes. This review identifies the current capabilities and prospective advancements in the application of robotic technology in partial nephrectomy.

Acetabular posterior column screws via an anterior approach.

Screw fixation of acetabular column fractures is a well-established alternative option to plate fixation providing comparable biomechanical strength and requiring less surgical exposure. For displaced acetabular fractures involving both columns open reduction and plate fixation of one column in combination with a column-crossing screw fixation of the opposite column via a single approach is a viable treatment option. Preoperative planning of posterior column screws (PCS) via an anterior approach is mandatory to assess the eligibility of the fracture for this technique and to plan the entry point and the screw trajectory. The intraoperative application requires fluoroscopic guidance using several views. A single view showing an extraarticular screw position is adequate to rule out hip joint penetration. The fluoroscopic assessment of cortical perforation of the posterior column requires several oblique views such as lateral oblique views, obturator oblique views and axial views of the posterior column or alternatively intraoperative CT scans. The application of PCS via an anterior approach is a technically demanding procedure, that allows for a relevant reduction of approach-related morbidity, surgical time and blood loss by using a single approach.

Neuroendoscopic versus Craniotomy Approach in Supratentorial Hypertensive Intracerebral Hemorrhage: An Updated Meta-Analysis

Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuroendoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compared the effectiveness of NES versus craniotomy in treating ICH. A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials or observational studies for confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using meta-analysis software. The analysis included 26studies (N= 3237 patients). NES was associated with significantly lower mortality compared with craniotomy (odds ratio 0.45, 95% confidence interval [CI] 0.33 to 0.60, P<0.00001). Hematoma evacuation rates were higher with NES (standardized mean difference 1.505, 95% CI 0.835 to 2.160, P<0.00001). NES also showed better functional outcomes (odds ratio 3.31, 95% CI 1.78 to 6.17, P=0.0002) and reduced blood loss (standardized mean difference-3.06, 95% CI-3.979 to-2.141, P=0.000). Additionally, NES was associated with shorter hospital and intensive care unit stays, shorter operative times, and fewer complications such as infection and rebleeding. NES is a promising alternative to craniotomy for treating ICH, offering advantages in terms of reduced mortality, improved functional outcomes, and fewer complications. Future studies should explore advances in neuroendoscopic techniques to optimize patient outcomes further.

Laparoscopic vs. open surgery for rectal cancer in patients with obesity: short-term outcomes and relapse-free survival across age groups.

To investigate the efficacy of laparoscopic surgery for rectal cancer in obese and older patients, who are often characterized by a higher prevalence of comorbidities and physical decline. This large-scale multicenter retrospective cohort study included 524 patients with a body mass index of 25 or higher who underwent either open or laparoscopic surgery for stage II or III rectal cancer between 2009 and 2013. We assessed the short-term outcomes and relapse-free survival by comparing these surgical modalities. The patients were stratified into 404 non-elderly (< 70years) and 120 elderly (≥ 70 years) patients. In both patient groups, laparoscopic surgery was associated with a significantly reduced blood loss (non-elderly: 41 vs. 545ml; elderly: 50 vs. 445ml) and shorter hospital stays (non-elderly: 10 vs. 19days; elderly: 15 vs. 20days) than open surgery. The overall complications and relapse-free survival showed no significant differences between the two surgical techniques in either age group. Additionally, the impact of the laparoscopic procedure on the relapse-free survival remained consistent between the age groups. Laparoscopic surgery offers short-term benefits for patients with obesity and rectal cancer compared to open surgery, regardless of age, without influencing the long-term prognosis.

Efficacy of Tranexamic Acid in Reducing Blood Loss in Cleft Palate Surgeries - A Systematic Review

Efficacy of Tranexamic Acid in Reducing Blood Loss in Cleft Palate Surgeries - A Systematic Review

Efficacy of tranexamic acid versus placebo in reducing blood loss during burn excisional surgery: a multi-center, double-blind, parallel, randomized placebo-controlled clinical trial (TRANEX)

BackgroundDespite an increase in knowledge, blood loss during burn excisional surgery remains a major challenge and is an independent predictor of mortality. During burn surgery, limited measures are available to control the bleeding. Increased fibrinolysis could be one of the contributing factors of blood loss during burn excisional surgery. Tranexamic acid inhibits the fibrinolytic response, and a small body of evidence shows positive effects of tranexamic acid on the volume of blood loss.MethodsThe main objectives of this study are twofold, (1) to investigate whether tranexamic acid reduces blood loss and (2) to investigate the changes in coagulation after burn trauma and during burn excisional surgery. This study is a multicenter double-blind randomized clinical trial in patients scheduled for burn excisional surgery within the Dutch burn centers. All adult patients scheduled for burn surgery with an expected blood loss of ≥ 250 are eligible for inclusion in this study. The study is powered on a blood loss reduction of 25% in the intervention group. In total, 95 subjects will be included. The intervention group will receive 1500 mg tranexamic acid versus placebo in the other group. Primary endpoint is reduction of blood loss. Secondary endpoints include occurrence of fibrinolysis during surgery, graft take of the split skin graft, and differences in coagulation and blood clot formation.DiscussionThis protocol of a randomized controlled trial aims to investigate the efficacy of tranexamic acid in reducing blood loss during burn excisional surgery. Furthermore, this study aims to clarify the coagulation status after burn trauma and during the surgical process.Trial registrationEudraCT: 2020-005405-10; ClinicalTrial.gov: NCT05507983 (retrospectively registered in August 2022, inclusion started in December 2021).