Time Of Removal Research Articles

Risk factors for the development of premature physeal closure after a McFarland fracture in children.

In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC). We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts. PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2cm, and five patients with PPC complained of postoperative pain. Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5mm are at a higher risk for PPC. Observational study.

Development of an innovative intravaginal model of probiotic inoculation in dairy ovine flocks: positive effects on the vaginal microbiota, vaginitis and fertility.

In vitro studies have reported the antimicrobial effect of an inoculum (L2) made from commercial probiotic strains of Lactobacillus spp. (Lactobacillus (L.) crispatus, L. brevis and L. gasseri) against some ruminants' pathogens. However, their possible beneficial effects on controlling the vaginosis caused by the use of intravaginal sponges for oestrus synchronisation have not been evaluated in in vivo models. Therefore, the purpose of this study was to perform an intravaginal double inoculation of this same non-lyophilised (non-freeze-dried) L2 inoculum, in 120 ewes from four dairy commercial ovine flocks using straws similar to those used in artificial insemination. Globally, in the entire study population, the fertility percentage (65%) of the inoculated groups increased by 10% compared to the control groups (55%). Specifically, increases in the percentages of pregnant sheep in flocks 1 and 4 (10.7 and 5.7% respectively; P>0.05) and flock 3 (27.3%; P<0.05) were observed in inoculated ewes. Overall, the administration of L2 on the day of intravaginal sponge insertion decreased the number of ewes with vaginitis by 11.13% at the time of sponge removal (T1). In the first flock, the administration of the probiotic positively modulated the microbiota with an increased richness and presence of Lactobacillales accompanied by a reduction in Mycoplasma spp. Genera such as Fusobacterium, Streptobacillus, Campylobacter or Trueperella were linked to the presence of vaginitis at T1. Genera belonging to Lactobacillales, including some genera previously reported to be beneficial for pregnancy, significantly increased at the time of pregnancy diagnosis but significantly decreased at T1. The results of this study suggest that the use of probiotics via intravaginal inoculation as a strategy to positively modulate the microbiota and vaginal inflammation, derived from the use of intravaginal sponges, is also associated with improved fertility. This novel approach could improve animal welfare in oestrus-synchronisation protocols and represents an alternative to the prophylactic use of antibiotics.

Postinsertion Management of Cholecystostomy Tubes for Acute Cholecystitis: A Systematic Review.

Percutaneous gallbladder drainage (PGD) is indicated to treat high-risk patients with acute cholecystitis. Trends suggest increasing use of PGD over time as the population ages and lives longer with multiple comorbidities. There is no consensus on the management of cholecystostomies tube once inserted. This review aims to synthesize and describe the most common protocols in terms of the need and timing of follow-up imaging, management of a destination tube, timing of tube removal, and optimal interval time from tube positioning to delayed cholecystectomy. The study protocol has been registered on the International Prospective Register of Systematic Reviews-PROSPERO. Studies on adult patients diagnosed with acute cholecystitis who underwent a PGD from 2000 to November 2023 were included. The databases searched were MEDLINE, Embase, and Cochrane. The quality assessment tools provided by the NHLBI (National Heart, Lung, and Blood Institute) were applied and descriptive statistics were performed. We included 22,349 patients from 94 studies with overall fair quality (6 prospective and 88 retrospective). In 92.7% of papers, the authors checked by imaging all patients with a PGD (41 studies included). Depending on protocol time, 30% of studies performed imaging within the first 2 weeks and 35% before tube removal (40 studies included). In the case of a destination tube, 56% of studies reported removing the tube (25 studies included). In the case of tube removal, the mean time after insertion was more than 4 weeks in 24 of the 33 included studies (73%). Interval cholecystectomies are more frequently performed after 5 weeks from PGD (32/38 included studies, 84%). Limitations included high clinical heterogeneity and prevalent retrospective studies. A standard management for percutaneous cholecystostomy after insertion is difficult to define based on existing evidence, and currently we can only rely on the most common existing protocols.

Application of 3D-printed resin guides for the removal of molar fiber posts

To evaluate the digital guide technique for removing fiber posts from molars and compare it with the conventional microscope-assisted ultrasound method. Two mandibular dentition models, each comprising six extracted molars, were prepared. Two thick and straight canals distributed separately in the distal and mesial roots of each molar were selected for placing the fiber posts. The 24 posts in the two dentition models were removed using 3D-printed resin guides, or a microscope and an ultrasonic device. The time taken to remove the fiber post from each tooth was recorded. The volume loss, deviation values (angular deviation and horizontal and vertical deviations of the tip), and formation of microcracks before and after fiber post removal were determined using micro-computed tomography images. The digital guide technique took significantly less time than the microscope-assisted ultrasound technique (p < 0.05). No significant differences in horizontal and vertical tip deviations were observed between the two groups. The angular deviation and volume loss in the guide group were significantly lower than those in the ultrasound group (p < 0.05). New dentin microcracks were formed in the ultrasound group but not in the digital guide group. Using a 3D-printed resin guide plate can shorten the fiber post removal time and improve the stability and safety compared to the microscope-assisted ultrasound technique. 3D-printed resin guides can reduce the fiber post removal time and provide better stability and safety than the conventional method.

Influence of Time of Weed Removal on Maize Yield and Yield Components Based on Different Planting Patterns, the Application of Pre-Emergence Herbicides and Weather Conditions

Influence of Time of Weed Removal on Maize Yield and Yield Components Based on Different Planting Patterns, the Application of Pre-Emergence Herbicides and Weather Conditions

Tailoring anaesthetic strategies for diabetes research: Acepromazine vs. medetomidine in Aachen minipigs.

Pre-established anaesthetic protocols in animal models might unexpectedly interfere with the main outcome of scientific projects and therefore they need to account for the specific research goals. We aimed to optimize the anaesthetic protocol and animal handling strategies in a diabetes-related-study exemplifying how the anaesthetic approach must be adjusted for individual research targets. Aachen minipigs were used as a model to test long-lasting skin glucose sensors for diabetic human patients. A total of 6 animals participated in two or three rounds of experiments. Each round lasted 2 months, with a maximum of 2 rounds per year. In each round, animals were anaesthetised 4 times: for glucose sensors insertion, twice for glucagon stress tests (GST), and a last time for removal of sensors. Acepromazine (ACE) was compared to medetomidine (MED) in association with butorphanol (BUT) and Ketamine (KET) and 4 parameters were analysed to define the optimum anaesthetic protocol including: sedation level, anaesthesia duration, effects on blood glucose and safety. ACE-BUT demonstrated a weaker sedative effect but reduced overall experimental time, minimized anaesthetic risk and minimally interfered with the glucose metabolism. The improvement obtained by animal conditioning and handling strategies applied in this study were not objectively estimated, although the aversion behavior was completely abolished. Based on the analysed parameters, the use of acepromazine is proposed to be superior when Aachen Minipigs are used specifically as a model for diabetes-related studies, albeit the recommendations for the anaesthesia of minipigs suggest otherwise.

Characterizing dry and early lactation dairy cow management practices in Wisconsin and Minnesota.

The non-lactation ("dry") period and first few weeks after calving are a crucial time in a dairy cow's life which can greatly impact her welfare and success within a herd. Additionally, cow-calf separation has become a controversial topic in dairy production and there is a knowledge gap regarding the time of calf removal from the cow on US dairy farms. A description of animal management practices during the dry period and early lactation can provide key information if recommended practices are being implemented and what can be changed to enhance the overall welfare of transition cows. The objective of this study was to characterize farmer-reported housing, management, and disease incidence of dairy cows from 60 d before to 30 d after calving on dairy farms in Wisconsin and Minnesota. Surveys were mailed to a random sample of 1,503 dairy producers in Wisconsin (n = 948) and Minnesota (n = 555). The survey included questions regarding farm demographics, cow management from 60 d before 30 d after calving, calf separation practices, and transition cow disease incidence. The response rate was 31% (466/1,503; Minnesota: n = 145, Wisconsin: n = 321) at the end of the 10 wk data collection period. Respondents had an average of 219.5 ± 712.3 (±SD) milking cows with a range of 2-12,000 milking cows. Cow management varied greatly between farms during the dry period and early lactation. The most common dry cow housing used was a close-up pen (38% of farms) and freestalls for both fresh (15.9%) and lactating cows (39.3%). Cows were moved into new pens 0 - 6 times (median = 2) during the 60 d before to 30 d after calving and approximately one quarter of farms (26%) moved cows into new pens twice. Removal of calves from the calving pen was most commonly reported to occur less than 1 h (16.7% of farms), 1.1 to 2 h (22.3%), and 2.1 to 12 h (39.5%) after birth. Calf removal from the calving pen was reported to occur sooner after birth on farms with larger herds and if cows remained in the calving pen for less time after calving. Dystocia was reported to occur at a greater incidence than other transition diseases (7.0% ± 7.4), followed by retained placenta (6.4% ± 6.5). The results of this survey provide evidence that recommended care practices, such as using a calving pen and not overstocking a fresh cow pen, are being provided to dry and early-lactation cows on many dairy farms in this region. However, animal-based measures would be required to assess if cows are in a good welfare state. Nonetheless, these results can help identify possible barriers to success and opportunities for improvement for the management and potential performance of dairy cows.

Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta-analysis.

Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. We conducted a systematic review and meta-analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random-effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach. From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD-removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55). This meta-analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high-quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device.

Modeling absorbed alpha particle dose from diffusing alpha-emitters radiation therapy in changing tissue volumes.

Diffusing alpha-emitters Radiation Therapy ("Alpha DaRT") is a promising new radiation therapy modality for treating bulky tumors. 224Ra-carrying sources are inserted intratumorally, producing a therapeutic alpha-dose region with a total size of a few millimeter via the diffusive motion of 224Ra's alpha-emitting daughters. Clinical studies of Alpha DaRT have reported 100% positive response (30%-100% shrinkage within several weeks), with post-insertion swelling in close to half of the cases. While dosimetry recommendations informed by the effects of edema are standard in some radiation therapy modalities, the effect of edema and tumor shrinkage on the absorbed dose delivered by Alpha DaRT is stillunknown. The aim of this work is to develop a simple model for Alpha-DaRT dose deposition in a time-dependent tissue volume in order to study the effect of geometrical changes in source location due to edema and tumor shrinkage on the delivered alpha particledose. We perform FEM-based dose deposition modeling for a single Alpha-DaRT source inside shrinking and swelling tissues. Gradual volume change models were used for shrinkage and swelling, and an additional immediate volume gain model was also used for "worst case" swelling. Volume change rates were estimated from source location data from serial scans acquired at time of insertion and removal for seven patients treated using Alpha DaRT. We calculate absorbed dose profiles under both the high- and low-diffusion regimes described by the Diffusion-Leakagemodel. Changes in tissue volume can lead to over- or underestimation of the calculated absorbed dose. In the low-diffusion regime, gradual tissue shrinkage can result in an increase of 100% and gradual swelling can result in a 35% decrease in absorbed dose compared to a calculation in static tissue. Although immediate post-insertion swelling can reduce the absorbed dose by close to 65% for very closely spaced sources, in all cases analyzed the final absorbed dose continues to exceed the 10Gy target. These effects are less severe in the high-diffusionregime. These results indicate that tissue swelling and shrinkage can have a non-negligible effect on the tumor absorbed dose. Further study of tissue dynamics during Alpha-DaRT treatment will be necessary for improvements in dosimetrypractice.

Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric patients: A Prospective Pilot Study.

The physiologic benefits of the minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function are poorly understood in pediatrics. We sought to examine the effects of MIRPE on exercise response during cardiopulmonary exercise testing (CPET). A prospective-pilot study was conduct of patients ≤18 years who presented for pectus bar removal. All patients had CPET prior to MIRPE and following bar removal. Paired sample T tests were used to compare pre- and post-MIRPE CPET results. Twenty-five patients completed post-MIRPE CPET (72% male, median age 18.6 [IQR:17.5-19.8]). The median Haller and correction indices were 4.5 and 29.4%, respectively. There was significant increase in O2Pulse, (10.3 vs 12.1mL/beat, p=0.004), and percent predicted O2Pulse (79.5% vs 84.4%, p=0.046) following MIRPE/bar removal. The peak-VO2/kg and did not change significantly following MIRPE/bar removal; however, peak-VO2 (ml/min) increased. Patients with decreased activity levels at time of bar removal compared to pre-MIRPE had decreased peak-VO2/kg and predicted peak-VO2/kg. Following MIRPE, patients experience increased in O2Pulse, which is a surrogate measure of stroke volume response to exercise and may reflect relief of cardiac compression. Cardiopulmonary function is multifactorial and despite improvement in stroke volume, other factors may impact exercise capacity (VO2) following MIRPE. Treatment Study. IV.

Critical Period for Italian ryegrass (Lolium perenne L. spp. multiflorum) Control in Winter Wheat in North Carolina

Field studies were conducted in North Carolina to determine the critical period of weed control (CPWC) for Italian ryegrass in winter wheat. Soft red winter wheat was planted in late fall in 2017 and 2018 in no-till fields near Salisbury, NC. Treatments consisted of allowing weeds to grow from crop emergence for different intervals until removal (“weedy”), maintaining “weed-free” conditions from crop emergence for the same intervals, and then letting the weeds emerge and compete with the crop for the duration of the season. In 2017, weed removal occurred in two-week intervals from crop emergence up to 18 weeks after crop emergence (WAE) and three-week intervals up to 18 WAE in 2018. Additional biological measurements, including Italian ryegrass density and height, were collected at 6, 12, and 18 WAE to characterize the effect of crop-weed interactions on the CPWC and weed populations. Non-linear regression analysis was conducted to relate the timing of weed removal and yield loss. The analysis was done using growing degree days (GDD) accumulated at corresponding WAE. Italian ryegrass density ranged from 292 to 824 plants m-2, which created intense competitive conditions with wheat. In the absence of weed control, yield loss surpassed 60%. Using 5% yield loss as an accepted threshold, the CPWC for Italian ryegrass in no-till planted wheat was estimated to be from 1100 to 1900 GDD. This relatively short period makes it possible to reduce weed control intensity if control actions are properly timed.

Outcomes of intravitreal dexamethasone implant (Ozurdex®) in patients with post-surgical macular edema – a real-world scenario

BackgroundClinically significant macular edema (CME) is the leading cause of visual loss after ophthalmologic surgery due to the release of inflammatory mediators promoted by the procedures. We aimed to evaluate the outcomes of intravitreal Ozurdex® (700 µg dexamethasone) implants as a primary therapeutical option for post-surgical macular edema cases.MethodsPatients with post-surgical macular edema diagnosed by optical coherence tomography (Cirrus SD-OCT) and treated with Ozudex were selected for the current study. Data was retrospectively collected from medical records from January 2020 to December 2022 and included sex, age, laterality, and timeline of treatment (i.e. implant alone or at the time of silicon oil removal in cases requiring vitreorretinal surgery). Complications associated with treatment were also noted as well as the need of further treatments. The structural analysis focused on measuring central macular thickness (CMT—average thickness within the 1 mm circle of the ETDRS) from the internal limiting membrane to the Bruch’s membrane complex, as well as the average total macular thickness including parafoveal and perifoveal regions determined by the device (CAT). The functional evaluation was based on the best-corrected visual acuity (VA) measured in logMAR.ResultsA total of 46 participants were included (56.2% males, mean age: 60.9 ± 11.2 years old). A statistically significant change was observed in the postoperative versus the preoperative period for all parameters (p < 0.05). The mean VA difference was − 0.17 ± 0.24; CMT was − 109.22 ± 124.85 and CAT was − 14.76 ± 58.95. We observed a significant effect of the moment of Ozurdex implantation on VA improvement, so that cases with implantation at the time of oil removal showed lower improvement than cases with implantation at a distinct timing (Coef. 0.19, 95%CI: 0.02 to 0.36, p = 0.027). Eleven cases (23.9%) required further treatment such as new Ozurdex implantation (8 cases) or surgery (3 cases). Only one case (2.17%) showed increased intraocular pressure and underwent glaucoma surgery.ConclusionsIntravitreal Ozurdex implants significantly improved functional and structural aspects in post-surgical macular edema. The timing of implantation influenced VA improvement, with a distinct step approach showing better outcomes than at the time of oil removal.

Treatment of unstable pelvic fractures with double INFIX

BackgroundThis study investigated the clinical efficacy of Double INFIX for the treatment of unstable pelvic fractures.MethodsWe performed a retrospective analysis of 23 patients with unstable pelvic fractures treated using the Double INFIX minimally invasive technique. The cohort included five cases of Tile B1 type, eight cases of B2 type, six cases of B3 type, three cases of C1 type and one case of type C2. Pre- and postoperative evaluations included standardised pelvic serial films and three-dimensional CT scans. Key observational indicators were fracture reduction quality (assessed using Matta’s criteria), fracture healing, functional recovery (evaluated with the Majeed function assessment criteria), and incidence of complications.ResultsThe mean follow-up duration was 24.48 ± 1.78 months. The average fracture healing time was 4.00 ± 1.41 months, and the average time for removal of fixation was 7.43 ± 1.75 months. Repeat imaging at 12 months postoperatively using Matta’s criteria showed eight cases with excellent results (52.17%), 13 cases with good results (34.78%), three cases with fair results (13.04%), and no cases with poor results. The combined excellent and good rate was 86.96%, whereas the fair rate was 13.04%. The average Majeed hip joint function score at the final follow-up was 95.04 ± 1.72. Postoperative complications included meralgia paresthetica in two cases (8.7%) and sacrococcygeal discomfort in three patients when lying flat.ConclusionDouble INFIX is a minimally invasive treatment technique with adequate clinical efficacy for managing unstable pelvic fractures.

Diagnosis of stone-related pyelonephritis activity by monitoring urine electrochemical properties and dynamics of urinary inflammatory mediator IL–8

Introduction. Percutaneous nephrolithotripsy is an important minimally invasive method for treating kidney stones. It is appreciated for its low injury rate and quick recovery. However, one of the most serious complications that can occur after this procedure is calculous pyelonephritis. The timing and safe removal of nephrostomy drainage in the postoperative period remain a significant concern for urologists. Objective. To determine the possibility of using joulemetry and monitoring urinary IL-8 levels to diagnose stone-related pyelonephritis activity following percutaneous nephrolithotripsy. Materials &amp; methods. The study involved 220 patients with kidney stones who had percutaneous nephrolithotripsy at the SSMU Urology Clinic in 2022 – 2023. The patients were aged between 25 and 65 years, including 135 women (61.3 %) and 85 men (38.7 %). The control group consisted of 30 healthy people aged 24 to 67 years: 18 women (60 %) and 12 men (40 %). After surgery, electrochemical urine examination using the joulemetric method according to a patented technique was performed for patients with stone-related pyelonephritis and for those in the control group. Results. When analysing the urine IL-8 level, leukocyturia in the urine test, and the current operation based on joulemetry data, we observe a significant increase in all studied parameters on day 1 compared to the control group (p &gt; 0.05). The values of the studied indicators reach their peak range by day 3 and return to those of the control group by day 5. At the same time, even if there is no leukocyturia on day three, the values of the current parameter and the urine IL-8 level remain elevated in most patients. Conclusion. Joulemetry helps to diagnose the activity of stone-related pyelonephritis in the postoperative period. This is confirmed by general clinical examinations and the determination of urine IL-8 as a marker of inflammation. Using this method allows optimising the timing of drainage removal after surgery.

Flexible Flow Shop Scheduling Problem with Removal Times

Flexible Flow Shop Scheduling Problem with Removal Times

Environmental application of dicarboxylated hairy cellulose crosslinked with calcium for removal and confining of Pb(ii)

DCCa is a cellulose based biopolymer which was used for the first time for removal of lead from simulated wastewater. DCCa has shown remarkable Pb(ii) sorption capacity which makes it a competitive material for lead removal and confining.

The Effects of Different Doses of eCG Injection on Reproductive Parameters in Nulliparous Merino Ewes During the Non- Breeding Season

In this study, the effects of adding 400, 500, and 600 IU eCG to progesterone treatment on rate of estrus, conception, pregnancy, fetal mortality, lambing, multiple birth and litter size in nulliparous Merino ewes the out of breeding season were investigated. A total of 90 nulliparous Merino ewes were utilized in the study. On day 0, a vaginal sponge containing 60 mg medroxyprogesterone acetate was inserted for a seven-day period. Ewes were randomly divided into three groups at the time of sponge removal. Group I (G-400), comprising 30 ewes, received 400 IU of eCG. Group II (G-500) received 500 IU of eCG (n=30), while Group III (G-600) received 600 IU of eCG (n=30). The statistical analysis revealed that the conception rates between the groups were statistically higher in the G-600 group than in the G-400 and G-500 groups (G-400 vs. G-600, P=0.091; G-500 vs. G-600, P=0.080). Pregnancy rates between the groups were found to be statistically higher in the G-600 group than in the G-400 group (P

Spontaneous pneumothorax: intubated or non-intubated surgery?

The aim of our clinical study was to justify and implement non-intubated video assisted thoracic surgery as a part of enhanced recovery after surgery pathway in treatment of spontaneous pneumothorax. Data of 150 patients who underwent surgical treatment were retrospectively analyzed. Among them group 1 of 75 patients underwent video-assisted thoracoscopic surgery (VATS) and group 2 of 75 patients underwent non-intubated VATS surgical treatment. All patients underwent atypical resection of the lung and pleural abrasion, diaphragm augmentation with mesh if diaphragm endometriosis was suspected. The perioperative data, short-term outcomes and recurrence rates of these two groups were compared. The two groups had comparable demographic, perioperative investigations, fluid infusions during surgery, the volume of surgery intraoperatively, blood loss, time for chest drain removal, length of stay in the hospital and the rate of complications. There were no conversions to thoracotomy or intubated general anaesthesia, no mortality. The peak end-tidal carbon dioxide was significantly higher in the non-intubated group than in the intubated group (mean: 48±8.6 vs 34±6.2 mmHg, p&lt;0.001). The mean follow-up was 20.2±3.9 months in the non-intubated group and 24.7±4.2 months in the intubated group (p&gt;0.05). Chest tube duration was 4.11 days in group 1 and 3.76 days in group 2. The recurrence rate of pneumothorax after surgery was 4% in both groups. Nnon-intubated video-assisted thoracic surgery for spontaneous pneumothorax could be considered a feasible, safe and effective method of treatment, even with mesh diaphragm augmentation, in cases of catamenial pneumothorax and can be a part of Enhanced Recovery After Surgery pathway. Continious follow-up and additional clinical investigations are supposed to validate the profits of the suggested approach.

Robotic-assisted Kasai portoenterostomy for child biliary atresia.

The Kasai procedure (KPE) is an important treatment for biliary atresia (BA), the most common cause of neonatal obstructive jaundice. To investigate the efficacy of robotic-assisted Kasai portoenterostomy (RAKPE) in patients with BA. Clinical data of 10 patients with BA who underwent RAKPE at the Seventh Medical Center of the People's Liberation Army General Hospital between December 2018 and December 2021 were retrospectively analyzed. One patient underwent Open Kasai portoenterostomy (OKPE) due to intraoperative bleeding. Consequently, nine patients were included in this study. Fifty-two patients who underwent OKPE during the same period served as the control group. Preoperative and postoperative biochemical indexes, surgery-related indexes, and postoperative clearance of jaundice (CJ) were recorded and statistically analyzed. RAKPE was successfully completed in all nine patients, with an average total operative time of 352.2 minutes (including intraoperative cholangiography). Milk feeding resumed on an average 9.89 days postoperatively, and the average time of drainage tube removal was 18.11 days. All patients were followed up for 6 months to 2 years. The liver function indicators and bilirubin levels in 8 patients returned to normal within 3 months after surgery. Three patients developed recurrent cholangitis after discharge, with elevated white blood cell counts, liver function indicators, and bilirubin levels, requiring hospitalization for intravenous antibiotic treatment. The duration of cholangitis ranged from 5 to 8 months post-surgery. To date, no subsequent cases of cholangitis have occurred. All patients have normal liver function and bilirubin levels, with no intrahepatic bile duct dilatation on ultrasonography. Statistical analysis comparing these indicators with those of patients who underwent OKPE showed that the RAKPE group had longer operative times and postoperative drainage tube removal durations. However, there were no significant differences in intraoperative blood loss, postoperative oral milk intake resumption, postoperative hospital stay, or CJ at 3 months post-surgery. RAKPE is technically feasible, safe, and effective for treating BA. Once the technique is mastered, RAKPE may achieve CJ outcomes comparable to those of OKPE.

Advancing the timing of drainage removal: a comprehensive analysis of different drainage removal criteria in patients undergoing short-level lumbar fusion surgery

ObjectiveTo specifically evaluate the safety and benefit of different drainage removal criteria (50 ml and 100 ml per 24 h) in patients undergoing short-level lumbar fusion surgery.MethodsPatients with degenerative lumbar diseases who underwent short level lumbar fusion with instrumentation between January 2021 and January 2023 were retrospectively recruited in the study. Based on the different criteria for drainage removal, the patients were divided into 2 groups (group A and group B). To control for confounding factors, a 1:1 nearest propensity score matching of significant variation, especially age, gender, BMI, number of fused levels, intraoperative blood loss, and surgical duration, were performed between groups. Perioperative outcomes were compared between groups. Multivariate logistic regression was performed to determine the risk factors for overall complications.ResultsA total of 1004 eligible patients were reviewed in this study with 676 patients in group A and 328 patients in group B. After propensity score matching, 616 patients, 308 in each group were included in the final analysis. There were significantly more patients getting drainage removed on POD 2 (23.1% vs. 32.1%, p = 0.012) and POD 3 (37.0% vs., 45.1%, p = 0.041) in group B. In addition, patients in group B had earlier postoperative timing of ambulation (3.87 ± 1.12 vs. 2.41 ± 1.34, p = 0.012). No significant difference in symptomatic hematoma and surgical site infection was observed, but there were significant fewer overall complications (10.39% vs. 5.19%, p = 0.016) in the group B. Multivariate logistic regression indicated that postoperative timing of ambulation (OR 2.38, 95% CI 1.19–3.97, p < 0.001) was independently associated with overall complications.ConclusionIn this study, we found that the relaxation of the criteria for drainage removal could significantly shorten the length of stay, in addition, it could promote early postoperative ambulation of patients and thus reduce the occurrence of perioperative overall complications.