Resumption Of Feeding Research Articles

Boldness as an Individual Trait of Behaviour in a Natural Population of Birds

Individual resoluteness during the resumption of feeding of nestlings was examined in tests involving the presentation of an unfamiliar object near the nests of the pied flycatcher (Ficedula hypoleuca) in a natural environment. Over the course of five breeding seasons, 229 individuals were tested, 41 of which were tested 2 to 4 times. Repeat testing of the same birds was conducted at different nests with intervals ranging from 3 to 1103 days (Med=367). We took into account the number and age of nestlings, nesting periods, the sex and age of the individual and its partner, the presence of molting, the intensity of nestling feeding, the behavior of the partner, as well as the presence of simultaneous bigamy in the male. We revealed a significant repeatability of test results over substantial time intervals (R=0.21), indicating the individual’s stability over time in response (boldness) to changing conditions in the natural environment.

Laparotomy-assisted endoscopic removal of gastrointestinal foreign bodies: Evaluation of this technique and postoperative recovery in dogs and cats.

To compare the outcome of the laparotomy-assisted endoscopic removal (LAER) of gastrointestinal foreign bodies (FBs) with traditional enterotomy, and to determine which factors affected the ability to remove FBs. Retrospective observational study. Dogs and cats (n = 81) with gastrointestinal FBs. Dogs and cats were divided into Group 1 (LAER, n = 40) and Group 2 (Enterotomy, n = 41). The localization and characteristics of the FBs (sharp or blunt; discrete or linear; single or multiple) were evaluated statistically to identify the factors that affected the ability of LAER to remove, partially or completely, the FBs (χ2 test). The length of the postoperative stay, postoperative analgesia, and resumption of spontaneous feeding were compared between groups (Mann-Whitney U-test). Short-term follow up (14 days) was recorded. Laparotomy-assisted endoscopic removal allowed complete or partial removal of FBs in 35/40 dogs and cats, regardless of the characteristics or the localization of the FBs. The presence of intestinal wall damage (p = .043) was associated with the conversion to an enterotomy. Group 1 required a shorter postoperative hospital stay (p = .006), less need for analgesia (p < .001), and experienced a faster resumption of spontaneous feeding (p = .012), and similar complication rate to Group 2. Laparotomy-assisted endoscopic removal resulted in a faster postoperative recovery when compared with an enterotomy. The FBs' characteristics or localization did not affect the efficacy of the technique to remove FBs. Laparotomy-assisted endoscopic removal allows the removal of a variety of FBs, avoiding intestinal incision and resulting in a fast postoperative recovery.

Characterization of adaptive expression regulation of yellowtail kingfish (Seriola lalandi) leptin, receptor, and receptor overlapping transcript genes in response to fasting and re-feeding strategies.

Leptins and other related genes have been proven to play vital roles in food intake, weight control, and other life activities. While the function of leptins in yellowtail kingfish (Seriola lalandi) has not yet been explored, in the present study, we investigated the structure and preliminary function of four leptin-related genes in S. lalandi. In detail, the sequence of two leptin genes (lepa and lepb), one leptin receptor gene (lepr), and one leptin receptor overlapping transcript (leprot) gene were obtained by homology cloning and RACE methods, in which lepa and lepb have similar structure. Moreover, homologous sequence alignment and evolutionary analysis of all four genes were clustered with Seriola dumerili. The tissue distribution of these four genes in thirteen tissues of yellowtail kingfish was detected by RT-qPCR. Both lepa and leprot were highly expressed in the brain and ovary, while lepb was highly expressed in the pituitary, gill, muscle, and ovary; lepr was highly expressed in the gill, kidney, and ovary. Additionally, these four genes also played roles in embryo development and early growth and development of larvae and juveniles of yellowtail kingfish. Finally, the function of leptin and leptin-related genes was investigated during fasting and re-feeding adaption of yellowtail kingfish. The results showed that these four genes have different regulation functions in five tissues; for example, the mRNA levels of lepa, lepr, and leprot in the brain decreased during fasting and immediately increased after re-feeding, while the mRNA level of lepb did not show significant fluctuation during starvation but significantly lowered after re-feeding. However, lepa and lepb mRNA levels were significantly elevated during fasting and returned to control levels after re-feeding, and there were no significant changes in the expression of lepr and leprot in the liver during fasting and after re-feeding. Moreover, the body mass of fish in the experimental group was measured, and compensatory growth was found after the resumption of feeding. These results suggested that leptin and receptor genes play different functions in different tissues to regulate the physiological state of fish in food deficiency and gain processes.

Acute postoperative pain management techniques, their efficacy and complications after major gastrointestinal and hepato-pancreato-biliary cancer surgeries: An observational study.

Patients undergoing major gastrointestinal (GI) surgery including hepato-pancreato-biliary (HPB) surgeries have large incisions, which cause severe acute postoperative pain that, if untreated, is associated with a higher incidence of postoperative morbidity and delayed recovery. Our study included all patients who underwent elective major upper GI and HPB surgeries from 1 January 2018 to 31 December 2018. The patients were divided into two groups: the epidural and the non-epidural group. The average and worst pain scores at rest and movement were compared between both groups. We also studied the effect of pain relief in the two groups and associated postoperative outcomes, resumption of feeding, ambulation, hospital stay and intensive care unit stay. A total of 566 patients were included in the study, out of which 490 received epidurals, and the rest, 76, belonged to the non-epidural group (transversus abdominis plane, rectus sheath block or no regional analgesia technique). The median average pain score at rest and movement was 2.0 and 3.0, respectively, in the epidural and non-epidural groups. The postoperative outcomes showed no statistical difference. The epidural group and the non-epidural group had similar pain scores, and the postoperative outcomes were also comparable.

Abstract WMP34: Impact of Complete Oral Feeding Resumption on Nutrition and Hydration in the Rehabilitation Inpatient With Stroke

Objective: Oral feeding resumption after feeding tube placement is an important therapeutic goal for stroke patients with dysphagia. Available information on nutrition and hydration status in stroke is limited after changing intake from commercial formula for tube feeding to dysphagia diet for oral. The aim is to explore the impact on nutrition and hydration after complete oral feeding. Methods: A total of 134 stroke patients who recovered from tube feeding to complete oral feeding were enrolled in rehabilitation hospital from Jan. 2020 to Jul. 2023. The swallow function was detected by the modified Volume-viscosity Swallow Test (V-VST). If a patient completed every viscosity more than 5 mL, feeding tube would be removed. We assessed the nutritional status of stroke patients and provided strategies of dysphagia diet for patients’ food and fluid intakes. Thickeners were used to prevent the risk of aspiration. Serum biochemical measures were obtained for nutrition (prealbumin) and hydration status (BUN/Cr ratio) at admission, before removing feeding tube and within the first week following oral feeding resumption. Results: 48.51% patients could regain oral intake within 14 days from admission. Compared to admission and tube feeding phase, the level of prealbumin (mg/L) after oral feeding was significantly higher. (19.26±5.32. vs 22.57±5.03; P&lt;0.001) (20.68±5.10 v 22.57±5.03; P=0.003). Based on prealbumin 20 mg/dL, 58.21 % of patients demonstrated poor nutrition at admission and 34.33 % after oral feeding resumption. BUN/Cr &gt; 20:1 identified deficient hydration in 53.72 % of patients in tube feeding phase and 46.27 % of patients after oral intake. Differences in nutrition and hydration status were attributed to complete oral feeding resumption. Conclusion: Clinical practice of complete oral feeding resumption including evaluating swallow function of varying viscosities, dietary and fluid recommendations could achieve better nutrition and hydration status.

Audit of Pain Management After Colorectal Surgeries in a Tertiary Care Cancer Hospital.

Surgery for gastrointestinal malignancy is associated with severe post-operative pain, which if inadequately treated, can lead to pulmonary complications and, in addition, delayed mobilization leading to delayed recovery and discharge. We audited our practices looking at the various pain modalities used and their effects on the post-operative recovery in colorectal surgeries, in a tertiary care cancer centre during the era of ERAS. The primary aim of the study was to assess the average pain score on movement in the first 72 h of post-operative period among patients. The secondary aim was to study the various modalities of pain management used and complications, perioperative vasopressor requirement, post-operative resumption of enteral feeding, ambulation, duration of hospital stay, duration of ICU/HDU stay, and worst pain scores in the first 72 h. We analyzed a total of 174 patients who underwent colorectal surgeries for the period of 1 year from 1st January 2018 till 31st December 2018. Out of the 174 patients, 86 (49.4%) patients received epidural analgesia and 88 (50.6%) patients who did not receive epidural analgesia, belong to the non-epidural group. Average pain scores on movement at 72 h in the epidural group was 2 [2, 3] and 2 [1, 2] in the non-epidural group (p < 0.001). Worst pain score at post-operative 72 h in epidural group was 3 [3, 4] and 3 [2, 4] in the non-epidural group (p = 0.016). In conclusion, we conclude, that the analgesic efficacy of epidural analgesia was not found to be superior in our study in patients undergoing major colorectal surgeries.

GLIOMA-07 E.R.A.S. IN NEURO-ONCOLOGY

Abstract BACKGROUND We performed a retrospective study assesses the efficacy and safety of a protocol for the enhanced recovery after surgery for supratentorial gliomas and metastasis.The protocol applied to the Ca' Foncello Hospital in Treviso starts from the recommendations on the subject that the medical literature reported up to December 2018.Briefly, three main sections:1) preoperative functional status evaluation, preoperative oral carbohydrate loading; 2) minimally invasive surgery, scalp incision anesthesia, nonopioid analgesia; 3) early urinary-catheter removal, standing and feeding resumption within 3-4 hours from surgery. METHODS We analyzed data on 28 patients operated on ERAS protocol and compared them to a control group (22 patients). The main clinical variables are: age, ASA and Charlson comorbidity index; times urinary-catether removal, adherence ambulation, taking food by mouth; hospital long of stay (LOS). We also collected studies from 2016 to 2020 describing data about ERAS and craniotomy and we pooled these into a meta-analysis. RESULTS Postoperative pain was significantly lower in the ERAS group (2.47 vs. 3.95, p-value=0.0007)) as long as time to removal of urinary catheter (3.1 vs. 25.0 hours, p-value &amp;lt; 0.001), adherence to ambulation (4 vs. 25 hours, p-value &amp;lt; 0.001), and first oral solid food intake (5.3 hours vs. 23.7 hours, p-value &amp;lt; 0.001). The mean LOS was 2.9 days in the ERAS group and 4.8 days in the control group (p-value &amp;lt; 0.001), and no differences in terms of surgical and medical complications, 30 days readmission rate, and time between surgery and RT were found. Our data are in line with those reported in the literature as highlighted by our meta-analysis, where hospital LOS and moderate to severe postoperative pain rates (&amp;gt; 4 points on NPRS) were significantly lower in ERAS patients. CONCLUSIONS Our protocol for ERAS in neuro-oncology appears to have significant benefits over conventional management: it may accelerate functional recovery and decrease length of stay

Multi-Stage Transcriptome Analysis Revealed the Growth Mechanism of Feathers and Hair Follicles during Induction Molting by Fasting in the Late Stage of Egg Laying.

Induced molting is a common method to obtain a new life in laying hens, in which periodic changes in feathers are the prominent feature. Nevertheless, its precise molecular mechanism remains unclear. In this study, feather and hair follicle samples were collected during fasting-induced physiological remodeling for hematoxylin-eosin staining, hormone changes and follicle traits, and transcriptome sequencing. Feather shedding was observed in F13 to R25, while newborns were observed in R3 to R32. Triiodothyronine and tetraiodothyronine were significantly elevated during feather shedding. The calcium content was significantly higher, and the ash content was significantly lower after the changeover. The determination of hair follicle traits revealed an increasing trend in pore density and a decrease in pore diameter after the resumption of feeding. According to RNA-seq results, several core genes were identified, including DSP, CDH1, PKP1, and PPCKB, which may have an impact on hair follicle growth. The focus was to discover that starvation may trigger changes in thyroid hormones, which in turn regulate feather molting through thyroid hormone synthesis, calcium signaling, and thyroid hormone signaling pathways. These data provide a valuable resource for the analysis of the molecular mechanisms underlying the cyclical growth of hair follicles in the skin during induced molting.

Management of the Zenker diverticulum: multicenter retrospective comparative study of open surgery and rigid endoscopy versus flexible endoscopy.

Zenker's diverticulum is a rare disease that affects quality of life due to dysphagia and regurgitation. This condition can be treated by various surgical or endoscopic methods. Patients treated for Zenker's diverticulum in three centers in the south of France between 2014 and 2019 were included. The primary objective was clinical efficacy. Secondary objectives were technical success, morbidities, recurrences, and need for a new procedure. One hundred forty-four patients with a total of one hundred sixty-five procedures performed were included. A significant difference was found between the different groups in terms of clinical success (97% for open surgery versus 79% for rigid endoscopy versus 90% for flexible endoscopy, p = 0.009). Technical failure occurred more frequently in the rigid endoscopy group than in the flexible endoscopy and surgical groups (p = 0.014). Median procedure duration, median time to resumption of feeding, and hospital discharge were statistically shorter for endoscopies than for open surgery. On the other hand, more recurrences occurred in patients treated by endoscopy than those treated by surgery, and more reinterventions were required. Flexible endoscopy appears to be as effective and safe as open surgery in the treatment of Zenker's diverticulum. Endoscopy allows a shorter hospital stay at the expense of a higher risk of recurrence of symptoms. It could be used as an alternative to open surgery for the treatment of Zenker's diverticulum, especially in frail patients.

Transoral Laser Microsurgery versus Robot-Assisted Surgery for Squamous Cell Carcinoma of the Tongue Base (Oncological and Functional Results)-A Retrospective GETTEC Multicenter Study.

The base of the tongue (BOT) is the second most common site for squamous cell carcinoma (SCC) in the oropharynx. There are currently no clear guidelines for the management of BOT SCC. Our main objective was to compare the oncological outcomes of two minimally invasive approaches, transoral laser microsurgery (TLM) and transoral robot-assisted surgery (TORS). This was a retrospective French GETTEC (Groupe d'Études des Tumeurs de la Tête et du Cou) multicenter study of patients with BOT SCC removed surgically either by TLM or TORS between 2005 and 2021. The study group included 16 patients treated by TLM and 38 by TORS, with median follow-up times of 14.4 and 37.2 months, respectively. The overall survival (OS) rates at 2 and 3 years were 67% in the TLM group and 90% at 2 years and 86% at 3 years in the TORS group (p = 0.42, p = 0.20). There was no significant difference in recurrence-free survival (RFS) between the two techniques after 2 and 3 years. The tumors removed by TORS were significantly larger. Operative times were significantly shorter in the TLM group. There were no differences in feeding resumption; none of the patients in the TLM group required a tracheotomy. Postoperative hemorrhagic complication rates were similar in the two groups (12% for TLM and 13% for TORS). Both TORS and TLM showed encouraging oncological, functional, and safety results in BOT SCC even in recurrence or second primary cancer patients, without a technique being found superior in terms of OS or RFS. Tumors removed by TORS were larger without an increase in postoperative bleeding, extending the possibilities of transoral treatment.

Efficacy analysis of enhanced recovery after surgery in laparoscopic-assisted radical resection of type I choledochal cyst.

The objective of this study was to investigate the feasibility and effectiveness of laparoscopic-assisted radical resection of type I choledochal cyst (CC) guided by the principles of enhanced recovery after surgery (ERAS). A retrospective cohort study of type I CC admitted to our hospital between May 2020 and December 2021 were analyzed, a total of 41 patients with choledochal cyst underwent surgery during this period and 30 cases were selected based on inclusion and exclusion criteria. Patients (n = 15) who received the traditional treatment from May 2020 to March 2021 were included in the traditional group. Patients (n = 15) who received ERAS from April 2021 to December 2021 were included in the ERAS group. Both groups underwent surgery performed by the same surgical team. Preoperative data of the two groups were recorded, and relevant data were statistically analyzed and compared. There was a statistically significant difference in the dose of opioids. Significant differences were observed between the ERAS and traditional groups in the results of the FLACC pain assessment scale on the 1st and 2nd day after surgery, time of gastric tube, urinary catheter and abdominal drainage tube removal, time of first defecation after operation, time of first eating after operation, time to reach full food intake, results of CRP, ALB, and ALT on the 3rd and 7th postoperative day, postoperative hospital stay, and total treatment cost. No significant differences were observed between the two groups in terms of gender, age, body weight, cyst size, preoperative CRP, ALB, ALT, intraoperative blood loss, operation time, and the number of cases converted to laparotomy. Neither the FLACC pain assessment scale on the 3rd day after surgery, the incidence of postoperative complications, nor the rate of readmission within 30 days showed significant differences. Laparoscopic-assisted radical resection of type I CC guided by the principles of ERAS is safe and effective for children. The ERAS concept demonstrated advantages over traditional laparoscopic surgery, including reduced opioid use, shorter time to first postoperative defecation, earlier resumption of postoperative feeding, shorter time to reach full feeding, shorter postoperative hospital stay, and lower total treatment cost.

Effect of induced molting on ovarian function remodeling in laying hens

Induced molting (IM) can restore the laying rate of aged laying hens to the peak level of laying and rejuvenate ovarian function for the second laying cycle. To explore the mechanism of ovarian function remodeling during IM in laying hens, in this study, ninety 71-wk-old laying lady hens with 60% laying rate and uniform weight were selected for molting induction by fasting. Samples (serum and fresh ovarian tissue) were collected on the day before fasting (F0), the 3rd and 16th days of fasting (F3, F16), and the 6th, 15th, 32nd days of refeeding (R6, R15, and R32), and the number of follicles in each period was counted. Then, the reproductive hormone levels in serum and antioxidant levels in ovarian tissues were detected at different stages, and the gene expression of the KIT-PI3K-PTEN-AKT pathway and GDF-9 in ovaries was measured by qRT-PCR. The results showed that the laying rate increased rapidly after refeeding and returned to the prefasting level by R32. At F16 and R6, the number of mature follicles significantly decreased; the number of primary and secondary follicles significantly increased; the contents of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone (P4) in serum decreased; the relative expression of KIT, PI3K, AKT, and GDF-9 significantly increased; and that of PTEN significantly decreased. At R15 and R32, except for GDF-9, which maintained a high expression state, other indicators showed opposing trends to those observed at F16 and R6. In conclusion, IM activated the KIT-PI3K-PTEN-AKT signaling pathway and promoted the activation of primordial follicles during the fasting period and early resumption of feeding; gonadotropin secretion increased gradually, which promoted the rapid development of primary and secondary follicles to mature follicles and ovulation. This study explained the mechanism of ovarian function remodeling in the process of IM and provided a theoretical basis for improving the ovarian function of laying hens and optimizing the IM program.

MP52-19 ROBOTIC VERSUS OPEN CYSTECTOMY WITH ILEAL CONDUIT FOR THE MANAGEMENT OF NEUROGENIC BLADDER: A COMPARATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP52-19 ROBOTIC VERSUS OPEN CYSTECTOMY WITH ILEAL CONDUIT FOR THE MANAGEMENT OF NEUROGENIC BLADDER: A COMPARATIVE STUDY Jeanne Beirnaert, Ugo Pinar, Davy Benarroche, Morgan Roupret, Véronique Phé, Christophe Vaessen, Jerome Parra, Emmanuel Chartier-Kastler, and Thomas Seisen Jeanne BeirnaertJeanne Beirnaert More articles by this author , Ugo PinarUgo Pinar More articles by this author , Davy BenarrocheDavy Benarroche More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Véronique PhéVéronique Phé More articles by this author , Christophe VaessenChristophe Vaessen More articles by this author , Jerome ParraJerome Parra More articles by this author , Emmanuel Chartier-KastlerEmmanuel Chartier-Kastler More articles by this author , and Thomas SeisenThomas Seisen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystectomy associated with non-continent ileal diversion is a common surgery in patients with neurogenic bladder. Few data are available, especially for the robotic approach. Our purpose was to compare open cystectomy (OC) and robot-assisted radical cystectomy (RARC) with ileal conduit, regarding peri- and postoperative outcomes. METHODS: We included each patient who underwent cystectomy and ileal conduit for neurogenic bladder in a referral-center between January 2017 and November 2021. Datas were retrospectively analysed. Median follow-up was 16.6 months [IQR: 5; 41]. All patients had neurogenic bladder with failure of conservative treatment and/or impacted Quality of Life (QoL). Open cystectomy with non-continent ileal diversion and robot-assisted cystectomy with intra-corporeal non-continent ileal diversion were compared. Primary endpoint were postoperative complications. Secondary endpoints were length of hospital stay (LOS), surgery duration, blood loss and ureteral anastomosis stricture. RESULTS: A total of 123 patients were included, 85 (69.1%) undergoing OC and 38 (30.9%) RARC. Significant differences were observed for: operative time (OC: 266.9±64 vs. RARC: 205.8±55.5 min, p<0.001), blood loss (OC: 737.7±515.8 vs. RARC: 245.8±169.6 ml, p<0.001), delay until feeding resumption (OC: 7.1±4.7 vs. RARC: 5.5±2.9 days, p=0.05) and mean LOS (OC: 21.6±13.9 vs. RARC: 16.2±7.6 days, p=0.03). In RARC group, there were 10.5% complications Clavien-Dindo >2 whereas 23.8% complications underwent in the OC group (p=0.1). With regards to uretero-ileal anastomosis stenosis, 23 (18.7%) events occurred after a median follow-up of 16.6 months [IQR: 5; 41] including 20 (23.5%) and three (7.9%) in the ORC and RARC groups, respectively (p=0.07). Patients who underwent RARC had better ureteral stenosis-free survival rates than those who underwent ORC (log-rank test, p=0.05). CONCLUSIONS: RARC is a safe approach for management of neurological bladder showing significantly better perioperative outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e710 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeanne Beirnaert More articles by this author Ugo Pinar More articles by this author Davy Benarroche More articles by this author Morgan Roupret More articles by this author Véronique Phé More articles by this author Christophe Vaessen More articles by this author Jerome Parra More articles by this author Emmanuel Chartier-Kastler More articles by this author Thomas Seisen More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract NS8: Predictors Of Complete Oral Feeding Resumption After Stroke Based On The Modified Volume-viscosity Swallow Test In A Rehabilitation Hospital

Objective: Although the importance of early tube feeding after stroke has been established, many risks and problems such as negative impacts on swallow function, respiratory infections and feeling uncomfortable, also warrant attention. The trajectory of swallowing function recovery may be related to each patient’s characteristics. There is still no systematic predictors for clinical decision-making regarding oral feeding resumption. The aim is to explore predictors of complete oral feeding resumption after feeding tube with stroke based on the modified V-VST. Methods: A total of 86 stroke patients with tube feeding were enrolled after admission in rehabilitation hospital from 2020 to 2021. The swallowing function was screened with modified V-VST. If a patient complete every viscosity more than 5ml, feeding tube will be removed. Oral feeding was begun using mechanical soft diet and thickener to ensure every meal safe. 55 patients(63.95%) resumed complete oral intake, while 31 patients(36.05%) presented a more permanent way of tube feeding. We compared the baseline and clinical characteristics between the groups. To analyze oral feeding resumption probability, the Kaplan-Meier method was used. Results: The days of onset to rehabilitation hospital admission was significantly shorter in the complete oral resumption group(20.89±11.27 vs 37.16±27.37; P&lt;0.001). The group was also measured better performance in activities of daily living (Barthel Index). Patients in the tube feeding group have high rate of previous stroke. Kaplan-Meier estimated oral feeding resumption rates, patients with longer days(&gt;21days) tolerated tube feeding longer.(P&lt;0.001). Conclusion: Days of onset to rehabilitation hospital was the strongest predictor of complete oral feeding resumption. Patients might benefit from early recovery in rehabilitation hospital and start oral intake as early as possible.

Robotic versus open cystectomy with ileal conduit for the management of neurogenic bladder: a comparative study.

Cystectomy associated with non-continent ileal diversion is a common surgery in patients with neurogenic bladder. Few data are available, especially for the robotic approach. Our purpose was to compare open cystectomy (OC) and robot-assisted radical cystectomy (RARC) with ileal conduit, regarding peri- and post-operative outcomes. We included each patient who underwent cystectomy and ileal conduit for neurogenic bladder in a referral-center between January 2017 and November 2021. Data were retrospectively analyzed. Median follow-up was 16.6months [IQR: 5; 41]. All patients had neurogenic bladder with failure of conservative treatment and/or impacted Quality of Life (QoL). Open cystectomy with non-continent ileal diversion and robot-assisted cystectomy with intra-corporeal non-continent ileal diversion were compared. Primary endpoint was postoperative complications. Secondary endpoints were length of hospital stay (LOS), surgery duration, blood loss and ureteral anastomosis stricture. A total of 123 patients were included, n = 85 (69.1%) undergoing OC and n = 38 (30.9%) RARC. Significant differences were observed for: operative time (OC 266.9 ± 64 vs. RARC 205.8 ± 55.5min, p < 0.001), blood loss (OC 737.7 ± 515.8 vs. RARC 245.8 ± 169.6ml, p < 0.001), delay until feeding resumption (OC 7.1 ± 4.7 vs. RARC 5.5 ± 2.9days, p = 0.05) and mean LOS (OC 21.6 ± 13.9 vs. RARC 16.2 ± 7.6days, p = 0.03). In RARC group, there were 10.5% complications Clavien-Dindo > 2 whereas 23.8% complications underwent in the OC group (p = 0.1). RARC is a safe approach for management of neurological bladder showing significantly better perioperative outcomes.

Effectiveness of Aspiration Under Ultrasound Guidance in Breast Abscess in Terms of Early Resumption of Breast Feeding: A Randomized Controlled Trial

Objective: Effectiveness of aspiration under ultrasound guidance in breast abscess in terms of early resumption of breast feeding. Study Design: Randomized controlled trial Place and Duration: Mardan Medical Complex and Teaching Hospital and Jinnah International Hospital, Abbottabad, from November, 2021 to April, 2022. Methods: There were a total of 140 female participants. The patients ranged in age from 16 to 50. After obtaining the patient's written consent, demographic information including age, weight, height, and body mass index were collected. Breast abscess diagnosed on clinical examination and ultrasound breast were included. Seventy patients were assigned to Group I and treated with percutaneous aspiration, whereas the same number were assigned to Group II and underwent incision drainage. Early breast feeding was restored in both groups and compared for their respective outcomes. The entire dataset was analyzed using SPSS 20.0. Results: We observed that the percentage of patients in group I who were able to resume breast feeding was 61 (87.1%), and in group II was found in 42 (60%) patients. The level of comfort experienced by patients in group I 60 (85.7%), as compared to group II 35 (50%), was significantly greater. Conclusion: In this study, we came to the conclusion that percutaneous aspiration in breast abscess was successful and effective in comparison to incision drainage, with less problems and a high percentage of satisfaction among the women. Keywords: Incision drainage, Breast abscess, Percutaneous aspiration

Factors determining postoperative length of stay and time to resumption of feeding following free flap reconstruction for oral cancer

Microvascular free tissue transfer reconstruction following resection of oral cancer is commonly chosen as the first line of treatment due to its superior functional outcomes. Multiple patient and surgical factors impact the length of postoperative stay, and the time taken for patients to recommence oral feeding. This study aimed to identify factors that increase the length of stay and time to resumption of feeding. We retrospectively evaluated 100 cases from March 2015 to October 2020, and identified variables associated with increased length of stay (LOS) and time to resumption of feeding in univariate and multivariate analyses. Factors found to be associated with increased LOS in multivariate analysis were increasing age, elective tracheostomy, tumours originating from the floor of the mouth and mandible, a longer operating time, and use of fibular free flaps (p<0.05). Tracheostomy, increasing age, and female gender were strongly associated with delays in resumption of some types of oral feeding, and an integrated critical care unit (ICCU) stay of two or more days was associated with a longer time to resumption of free fluids. This information can be used to anticipate extensions to typical LOS, to produce cost analyses, develop individual patient risk stratification, manage patient expectations, and target the use of enhanced recovery programmes.

The Effectiveness of Three Regimens of Sedation for Children Undergoing Magnetic Resonance Imaging: A Clinical Study.

Magnetic resonance imaging (MRI) under sedation requires faster recovery for early discharge and feeding resumption in children with neuropsychiatric disorders. The use of dexmedetomidine alone results in delayed recovery. Propofol, when used alone, can cause hypotension and respiratory depression. A new regimen for sedation was evaluated by exploiting the properties of these drugs, to allow faster recovery with minimal adverse events. One hundred and fifty children aged 2-12 years requiring MRI were randomly allocated to these three groups. Group P (n = 50) received propofol bolus at 2 mg.kg-1 over 10 min followed by infusion at 100 μg.kg-1.min-1. Group D (n = 50) received dexmedetomidine bolus of 2 μg.kg-1 over 10 min followed by infusion at 1 μg.kg-1.h-1. Group PD (n = 50) received propofol bolus at 2 mg.kg-1 over 10 min followed by dexmedetomidine infusion at 1 μg.kg-1.h-1. Recovery characteristics were noted. Recovery following sedation in Group PD (15 ± 7.0 min) and Group P (17.35 ± 7.4 min) were comparable and significantly (P = 0.03) lesser than Group D (27.58 ± 8.09 min). Emergence delirium scores were significantly less in Group PD (5 ± 1.08) and Group D (5.6 ± 2.4), unlike scores in Group P (9 ± 2.43). About 79.5% (39/49) of children in Group P, 88.2% (45/51) of children in Group D, and 86% (43/50) of children in Group PD completed MRI without any movement. Seven (14.58%) in Group P, 2 (4%) in Group D, and 5 (10.20%) in Group PD required rescue sedation. The regimen with propofol bolus and dexmedetomidine infusion provided adequate sedation and better recovery characteristics in children aged 2-12 years without systemic complications, as compared to the use of either agent alone.

Scorpion envenomation in buffalo calf - Case report

Scorpion bit a three-month-old male buffalo calf of college sub-center in evening hours followed by rapid onset of clinical signs. Acute signs with lateral recumbency, paddling of legs, bellowing, nystagmus, frequent urination was observed in a calf. Clinical examination revealed subnormal body temperature (97.9oF), tachycardia (88/minute) and tachypnea (40/minute) with hyperemic conjunctival mucous membranes. Haematology showed severe leukocytosis (17.65x103/μl) while biochemistry showed slightly elevated serum total bilirubin (0.79 mg/dl) with normal blood urea nitrogen (25 mg/dl) and creatinine (1.4 mg/dl) values. Centrifugation of both whole blood sample in EDTA vial and clot activator tube showed haemolysed plasma and serum. Based on the evidence of scorpion bite, buffalo calf was treated symptomatically with Inj. Dextrose 5% 1 lit iv, Inj. Dexamethasone 0.04 mg/kg iv, Inj. Diazepam 1 mg/kg iv and Inj. Chlorpheniramine maleate 0.2 mg/kg im. Clinical signs of pain, nystagmus, bellowing, and excitation were subsided within half hour post-treatment while vital parameters were restored to normal after 12 h. A second treatment comprising of 1 liter Dextrose 5% 12 h later was followed by appreciable clinical improvement with resumption of normal suckling, feeding, and watering in treated calf. In conclusion, scorpion bite in bovines can be treated symptomatically with fluids, steroids, anti-allergic drugs, and sedatives in severe cases of nervous excitatory symptoms.

Predictors of complete oral feeding resumption after feeding tube placement in patients with stroke and dysphagia: Asystematic review.

The aim was to synthesise and discuss predictors of complete oral feeding resumption after feeding tube placement in stroke patients with dysphagia. This was a systematic review, following the PRISMA 2020 checklist. Eight databases (PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang and Vip) were searched for eligible studies from inception up to June 2021. The JBI Manual for Evidence Synthesis was used to guide this systematic review. Any cross-sectional survey, longitudinal study, cohort study or case-control study that explored the recovery from tube feeding to complete oral feeding in patients with dysphagia after stroke was included. Qualitative studies, review articles, case reports and conference abstracts were excluded. Two reviewers independently screened and appraised the studies. The Newcastle-Ottawa scale was used for quality assessment. Content analysis was used to categorise factors predicting feeding tube removal in stroke patients with dysphagia. This review included a total of 15 studies consisting of 1746 participants, of which 2 were case-control studies and 13 were cohort studies. Four studies were rated as having low risk of bias, and the other 11 had high risk of bias. The factors examined in the studies were categorised into demographic characteristics (age and sex), swallowing function (instrumental assessments and non-instrumental assessments), stroke characteristics (stroke severity, past stroke history and location of the stroke), functional status (cognitive function and physical function) and clinical measures (body mass index, geriatric nutritional risk index, white blood cell count and C-reactive protein level). The major limitation of this review is the failure to identify predictors of different tube feeding types. Although the current evidence is insufficient to support or oppose the predictive effect of any single factor, these factors are still valuable data for clinical staff that provide information that researchers can use in developing prognostic models. Rigorously designed and high-quality research is needed to further explore the predictive value of these factors. This review was registered prospectively with PROSPERO [CRD42021272552]. Healthcare providers should strengthen the monitoring of swallowing function in patients with stroke to promote complete oral feeding resumption. As the predictive value of the identified factors is still uncertain, large, well-designed, studies are needed to better clarify the importance of these predictors. No patient or public was involved in the design, analysis, preparation or writing of this review.