Routine Preoperative Examination Research Articles

Comparison of Routine Preoperative Ultrasound-Guided Airway Examination Versus Clinical Airway Examination in Predicting Difficult Laryngoscopy in Patients Coming for Elective Surgery: An Observational Study.

Background As part of preoperative patient evaluations, it is customary to estimate the likelihood of difficulties during laryngoscopy and intubation. A diverse array of predictors is frequently employed by anesthesiologists to anticipate difficult laryngoscopy (DL); however, no single predictor has been established as the gold standard. In the present study, we compared routine preoperative ultrasound-guided airway examination and clinical airway examination in predicting DL in patients coming for elective surgery. Methodology The present study is a single-blinded observational study that spanned 12 months, beginning in March 2018 and concluding in February 2019. The study took place at Kovai Medical Center and Hospital (KMCH), which is a tertiary-care facility in Coimbatore, India. The data were obtained through face-to-face interviews, with a sample size of 135 research participants. The questionnaire contained comprehensive data regarding the patient's age, weight, gender, comorbidities, planned surgery, and preoperative assessment, which encompassed a detailed examination of the airway. The clinical airway examination comprised assessing mouth opening, performing the modified Mallampati test, measuring thyromental height (TMH) and thyromental distance (TMD), evaluating neck circumference, and observing neck extension. Ultrasound-guided airway examination was performed during the immediate pre-operative period, focusing on specific parameters such as the pre-epiglottic space, anterior neck soft tissue at the level of vocal cords, thyrohyoid membrane, suprasternal notch, hyoid bone (single parameter measured at different levels), hyo-mental ratio, and tongue volume (TV). Results Among the ultrasound parameters, TV (72.15 cm3) is the best ultrasound parameter to predict DL (95%CI: 0.65 to 0.82), with a high sensitivity of 82% and specificity of 45.88%. Other parameters that are useful are anterior neck soft tissue at the level of the thyrohyoid membrane (0.67 cm), suprasternal notch (1.01 cm), and, lastly, pre-epiglottic space (0.57 cm). Among clinical parameters, modified Mallampati grade (grade 3 or more) is the best parameter to assess the airway clinically and predict DL, followed by neck circumference (>42 cm) and TMH (>5 cm). Based on the findings, we observed that both clinical and ultrasound parameters are comparable to predict DL. Conclusion We observed that routine clinical airway examination and ultrasound examination yielded comparable results in predicting DL. Therefore, the routine use of clinical airway examination still holds good in predicting DL.

Effect of posterior chamber phakic refractive lens implantation on the ocular surface and tear film

To evaluate changes in dry eye-related parameters after posterior chamber phakic refractive lens (PC-PRL) implantation. This prospective study included 21 highly myopic patients (39 eyes) who underwent PC-PRL implantation at Lanzhou Huaxia Eye Hospital between January 2021 and June 2022, with a 3-month postoperative follow-up. In addition to routine preoperative examinations, dry eye assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These assessments included the Ocular Surface Disease Index (OSDI) questionnaire score, non-invasive first tear break-up time (NIF-BUT), non-invasive average tear break-up time (NIA-BUT), tear meniscus height (TMH), meibomian gland loss (MGL) rate, and Schirmer I test (SIt). Repeated measures ANOVA was used to compare the differences in parameters across different time points, with pairwise comparisons conducted using the LSD-t test. After grouping, the Student's t-test was applied to compare normally distributed data, while the Mann–Whitney U test was used for non-normally distributed data. Categorical data were analyzed using the chi-square test. A total of 21 patients (39 eyes) were included, comprising 10 males (19 eyes) and 11 females (20 eyes), aged 19 to 49 years (33.76 ± 7.87). All patients completed the 3-month follow-up. Significant differences in OSDI scores were observed pre- and post-surgery (P = 0.008), with a peak at one week post-surgery (P < 0.001), then stabilizing at one and three months post-surgery. Postoperative NIF-BUT and NIA-BUT significantly decreased (P < 0.001 for both) but returned to preoperative levels within three months. There were no significant changes in TMH, MGL, or SIt postoperatively (P > 0.05). Significant differences in dry eye parameters were observed between the dry eye and control groups before and after surgery (P < 0.001). PC-PRL implantation impacts tear film stability on the ocular surface after surgery, leading to varying degrees of dry eye symptoms in patients. After surgery, all dry eye parameters return to their preoperative levels within three months.

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer.

In recent years, the incidence of colorectal cancer (CRC) has been increasing. With the popularization of endoscopic technology, a number of early CRC has been diagnosed. However, despite current treatment methods, some patients with early CRC still experience postoperative recurrence and metastasis. To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations. A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study. Results of blood routine test, liver and kidney function tests and tumor markers were collected before surgery. Patients were followed up through disease-specific database and telephone interviews. Tumor recurrence, metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis. We comprehensively compared the predictive value of preoperative blood routine, blood biochemistry and tumor markers for disease-free survival (DFS) and overall survival (OS) of CRC. Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS [hazard ratio (HR) = 0.995, 95% confidence interval (CI): 0.991-0.999, P = 0.015], while serum carcinoembryonic antigen (CEA) level (HR = 1.008, 95%CI: 1.001-1.016, P = 0.027) and serum total cholesterol level (HR = 1.538, 95%CI: 1.026-2.305, P = 0.037) were independent risk factors for OS. The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL. Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level, the difference between the two groups was not statistically significant (P = 0.075). For patients with T2N0M0 or T3N0M0 CRC, preoperative platelet count was a protective factor for DFS, while serum CEA level was an independent risk factor for OS. Given that these measures are easier to detect and more acceptable to patients, they may have broader applications.

Effect of anatomical liver resection on early postoperative recurrence in patients with hepatocellular carcinoma assessed based on a nomogram: a single-center study in China.

We aimed to investigate risk factors for early postoperative recurrence in patients with hepatocellular carcinoma (HCC) and determine the effect of surgical methods on early recurrence to facilitate predicting the risk of early postoperative recurrence in such patients and the selection of appropriate treatment methods. We retrospectively analyzed clinical data concerning 428 patients with HCC who had undergone radical surgery at Mianyang Central Hospital between January 2015 and August 2022. Relevant routine preoperative auxiliary examinations and regular postoperative telephone or outpatient follow-ups were performed to identify early postoperative recurrence. Risk factors were screened, and predictive models were constructed, including patients' preoperative ancillary tests, intra- and postoperative complications, and pathology tests in relation to early recurrence. The risk of recurrence was estimated for each patient based on a prediction model, and patients were categorized into low- and high-risk recurrence groups. The effect of anatomical liver resection (AR) on early postoperative recurrence in patients with HCC in the two groups was assessed using survival analysis. In total, 353 study patients were included. Multifactorial logistic regression analysis findings suggested that tumor diameter (≥5/<5 cm, odds ratio [OR] 2.357, 95% confidence interval [CI] 1.368-4.059; P = 0.002), alpha fetoprotein (≥400/<400 ng/L, OR 2.525, 95% CI 1.334-4.780; P = 0.004), tumor number (≥2/<2, OR 2.213, 95% CI 1.147-4.270; P = 0.018), microvascular invasion (positive/negative, OR 3.230, 95% CI 1.880-5.551; P < 0.001), vascular invasion (positive/negative, OR 4.472, 95% CI 1.395-14.332; P = 0.012), and alkaline phosphatase level (>125/≤125 U/L, OR 2.202, 95% CI 1.162-4.173; P = 0.016) were risk factors for early recurrence following radical HCC surgery. Model validation and evaluation showed that the area under the curve was 0.813. Hosmer-Lemeshow test results (X 2 = 1.225, P = 0.996 > 0.05), results from bootstrap self-replicated sampling of 1,000 samples, and decision curve analysis showed that the model also discriminated well, with potentially good clinical utility. Using this model, patients were stratified into low- and high-risk recurrence groups. One-year disease-free survival was compared between the two groups with different surgical approaches. Both groups benefited from AR in terms of prevention of early postoperative recurrence, with AR benefits being more pronounced and intraoperative bleeding less likely in the high-risk recurrence group. With appropriate surgical techniques and with tumors being realistically amenable to R0 resection, AR is a potentially useful surgical procedure for preventing early recurrence after radical surgery in patients with HCC.

Observing the factors affecting fibrovascular regrowth after pterygium excision and comparing the efficacy and complications of conjunctival autograft with sutures versus fibrin glue.

Aim: To observe the factors affecting fibrovascular regrowth after pterygium excision and to compare the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Materials and methods: 65 consenting patients with primary pterygium attending the outpatient department having appropriate indications for surgery were enrolled. Data was collected using personal interviews. Routine pre-operative ophthalmic examination was done, including visual acuity assessment, slit lamp examination, and fundus evaluation. Pterygium excision surgery was done on all patients using either Fibrin Glue or 10-0 nylon sutures. Patients were followed up at weeks 1, 4, 12, and 24 and any complications were duly noted. Results: The fibrin glue group showed milder postoperative discomfort, symptoms, and signs compared to the suture group. Pyogenic granuloma (3.12%), corkscrew vessels (6.25%), and subconjunctival hemorrhage (24.99%) were more common in the fibrin glue group. FVG not crossing the limbus was observed in 6.25% of glue cases and 9.09% of suture cases, more in fleshy and large pterygia, while age and gender did not alter the incidence of FVG. No recurrences were observed in any group. Conclusion: The incidence of fibrovascular regrowth (FVG) was not affected by age, gender, smoking, and surgical technique, but was positively correlated with length and grade of pterygium. The complication rate between the two groups was not found to be statistically significant. Despite causing severe postoperative discomfort and requiring prolonged surgical time, suture-assisted pterygium surgery is a cost-effective method still being used with long-term outcomes similar to fibrin glue.

Dental implant in anterior mandible according to mandibular lingual foramens and lingual mucosal vessels: using fusion volumetric images from computed tomography and magnetic resonance imaging

BackgroundPerforation of the lingual cortex while placing dental implants in the interforaminal region of the mandible can cause severe hemorrhage. The purpose of this study was to evaluate the features of mandibular lingual foraminals (MLFs) and locational relationship between them and lingual mucosal vessels (LMVs) by CT/MRI fusion volumetric images.Methods37 images within complete anterior mandibular region using both MSCT and three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) MRI were taken from our imaging archives. After exclusion of 11 for lesions or artifacts, 26 CT/MRI fusion volumetric images were included to evaluate the frequency, diameter, and position of MLFs. The anterior mandibular region was divided into 4 equal segments under each teeth, and 40 regions were got from C5 to D5. Furthermore, the positional relationship between MLFs and LMVs was analyzed in this coordinate system.Results62 MLFs (73.81%) were located below the incisors, followed by premolars (21.43%) and canines (4.76%). Female bias, the mean diameter of the female was 0.08 mm while the male was 0.21 mm. The total number of LMVs was most distributed on lingual side of C1 and D1. According to Spearman’s correlation coefficient, the location of MLFs was related to LMVs. The MLFs in fourth segment of D1 were positively moderately correlated with LMVs in fourth segment of D4, while the MLFs in third segment of C1 showed a weak positive correlation with LMVs in third segment of D4.ConclusionsThe features and the correlation between MLFs and LMVs in CT/MRI fusion volumetric images may offer reference to dentists when only MLFs can been seen on routine preoperative CT examination of implants.Trial registrationRetrospectively registered. (D2018-072)

Development and validation of a simple model to predict functionally significant coronary artery disease in Chinese populations: A two-center retrospective study

ObjectivesThis study sought to derive and validate a simple model combining traditional clinical risk factors with biomarkers and imaging indicators easily obtained from routine preoperative examinations to predict functionally significant coronary artery disease (CAD) in Chinese populations. MethodsWe developed five models from a derivation cohort of 320 patients retrospective collected. In the derivation cohort, we assessed each model discrimination using the area under the receiver operating characteristic curve (AUC), reclassification using the integrated discrimination improvement (IDI) and net reclassification improvement (NRI), calibration using the Hosmer-Lemeshow test, and clinical benefit using decision curve analysis (DCA) to derive the optimal model. The optimal model was internally validated by bootstrapping, and external validation was performed in another cohort including 96 patients. ResultsThe optimal model including 5 predictors (age, sex, hyperlipidemia, hs-cTnI and LVEF) achieved an AUC of 0.807 with positive NRI and IDI in the derivation cohort. Moreover, the Hosmer-Lemeshow test showed a good fit, and the DCA demonstrated good clinical net benefit. The C-statistic calculated by bootstrapping internal validation was 0.798, and the calibration curve showed adequate calibration (Brier score = 0.179). In the external validation cohort, the optimal model performance was acceptable (AUC = 0.704; Brier score = 0.20). Finally, a nomogram based on this model was constructed to facilitate its use in clinical practice. ConclusionsA simple model combined clinical risk factors with hs-cTnI and LVEF improving the prediction of functionally significant CAD in Chinese populations. This attractive model may be a choice for clinicians to risk stratification for CAD.

A novel radiographic analysis system for subaxial cervical spine pedicle screw placement

BackgroundPrecise pedicle screw placement of the subaxial cervical spine is difficult. Not every hospital is equipped with a guidance system that can provide effective help. Computed tomography (CT) scanning is almost a routine preoperative examination for cervical spine surgery in all hospitals. Appropriate measurement and analysis of the CT images could assist optimal cervical pedicle screw placement. The purpose of this study is to propose a new and universal method using computed tomography (CT) morphological parameters analysis to assist optimal cervical pedicle screw placement from C3 to C7.MethodsA localization system with six parameters was designed based on preoperative CT reconstruction to guide subaxial cervical spine pedicle screw placement. The six parameters were distance from the starting point to the midline [D1], distance from the starting point to the lower edge of the inferior articular process [D2], transverse section angle [TSA], sagittal section angle [SSA], pedicle width [PW], and pedicle height [PH]. The six parameters were analyzed in 53 participants.ResultsCombining D1 and D2 could localize the entrance of the pedicle screw, and we concluded that D1 and TSA and D2 and SSA could be a new standard for determination of the transverse and sagittal orientation of the pedicle screw. The six parameters were closely related to the patient’s gender, height, and weight. PH and PW were linearly correlated and could guide selection of the appropriate pedicle screw. SSA was an independent parameter of the relevant vertebral body, and changes in SSA had nothing to do with the curvature or posture of the cervical spine.ConclusionsUnderstanding and applying the six-parameter localization system are essential for achieving accurate and optimal pedicle screw placement in subaxial cervical spine, regardless of cervical sagittal alignment.

Cardiovascular therapy in patients hospitalized for elective large joint arthroplasty: real-world practice review

Background. The patients who require major lower limb joint replacement have a high prevalence of comorbidities, particularly hypertension. Also, they are mostly elderly, with concomitant obesity, chronic kidney disease, poor glycemic control, etc. These factors individually and collectively increase the risk of complications in the perioperative period.&#x0D; Aim. To study the features of preoperative drug therapy for cardiovascular diseases considering the indications in patients hospitalized for elective major lower limb joint replacement.&#x0D; Materials and methods. The study included an unselected sample of patients, 41 males and 77 females (n=118). The mean age was 64.711.1 years, and the mean body mass index was 30.74.9 kg/m2. All patients had a detailed history, an examination with blood pressure measurement, and their therapy for cardiovascular diseases was analyzed. Of 118 patients, 88 (74.6%) had hypertension, 68 (77.2%) received angiotensin-converting enzyme inhibitors, 20 (22.8%) angiotensin receptor blockers, 17 (19.3%) calcium channel blockers combined with other antihypertensive drugs, 11 (12.5%) had no antihypertensive therapy before hospitalization, despite a recorded high blood pressure for several years.&#x0D; Results. The routine preoperative outpatient examination included lipid profile in 77 (65.3%) patients, most of whom had total cholesterol only (66 had levels above normal); low-density lipoprotein levels were measured in only 14 (11.9%) patients, and 9 had levels above target for the relevant risk group. Statins were previously prescribed to only 18 (15.3%) patients. Twenty-two (18.6%) patients reported taking acetylsalicylic acid, with only 7 according to indications; 5 (4.2%) received clopidogrel, of which 1 patient had no indications.&#x0D; Conclusion. Most of the study patients had hypertension of varying severity. Some patients received suboptimal antihypertensive therapy and, in some cases, previously prescribed antihypertensive drug combinations not complying with relevant guidelines. Most patients with hypercholesterolemia did not receive statins with no rationale for not prescribing this class of drugs. Some patients received antiplatelet agents with no appropriate indications.

PLEOMORPHIC ADENOMA OF THE PALATE—A CASE REPORT

A 74-year-old male patient was referred to the oral and maxillofacial surgery service with a diagnosis of pleomorphic adenoma after a previous incisional biopsy under local anesthesia. The patient had complained of a painless nodular lesion on the hard palate, with slow and progressive growth for 1 year. Upon clinical examination, we observed a nodular lesion, sessile, with a firm consistency, 5.0 cm in its largest diameter and localized on the right side of posterolateral region on the hard palate, extending to the soft palate. Cone beam computed tomography showed no evidence of bone involvement or even communication with the maxillary sinus. After routine preoperative examinations, the patient underwent total excision of the lesion under general anesthesia. Histopathologic analysis of the specimen confirmed the preoperative diagnosis. After 8 months of postoperative follow-up, the surgical site was completely repaired with no signs of recurrence.

A large-scale study of patients with preoperative vocal cord paralysis associated with thyroid disease and related clinicopathological features.

The performance of thyroidectomies has been increasing over the last decade due to the growing prevalence of thyroid diseases. The purpose of this study was to investigate the clinical significance of preoperative vocal cord paralysis (VCP) associated with thyroid disease and other incidences of malignant or benign lesions, as well as different thyroid pathological features. Additionally, the epidemiological changes of thyroid diseases with preoperative VCP were investigated. Ninety-nine out of 12,530 patients with preoperative VCP who had undergone thyroid surgery for various diseases in the Zhejiang Cancer Hospital from January 2007 to December 2015 were identified. Their clinicopathological data was recorded and case distributions from different years and intraoperative recurrent laryngeal nerve statuses were retrospectively analyzed. The incidence of preoperative VCP in 2007 was reported to be 1.53% (9/590) and had decreased to 0.53% (12/2,247) by 2015 (P < 0.05). Among the 99 patients with preoperative VCP, 81 had malignancies (81.82%), while 18 (18.18%) had benign thyroid diseases. The incidences of preoperative VCP in malignant and benign diseases were 1.13% (81/7,159) and 0.35% (18/5,371), respectively (P < 0.05). There were only 5 (0.04%, 5/12,530) cases of papillary thyroid microcarcinoma with preoperative VCP. There was no statistical difference between the incidence of preoperative hoarseness in malignant 69.14% (56/81) and benign diseases 61.11% (11/18) with preoperative VCP. The preoperative VCP incidence rate had gradually decreased with an increased proportion of papillary thyroid cancer. Preoperative voice symptoms do not necessarily suggest a malignancy. Selective rather than routine preoperative laryngoscopic examinations should be performed on papillary thyroid microcarcinomas. The probability of preoperative VCP in malignancy was significantly higher than in benign lesions.

Acute coronary syndrome after liver transplantation in a young primary biliary cholangitis recipient with dyslipidemia: a case report

BackgroundPrimary biliary cholangitis (PBC) is a chronic, progressive liver disease associated with dyslipidemia. There is a consensus that PBC does not accelerate coronary artery disease despite high cholesterol levels, so the screening test for the coronary artery is not routinely performed before liver transplantation (LT). To date, no report has described the potential risk of PBC-related dyslipidemia for developing acute coronary syndrome (ACS) after LT.Case presentationA 40-year-old Asian female with a known history of PBC underwent ABO-incompatible living-donor LT, with her husband as the donor. Although she had high cholesterol and triglyceride levels that were refractory to medications, she passed all routine preoperative examinations, including cardiopulmonary function tests and infection screenings. One week after LT, she developed ACS with 90% stenosis of both the left anterior descending artery and left circumflex artery. Emergent stent implantation was successfully performed followed by dual antiplatelet therapy. The long history of PBC and associated severe dyslipidemia for 10 years would have accelerated the atherosclerosis, causing latent stenosis in the coronary artery. Inapparent stenosis might have become apparent due to unstable hemodynamics during the acute phase after LT.ConclusionsPBC-related dyslipidemia potentially brings a risk for developing ACS after LT. This experience suggests that the preoperative evaluation of the coronary artery should be considered for high-risk patients, especially those who have drug-resistant dyslipidemia.

Snoring induced reflux (SnoR) and a carcinoma in the gastro-oesophageal junction.

Little is known about the relationship between snoring and the development of carcinomas of the gastro-oesophageal junction. The aim of the paper is to draw attention to snoring induced reflux (SnoR) observed during a routine preoperative examination in a patient with AEG type II after neoadjuvant chemotherapy. During the examination the patient (body mass index 26.5) started to snore deeply. As a consequence, remarkable morphological-functional changes at the gastro-oesophageal junction became apparent. Reflux was periodically aspirated, accompanied by snoring on inspiration. In our patient, the carcinoma developed precisely at this point of contact. The phenomenon of SnoR is demonstrated in a video. SnoR could be an explanation for the described correlation between snoring and the occurrence of carcinomas in the gastro-oesophageal junction. Further studies on the phenomenon of SnorR could be of major interest for the understanding of AEG carcinomas. It is possible that new preventive measures can be derived from these findings.

Clinical Characteristics and Early Visual Outcomes of Highly Myopic Cataract Eyes: The Shanghai High Myopia Study.

Purpose: To report ocular characteristics and early visual outcomes of highly myopic cataract eyes, and to analyze the risk factors of low vision.Methods: A total of 2,027 eyes of 1,400 cataract patients with axial length (AL) ≥ 26 mm undergoing cataract surgery in Eye & ENT Hospital of Fudan University, who were registered in the Shanghai High Myopia Study, were analyzed. Routine pre-operative ophthalmic examinations were performed and macular scan of optical coherence tomography (OCT) were obtained. Macular complications, central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were evaluated from OCT images. Ocular and surgical history and perioperative complications were also recorded. Uncorrected and best-corrected visual acuity (UCVA/BCVA) 1 month post-operatively and its influencing factors were evaluated.Results: The average AL of all involved eyes was 29.52 ± 2.26 mm, and 39.7% of which were with an AL > 30 mm and 26.4% of which were with a corneal astigmatism more than 1.5 D. Nuclear cataract accounted for the largest proportion (70.6%). The rate of overall macular complications was 27.6%. Postoperative UCVA and BCVA were 0.70 ± 0.46 and 0.25 ± 0.32 logMAR, respectively. BCVA improved significantly after surgery (vs. P < 0.001) and affected by the elongation of AL (P < 0.001) and thinning of CFT and SFCT (both P < 0.001). The risk factors of post-operative low vision (BCVA < 20/66) were macular atrophy, lamellar macular hole, high corneal astigmatism, long AL, thin SFCT and junior surgeons, odds ratios ranging from 1.54 to 54.87 (all P < 0.05).Conclusion: Cataract surgery could improve the VA of highly myopic eyes. Eye with macular complications, higher corneal astigmatism, longer AL, thinner SFCT, and who was treated by a junior surgeon, may have a high risk of low vision after surgery.

Can the degree of fibrosis in the gallbladder wall be predicted by preoperative routine examinations in chronic cholecystitis? Retrospective analysis

Can the degree of fibrosis in the gallbladder wall be predicted by preoperative routine examinations in chronic cholecystitis? Retrospective analysis

Routine preoperative examination for diagnosis of periprosthetic joint infection and its recurrence in revision hip arthroplasty

To evaluate diagnostic value of routine preoperative laboratory tests such as erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and microbiological examination of joint aspirate in patients with periprosthetic joint infection or its recurrence in patients scheduled for revision hip arthroplasty. There were 117 patients. Preoperative CRP and ESR, the culture of pre- and intraoperative joint aspirates and tissue biopsies were studied. We analyzed diagnostic significance of these parameters and the likelihood of periprosthetic joint infection depending on increase of CRP/ESR and previous joint infection. According to microbiological data, periprosthetic joint infection was diagnosed in 19.7% of patients. High CRP in this group significantly increased the chance of joint infection diagnosis (OR 6.3; 95% CI 1.491-26.615). Concomitant increase of both ESR and CRP increased this likelihood by 7.7 times (OR 7.778; 95% CI 0.931-66.296). In the 2nd group, periprosthetic joint infection was confirmed in 25% of patients. At the same time, detection of pathogen in isolated or combined increase in CRP and ESR was less likely compared to the control group. Prognostic value of negative preoperative microbiological examination of joint aspirate was only 93%. We failed to obtain aspirate in 21.4% of cases. Increase of the routine serological parameters before revision hip arthroplasty is more sensitive for prediction of periprosthetic joint infection in patients without previous infection. Previous joint infection reduces diagnostic value of ESR and CRP in detection of recurrent periprosthetic joint infection. Preoperative examination of joint aspirate is not sufficient for etiological diagnosis of periprosthetic joint infection. However, positive microbiological culture should be taken into account for the choice of further management.

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

Role of 18F-FDG-PET/CT in Combination With Neutrophil-Lymphocyte Ratio in the Diagnosis of Upper Urinary Tract Lesion: Can We Accurately Predict Malignant Tumor?

ObjectiveTo explore whether preoperative 18Fluorine-Fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in combination with neutrophil–lymphocyte ratio (NLR) could accurately predict malignant lesions of upper urinary tract (UUT).Methods and MaterialsThe clinicopathologic data of a total of 252 patients with UUT lesions receiving surgical treatment at our center from January 2012 to November 2019 were retrospectively analyzed. All patients performed routine preoperative hematological examination, urine cytology, computed tomography urography (CTU), and 18F-FDG-PET/CT. Clinicopathologic data between 179 cases with malignancy (Group 1) and 73 cases with benign lesions (Group 2) were compared. Multivariate logistic regression analysis was used to explore the independent predictors of malignant UUT lesions. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability.ResultsAmong all patients, univariate analysis showed that NLR, hydronephrosis, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis revealed that NLR, CTU indicating malignancy, and PET/CT indicating malignancy were independent predictors of malignant UUT lesions; the area under ROC curve (AUC) of NLR, CTU, PET/CT, combining CTU and NLR, combining PET/CT and NLR, and combining PET/CT and CTU were 0.735, 0.788, 0.857, 0.863, 0.913, and 0.919, respectively, for postoperative pathological malignancy. Among 68 patients undergoing ureteroscopy biopsy, univariate analysis suggested that NLR, positive urine exfoliation cytology, CTU indicating malignancy, and PET/CT indicating malignancy were significantly associated with malignant UUT lesions; multivariate analysis demonstrated that positive urine cytology, PET/CT indicating malignancy, and NLR were independent predictors of malignant UUT lesions; the AUC of NLR, ureteroscopy biopsy, and combining PET/CT and NLR were 0.768, 0.853, and 0.839, respectively, for postoperative pathological malignancy.ConclusionsCombining preoperative NLR and PET/CT performed well in differentiating benign from malignant UUT lesions, which could not be identified by traditional imaging or urine cytology. Combining preoperative NLR and PET/CT could be used to reduce unnecessary ureteroscopy biopsy, which might result in tumor cell dissemination and risk of associated complications.

Clinically Significant Intraocular Lens Decentration and Tilt in Highly Myopic Eyes: A Swept-Source Optical Coherence Tomography Study

To investigate the occurrence and risk factors of clinically significant intraocular lens (IOL) decentration and tilt in highly myopic eyes using swept-source anterior segment optical coherence tomography (SS-AS-OCT). Cross-sectional study. This study included 334 participants (334 eyes) with high myopia, defined as axial length (AL) ≥26 mm, who underwent phacoemulsification with IOL implantation. Decentration and tilt of IOL were assessed by SS-AS-OCT. Clinically significant IOL decentration and tilt was defined as decentration ≥0.4 mm and tilt ≥7°. Routine preoperative and postoperative examinations included visual acuity, refraction, biometric measurement using IOLMaster 700 (Carl Zeiss Meditec), and objective visual quality evaluated by OPD-Scan III (Nidek Technologies). Among the 334 highly myopic participants, 71 (21.3%) had clinically significant IOL decentration, and 26 (7.78%) had clinically significant IOL tilt. The proportion of clinically significant IOL decentration (37.1% vs 14.0%, P < .001) and tilt (16.2% vs 3.90%, P < .001) in those with AL ≥30 mm was significantly higher than in those with AL <30 mm. The multivariable logistic regression model showed only AL ≥30 mm was associated with clinically significant IOL decentration (odds ratio, 1.65; P=.002). AL ≥30 mm (odds ratio, 2.09; P=.001) was an independent risk factor for clinically significant IOL tilt after adjusting for confounders. AL ≥30.3 mm could effectively predict IOL decentration ≥0.6 mm (area under the curve, 0.802). Participants with AL >30 mm have a higher risk of clinically significant IOL decentration and tilt, thus caution should be taken to implant multifocal or toric IOL for these patients.

Prognostic Value of Serum Apolipoprotein B to Apolipoprotein A-I Ratio in Hepatocellular Carcinoma Patients Treated with Transcatheter Arterial Chemoembolization: A Propensity Score-Matched Analysis

Introduction: The prognosis of advanced hepatocellular carcinoma (HCC) varies in patients receiving transcatheter arterial chemoembolization (TACE). In this study, we aimed to assess the prognostic value of serum apolipoprotein B (ApoB)/apolipoprotein A-I (ApoA-I) in this group of patients. Methods: The serum lipid levels of HCC patients undergoing TACE were obtained from routine preoperative blood lipid examination. A propensity score-matched (PSM) analysis was used to eliminate the imbalance of baseline characteristics of the high and low ApoB/ApoA-I groups. Then, univariate and multivariate analysis were conducted to evaluate the prognostic value of ApoB/ApoA-I. Results: In 455 HCC patients treated with TACE, ApoB/ApoA-I was positively correlated with AFP, T stage, distant metastasis, and TNM stage (p < 0.05). Patients with high ApoB/ApoA-I had a significantly shorter overall survival (OS) than those with low ApoB/ApoA-I (median OS, 21.7 vs. 39.6 months, p < 0.001). Multivariate analysis indicated that ApoB/ApoA-I was an independent prognostic index for OS (hazard ratio [HR] = 1.42, p = 0.008). After baseline characteristics were balanced, 288 patients were included in the PSM cohort. In this cohort, high ApoB/ApoA-I still predicted inferior OS in both univariate analysis (median OS, 27.6 vs. 39.3 months, p = 0.002) and multivariate analysis (HR = 1.58, p = 0.006). Conclusion: Serum ApoB/ApoA-I is a useful biomarker in predicting aggressive clinicopathological characteristics and poor prognosis in HCC patients treated with TACE.