Satisfactory Outcome Research Articles

Transcatheter Aortic Valve Replacement With a Fully Retrievable Self-Expanding Dry-Tissue Valve: First-in-Man Study.

Transcatheter Aortic Valve Replacement With a Fully Retrievable Self-Expanding Dry-Tissue Valve: First-in-Man Study.

Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury.

Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury.

Complex endovascular arch repair using fenestrated and branched devices: a single-centre experience.

Endovascular arch repair is a reasonable alternative for patients at high risk for open surgery. Despite a reduction in procedural invasiveness, complications remain, particularly in elderly and urgent cases. This study aimed to evaluate our institutional experience at a high-volume aortic center. Retrospective, single-center study of endovascular arch repair, along with subgroup analyses for urgent settings, octogenarian patients and graft design. Primary outcomes were technical success, 30-day mortality and morbidity. During follow-up, survival estimation, cumulative incidence of reintervention, endoleak and target vessels instability were evaluated. The study included 74 patients (mean age 72 ± 9 years) treated, between September 2018 and April 2024, with custom-made fenestrated/branched endograft. Technical success was achieved in 93.2% of the patients. Thirty-day mortality in elective setting was 5.4%, and 44.4% in urgent repairs. Major stroke occurred in 6.8% of patients. Urgent repairs showed higher rates of technical failure (22.2 vs 1.8% P < 0.01), 30-day mortality (44.4 vs 5.4%; P < 0.001) and major strokes compared to elective repairs (22.2 vs 1.8%; P < 0.01). Octogenarians had significantly higher 30-day mortality but no difference in major adverse events compared to younger patients (P < 0.01). Branched endografts had higher rates of type Ia endoleaks and reinterventions than fenestrated endografts. At 24 months, the estimated rates were as follows: survival 79% (standard error-SE 0.09), cumulative incidence of reintervention 24% (SE 0.074), endoleak 9% (SE 0.037) and target vessel instability 9% (SE 0.04). Endovascular arch repair is feasible and yields satisfactory outcomes in high-risk populations, particularly in elective settings. Urgent and elderly patients remain challenging, underscoring the importance of careful patient selection.

Surgical Management of Microstomia: A Comprehensive Review of Treatment Options.

Surgical Management of Microstomia: A Comprehensive Review of Treatment Options.

Total transvaginal natural orifice endoscopic surgery (v-NOTES) for colon cancer: A prospective cohort pilot study.

e15617 Background: The abdominal incisions after laparoscopic colorectal cancer surgery remain to bother surgeons and patients due to cosmetic concerns, potential scarring and related complications. Total transvaginal natural orifice endoscopic surgery (total v-NOTES) has emerged as a totally scarless and promising alternative. This cohort pilot study endeavors to evaluate the safety, feasibility, and long-term survival outcomes of employing total v-NOTES in the management of colon cancer for female patients. Methods: This non-randomized prospective cohort pilot study involved seven female patients who underwent total v-NOTES from September 2020 to January 2021 for Stage II or III colon cancer in our hospital. Demographic information, perioperative outcomes and oncological outcomes were recorded. Subsequently, overall survival (OS) was defined as the time period from surgery until death or loss of follow-up, and disease-free survival (DFS) was defined as the period from surgery until signs or symptoms of cancer, or loss of follow-up. 3-year OS and DFS were obtained from all patients. Results: For perioperative outcomes, the surgeries were successfully executed for all 7 patients via the transvaginal route, with no conversions to regular laparoscopic surgery. The median operative time was 275 minutes and the median estimated blood loss was 100 ml. No grade III or above postoperative complications by Clavien-Dindo grading were reported, and there were no readmissions within the 30-day postoperative period. For oncological outcomes, all patients achieved R0 resections, with no positive distal margin or circumferential margin. At least 12 lymph nodes were retrieved from all cases with a median of 14 harvested lymph nodes. At the 3-year follow-up, survival was maintained in all patients, with no instance of recurrence or metastasis. Conclusions: Total v-NOTES is a feasible and safe approach for selected patients with colon cancer, offering satisfactory perioperative and long-term outcomes. While these results are encouraging, further large-scale studies are essential to confirm its potential as a viable alternative to traditional laparoscopic surgery. Clinical trial information: NCT04527861 .

Submental island flap reconstruction in oral cavity cancer patients with pathological level I lymph node metastasis: Flap site recurrence and survival analysis.

Submental island flap reconstruction in oral cavity cancer patients with pathological level I lymph node metastasis: Flap site recurrence and survival analysis.

Comparable outcomes in single versus multiple septal branches alcohol ablation for obstructive hypertrophic cardiomyopathy.

Comparable outcomes in single versus multiple septal branches alcohol ablation for obstructive hypertrophic cardiomyopathy.

Computer-simulated mirror osteotomy in the treatment of post-traumatic cubitus varus deformity in children

PurposeTo explore the feasibility and early clinical efficacy of computer-based mirroring technology in simulating osteotomy for the treatment of post-traumatic cubitus varus deformity in children.MethodsA retrospective analysis was conducted on the data of 26 patients with cubitus varus deformity who were admitted between June 2019 and June 2024. Among them, there were 19 males and 7 females, with an average age of 8.12 ± 2.83 years (ranging from 5 to 15 years). The time from injury to surgery ranged from 13 to 84 months, averaging at 27.85 ± 21.91 months. The carrying angle and anteversion measured on full-length anteroposterior radiographs of both upper extremities and lateral radiographs of the elbow joint were used as osteotomy parameters. Low-dose CT scans of both upper extremities of the pediatric patients were performed to reconstruct three-dimensional (3D) models of the affected limb for computer-simulated osteotomy. The 3D mirror-imaging technique of the unaffected side was applied for overlay comparison, and the osteotomy parameters were adjusted accordingly. Surgeries were performed based on the final parameters obtained. Intraoperative data such as surgical duration and blood loss were recorded, and regular postoperative follow-ups were conducted with X-ray examinations to observe bone callus formation in the osteotomy area. At the final follow-up, the carrying angle, anteversion, and range of motion (flexion and extension) of the elbow joints on both the affected and unaffected sides were measured, and elbow function was assessed using the Mayo score.ResultsThe surgical duration for the 26 patients ranged from 35 to 55 min, averaging at 44.23 ± 7.83 min, with an average blood loss of 32.12 ± 6.35 ml (ranging from 20 to 40 ml). The mean follow-up duration was 31.12 ± 15.81 months (ranging from 6 to 60 months). Kirschner wires (K-wires) were removed 8–12 weeks postoperatively, and plates were taken out 4–6 months later. During the follow-up period, two patients experienced pin tract irritation symptoms after K-wire fixation, which improved after dressing changes; one patient had poor plate adherence causing skin irritation and recovered after early removal of the internal fixation. No complications such as fracture or loosening of the internal fixation devices occurred. At the final follow-up, the carrying angle of the affected elbow joint was (13.48 ± 4.19) °, the anteversion was (44.08 ± 3.80) °, the flexion was (143.27 ± 1.51) °, and the extension was (-7.23 ± 1.63) °. These values were significantly improved compared to those before surgery and showed no significant difference compared to the unaffected side. According to the Mayo Elbow Performance Score, 24 patients were rated as excellent and 2 as good.ConclusionUsing computer-based mirroring technology for osteotomy simulation enables precise bone resection, which not only shortens the surgical duration but also makes the surgical procedure easier to operate, with satisfactory clinical treatment outcomes in the short-term.

Clear aligner therapy combined with orthognathic surgery: A scoping review.

Clear aligner therapy combined with orthognathic surgery: A scoping review.

Can Collaboration Succeed in Siting a Spent Nuclear Fuel Facility in the United States?—A Challenge in Political Sustainability

We examine the U.S. Department of Energy (DOE)’s consent-based collaborative process to locate, build, and operate one or more federal consolidated interim storage facilities (FCISFs) for commercial U.S. spent nuclear fuel—instead of continuing to store the material at over 70 nuclear reactor sites. Technocratic siting of nuclear facilities in the U.S., most of which did not involve meaningful public participation, was not successful. We consider increasing pressure to find at least one FCISF site, as well as the critical role of trust in engaging communities and gaining their consent—leading some observers to assert that DOE is in the “trust building business”, not the siting business. We present case studies with the following: (1) illustrating community engagement that led to a more satisfactory outcome than had been anticipated (Fernald); (2) a planned consent-based process that failed to gain consent (Office of the Nuclear Waste Negotiator); and (3) a site that demonstrates the ongoing need for negotiations to keep a site open and operational (Waste Isolation Pilot Plant). The essay concludes with the observation that a consent-based siting effort can succeed in the U.S., but that five main challenges—related to trust and requiring patience—will need to be addressed.

Cascade Catalytic Nanozymes Induce Tumor Ca2+ Overload and Ferroptosis by Reducing Energy Supply and Amplifying Oxidative Stress.

Nanozyme-mediated nanocatalytic therapy, by mimicking the activity of redox enzymes, generates highly toxic reactive oxygen species (ROS) within tumor cells, thereby opening a pathway for tumor-specific therapy. However, achieving satisfactory therapeutic outcomes with nanozymes remains challenging due to the inherent complexity of the tumor microenvironment (TME). In this context, we designed a two-dimensional layered double hydroxide (LDH) nanozyme loaded with Au nanoparticles, while incorporating bioactive Ca2+ and Fe3+ ions (denoted as MgCaFe-LDH@Au NSs) to target the specific needs of the TME. The designed nanozyme mimics glucose oxidase to facilitate self-sufficient H2O2 production and simulates catalase and glutathione peroxidase to overcome the adverse conditions of hypoxia and elevated GSH levels in the TME. Subsequently, the nanozyme emulates peroxidase activity to generate ROS, amplifying oxidative stress and causing redox imbalance, ultimately inducing ferroptosis in tumor cells. Moreover, MgCaFe-LDH@Au NSs also function as an inorganic semiconductor sonosensitizer with a tunable band structure, enabling the generation of abundant ROS under ultrasound irradiation to achieve synergistic sonodynamic and catalytic therapy. Notably, the high levels of ROS induced by the nanozyme, along with the interference in tumor ATP synthesis, enhanced the calcium overload in the TME caused by the release of Ca2+ from the nanozyme. In summary, this two-dimensional nanomaterial, through nanozyme and ultrasound-catalyzed synergistic disruption of tumor energy supply and redox balance, exhibited significant therapeutic efficacy in a 4T1 tumor-bearing mouse model. This study also highlights the immense potential of multimetal LDHs as inducers of calcium overload and ferroptosis in tumor therapy.

Efficacy of Bed Exercise Following Primary Total Hip Replacement in Young Active Patients.

BACKGROUND Postoperative rehabilitation exercise is a crucial stage for promoting joint function recovery and ensuring satisfactory outcomes. However, limited evidence exists to guide rehabilitation for younger total hip replacement (THR) patients. This study evaluates whether bed exercise after total hip replacement (THR) in patients under 65 improves hip function, quality of life, and reduces postoperative complications. MATERIAL AND METHODS A retrospective analysis of 389 THR patients was conducted, dividing them into Group A (bed exercise + gait re-education) and Group B (gait re-education only). Harris Hip Score and SF-36 were assessed at baseline and at 5, 17, and 35 weeks postoperatively. RESULTS Group A showed superior outcomes in hip function, quality of life, and fewer complications compared to Group B. At 5 weeks, Group A had a significantly higher Harris Hip Score (78.1±9.4 vs 71.5±12.9, P=0.036) and SF-36 scores (PCS: 82.6±14.1 vs 73.1±16.0, P=0.019; MCS: 80.5±16.9 vs 67.9±18.8, P<0.001). Postoperative complications, including deep vein thrombosis (2.7% vs 14.1%, P<0.001) and joint stiffness (1.1% vs 5.3%, P=0.020), were less frequent in Group A. CONCLUSIONS Bed exercise significantly enhances hip function, improves quality of life, and lowers complication rates, making it an effective postoperative rehabilitation approach for THR patients under age 65 years.

Correction of nasal skin necrosis after filler injection with micro and nanofat grafting

Vascular compromise leading to skin necrosis is the most serious complication of filler injection. This report presents two cases of nasal skin necrosis treated with microfat and nanofat grafting. Microfat was harvested from the thigh, rinsed with saline, and filtered through sterile gauze. Nanofat was produced by mechanically emulsifying the microfat. Microfat was injected into the pre perichondrium and subcutaneous layers, while nanofat was delivered into the subdermal and intradermal layers. Both patients showed satisfactory outcomes without complications. The nasal tips healed with soft, natural-looking skin indistinguishable from the surrounding tissue. This technique offers a cost-effective alternative for repairing skin necrosis, avoiding the need for debridement or more invasive procedures such as skin grafts or flaps, which may result in scarring and asymmetry.

Mid-term efficacy of OLIF combined with unilateral pedicle screw fixation in the treatment of lumbar degenerative diseases

Unilateral pedicle screw (UPS) fixation has been applied in oblique lumbar interbody fusion (OLIF). However, the internal fixation strength required by OLIF is still controversial. Although satisfactory short-term outcome has been achieved with OLIF combined with UPS, the maintenance of stability in the fused segment remains a concern due to the lack of mid-term to long-term clinical follow-up reports. In this study, we compared the mid-term to long-term radiographic and clinical outcomes of unilateral (n = 100) versus bilateral (n = 86) instrumented one-level OLIF for lumbar degenerative disease (LDD).The mean follow-up duration was 75.09 ± 5.08 months. A significant decrease occurred in operative time, blood loss in UPS group. No statistical difference was detected regarding complication rate and fusion rate between the two groups. The VAS of low back pain at 6 months postoperatively was better than that of the BPS group. However, there were no significant differences in VAS and ODI at any other follow-up time point. The incidence of ASD was 12% lower in the UPS group than the 18.6% observed in the BPS group at the final follow-up. The standardized cross sectional area (SCSA) and degree of fat infiltration (DFF) of the multifidus muscle (MM) were better than those of the BPS group in the same period. The current data show that OLIF-UPS for the treatment of single-level LDD could achieve satisfactory mid-term to long-term outcomes comparable to BPS fixation, with less surgical time, less blood loss, and less DFF of the MM.

Mid- to long-term outcomes of covered balloon-expandable stent implantation for the management of vascular injuries in patients undergoing transfemoral transcatheter aortic valve implantation: the BE-SAFE Registry : for the RECOVER (REsults after percutaneous interventions with COVERed stents) Investigators.

Vascular complications occur in a non-negligible proportion of transfemoral transcatheter aortic valve implantation (Tf-TAVI) procedures. There is only limited evidence regarding the efficacy and safety of covered balloon-expandable (CBE) stents in the management of Tf-TAVI related vascular complications. We aimed to investigate the efficacy and safety of CBE stent implantation to treat access-related vascular complications in patients undergoing Tf-TAVI. The present retrospective analysis included patients undergoing CBE stent implantation following Tf-TAVI from April 2012 to January 2023 at our centre. The primary endpoint was technical success defined as successful device delivery and implantation at the intended location with angiographic confirmation of vessel patency and absence of residual bleeding. Clinical outcomes and color Doppler ultrasonography findings were evaluated at discharge, 30days and longest available follow-up. Among 3331 Tf-TAVI procedures, 93 patients (2.8%) required covered stent implantation for the treatment of access related vascular complications. Technical success was achieved in 92 patients (98.9%). BeGraft and Atrium Advanta V12 CBE stents were implanted in 76 (81.7%) and 17 (18.3%) patients, respectively. Median clinical follow-up was 455 [304; 798] days, with both in-hospital and 30-days mortality equaling 4.3% and 1-year mortality 15.1%. Pre-discharge Doppler ultrasonography was performed in 98.9% patients, with normal findings in 79.8% and minor findings (such as pseudoaneurysm, non-flow-limiting dissection, arterio-venous fistula) in the remaining patients. Clinical follow-up was available in 96.2% patients; no cases of new-onset claudication, need for repeat surgical or transcatheter vascular interventions were recorded. Follow-up Doppler ultrasonography (54.4% patients) showed persistent patency and no signs of stent failure in all patients. CBE stent implantation for the treatment of access site related vascular complications after Tf-TAVI is associated with excellent technical success rates, optimal short- to mid-term patency rates as well as satisfactory long-term clinical outcomes.

Clinical Profile and Outcomes of Thrombotic Microangiopathy: A Kidney Biopsy Registry Cohort

Background Thrombotic microangiopathy (TMA) is caused by injury to microvasculature that leads to thrombus formation and multisystem dysfunction. TMA can cause irreversible kidney failure and graft failure in kidney transplant patients. The data on etiology, clinical and histopathological characteristics, treatment patterns, and renal outcomes of patients with TMA from resource-limited health care setups is less. Materials and Methods From a South Indian teritiary care center biopsy registry of 16,054 patients, 87 TMA cases diagnosed between January 2011 and April 2022 were included, and follow-up data were collected from electronic medical records until June 2023. Results The mean age of the cohort was 31.7± 9.9 years. The biopsy incidence of TMA was 0.5% during the study period. The most common TMA etiology was autoimmune disease (25.2%), followed by atypical HUS (18.4%) and pregnancy-associated and malignant hypertension (14.9%) each. The most common renal biopsy finding was mesangiolysis (74.7%), followed by capillary wall thrombi and fragmented RBCS. On a median 6-month follow-up (1,36), 24 (27.6%) patients showed renal recovery, and 40 (46%) remained dialysis-dependent. Multivariate analysis showed that dialysis dependence at presentation adversely affected renal recovery. Conclusion TMA, although rare, carries a high risk of renal failure and death. With early diagnosis and treatment, satisfactory renal outcomes can be achieved even in resource-limited health care settings.

Force Plate Gait Analysis in Dogs After Femoral Head and Neck Excision.

Femoral head and neck excision (FHNE) remains a common orthopedic surgical procedure in many countries. However, data on postoperative outcomes regarding changes in hindlimb function are limited. This study aimed to evaluate hindlimb function after FHNE in dogs of different weights. Twenty-seven dogs that underwent FHNE were block-randomly assigned to two groups based on weight (≤20 kg and >20 kg). Hindlimb function was evaluated using force plate gait analysis to measure peak vertical force (PVF), alongside other orthopedic evaluations and a composite orthopedic assessment score at 1, 2, 3, 4, 5, 6, 9, and 12 months after surgery. Kaplan-Meier survival analysis and the log-rank test were used for statistical comparisons. The findings demonstrated no significant difference in PVF between the operated and non-operated limbs in either weight groups (≤20 kg and >20 kg) at four and three months postoperatively (median functional recovery time) (p = 0.33), nor were there significant differences in lameness scores at trot between weight groups five and three months after FHNE (p = 0.64). These results indicate that FHNE provides satisfactory functional outcomes and can be considered a suitable orthopedic intervention for medium- to large-breed dogs.

Evaluating the Safety of Rhinoplasty in Smokers

Abstract Goals/Purpose Smoking negatively impacts tissue perfusion and wound healing, raising concerns about infection and delayed recovery in surgical patients. While smoking remains a strict contraindication in some procedures with extensive dissection, such as abdominoplasty and facelift surgery, the risks of smoking in rhinoplasty patients are not well known. Given the nasal region's robust vascular supply, the risk of smoking complications may be less in rhinoplasty. This study explores whether smoking should be considered a contraindication for rhinoplasty by comparing postoperative infection rates and the need for revision surgery between smokers and nonsmokers. Using a decade of patient data, we aim to assess whether there is an increased risk of infection or revision surgery in smokers. The findings will provide valuable insights to guide plastic surgeons in making informed decisions and ensuring safe, successful outcomes for both smokers and nonsmokers. Methods/Technique A retrospective review was conducted on the senior author’s (R.G.R.) rhinoplasty cases from July 2014 to June 2022, including all patients treated in this period. The study was approved by the BRANY Institutional Review Board. All patients underwent open rhinoplasty under general anesthesia, prioritizing septal cartilage for reconstruction. If septal cartilage was inadequate, fresh frozen cartilage (FFCC) from MTF Biologics was used; no alloplastic materials were utilized. Patients were categorized as active smokers, former smokers, and non-smokers. Active smokers used any inhaled tobacco products (e.g., cigarettes, cigars, vaping) within 4 weeks before and/or after surgery. Former smokers had quit over 4 weeks prior to surgery with no intent to resume, and non-smokers had no history of tobacco use. Patients with less than one-year follow-up were excluded. After reviewing 2003 cases of rhinoplasty, 1884 patients were found to match both the inclusion and exclusion criteria. Patient demographics and surgical outcomes were collected through manual chart review. Primary outcomes included infection and revision rates, with infections identified by clinical signs requiring antibiotics or further intervention post-prophylactic antibiotics. Revision rhinoplasty was defined as any subsequent open procedure. Infection and revision rates were compared across active smokers, former smokers, and non-smokers, with subgroups for primary and revision rhinoplasty patients. Results/Complications A total of 1884 patients consisting of 1673 (88.80%) females and 211 (11.20%) males met inclusion criteria with an average age of 30.7 years and BMI of 22.47 kg/m2. Among these patients, 1421 (75.42%) were primary rhinoplasty cases and 463 (41.5%) were revisions. The average length of follow-up was 23.8 months. This study’s rhinoplasty patient population consists of 81 (4.30%) active smokers, 38 (2.02%) former smokers, and 1765 (93.68%) non-smokers (Table 1). In our patient population, we included patients who underwent both primary and revision rhinoplasty. In the overall population, there were 62 (3.29%) patients that underwent subsequent revision. 36 of 1421 (2.53%) of these patients belonged to the primary rhinoplasty group and 26 of 463 (5.62%) to the revision rhinoplasty population. In comparison, revisions were performed on 3 of 80 (3.75%) active smokers, 1 of 39 (2.56%) former smokers, and 58 of 1,765 (3.29%) non-smokers. Among these groups, all 3 of 71 (4.23%) revision patients were among primary rhinoplasty patients in the active smoker population, whereas in the non-smoker population, the distribution was 32 (2.42%) for primary and 26 (5.83%) for revision cases. No statistically significant difference was observed between groups (Table 2). Overall, 32 of 1884 (1.70%) of patients required 5-7 days of additional postoperative antibiotics for cellulitis. This was in addition to the standard postoperative antibiotic prophylaxis. 21 of 1421 (1.48%) of these patients belonged to the primary rhinoplasty group and 11 of 463 (2.38%) to the revision rhinoplasty patient population. 3 of 80 (3.75%) of patients requiring additional postoperative antibiotics were active smokers and 29 of 1765 (1.64%) were non-smokers. There was no incidence of use of additional postoperative antibiotics in the former smoker rhinoplasty population. Again, no statistically significant differences were found among the groups (Table 3). Conclusion The results of this study indicate that active smoking should not be considered a contraindication for rhinoplasty, as there is no significant increase in the need for revision surgeries in actively smoking patients compared to nonsmokers. While smoking is commonly associated with impaired wound healing and increased risk of infection due to its negative effects on tissue perfusion and immune response, our data demonstrate that these concerns can be managed effectively in the context of rhinoplasty. Among the 1884 patients included in this study, the revision rates for smokers (3.75%) and nonsmokers (3.29%) were comparable. This finding is particularly notable as it challenges the assumption that smokers are inherently at higher risk for suboptimal surgical outcomes. Despite the known systemic effects of smoking on vascular health and tissue healing, rhinoplasty in smokers appears to result in satisfactory outcomes when proper postoperative care is implemented.

The initial experience of natural orifice specimen extraction surgery in laparoscopic colorectal surgery.

Natural orifice specimen extraction surgery (NOSE) is an extension of minimally invasive colorectal surgery. NOSE was introduced into the unit in January 2024 in selected group of patients. The aim of this study was to evaluate the initial experience of NOSE surgery in minimally invasive surgery colorectal surgery in terms of feasibility and safety outcomes. Prospective data was collated for all cases of NOSE in colorectal surgery from Jan 2024 to Dec 2024. Data collected included patient demographics, comorbidities, underlying pathology, pre-, intra- and post-operative outcomes. There were 17 cases considered for NOSE surgery. Eight cases had successful transvaginal NOSE and six cases had successful transanal NOSE. The median age was 68.5 years (range 36-87 years). The median ASA was 3 (range 1-4). All the transvaginal NOSE were performed with laparoscopic right hemicolectomy for neoplasia. Of the six transanal NOSE, four were performed for benign and two for malignant indications. There were no intraoperative complications with no conversion to open surgery. There were no post-operative complications especially anastomotic leak, ileus, wound infection, and extraction-site related complications in transvaginal NOSE cases. There was one anastomotic leak in transanal NOSE that required laparoscopic washout and defunctioning ileostomy. All the neoplasia cases achieved satisfactory oncological outcomes (R0 resection & adequate lymph node yield). The median follow-up was 6 months (range 2-11). The early experience of NOSE in colorectal surgery is safe and feasible in well selected group of patients. It avoids abdominal wall trauma from extraction with reduction of wound infection, pain and long-term risk of incisional hernia.

Assessing environmental factors and human practices on the welfare of working donkeys in Kenya

Donkeys play a crucial role in supporting the livelihoods of low-income households in Kenya by providing complementary services in transportation, agriculture, and other economic activities. Their importance not withstanding, working donkeys frequently face poor welfare conditions, often due to mistreatment by owners, limited resources, poor environmental conditions, and a lack of recognition in policy frameworks like the national livestock master plan. Donkeys, due to their shared environment with humans are constantly exposed to welfare challenges, whose extent has not been quantified. This study aimed to assess the role of environmental and human factors on the welfare of working donkeys in Kenya, surveying 1059 donkey owners and their donkeys across 20 out of 47 counties. The Equine Welfare and Owner Behaviour tool, developed based on the Five Domains Model of animal welfare, was used to assess factors related to nutrition, environment, health, behaviour, and mental state. Data were collected through stratified random sampling, with responses from 26 questions in the tool categorized into three areas namely; (1) owner behaviour, practices and livelihood income outcomes, (2) environmental factors and (3) donkey welfare. Robust ethical guidelines ensured respectful and unbiased data collection. Overall, 28% of donkey owners demonstrated positive welfare practices while 72% required improvement, based on the set threshold of 0.85. Owner behaviour and practices scored 0.70 on average, with compassionate handling (0.75) and food quality (0.73) achieving relatively high ratings. Livelihood outcomes, reflecting socio-economic challenges, averaged 0.65, with 79% of owners reporting satisfactory outcomes and 21% requiring improvement. Environmental parameter scores averaged 0.64, with notable challenges in water access (0.59) and shelter provision (0.55), which are essential for sustaining donkey health and welfare. The overall welfare score for donkeys was 0.80, meeting acceptable standards in general health (0.86) and non-lameness (0.90), though ectoparasite presence (0.84) and body lesion occurrence (0.76) highlighted persistent welfare concerns. Improving environmental conditions, enhanced owner practices, and diversified income streams, are essential for better donkey welfare. Results of this study will inform evidence-based interventions aimed at improving the welfare of working donkeys in Kenya.