Surgery Score Research Articles

Interest of the POSPOM score in estimating postoperative complication risk after radical cystectomy

IntroductionIdentifying patients at risk after cystectomy for cancer is essential. The POSPOM score is a non-specific urological surgery score for estimating postoperative hospital mortality. This study sought to validate the POSPOM score for predicting postoperative morbidity and mortality after cystectomy. MethodsThe study retrospectively included all patients undergoing cystectomy for muscle-invasive or locally advanced bladder cancer between 2010 and 2019 in one center. The primary objective was validation of the POSPOM score for calculating severe postoperative morbidity [Clavien–Dindo (CDC)≥3] and 90-day mortality after cystectomy. Secondary objectives were comparison to other predictive scores [Charlson (CCI), ASA]. ResultsAt 90days, out of 167 patients, 26% (n=44) had a CDC≥3 complication and 8.4% (n=14) had died. POSPOM correlated with the risk of death at 90days (P<0.001) and postoperative transfusion (P<0.01). Patients with CDC≥3 complications had higher CCI and POSPOM (median 6.5 vs. 5, P<0.01 and 6.49% vs. 5.58%, P=0.029, respectively). Patients who died postoperatively had higher CCI and POSPOM (median 8 vs. 6, P<0.001 and 23.9% vs. 5.58%, P<0.001, respectively). The prognostic value of the POSPOM score for predicting mortality appears better [AUC=0.886 (0.798–0.973)] compared with CCI [AUC=0.812 (0.710–0.915)] and ASA [AUC=0.739 (0.630–0.849)], but not for predicting morbidity. ConclusionThis study confirms the robustness of the POSPOM score for estimating mortality and its limitations for predicting postoperative morbidity. Level of evidence3.

The Impact of SARS-CoV-2 Infection on the Length of Stay in the Neuro-ICU:A Prospective Multicenter Cohort Study in Eight Neuro-ICU, China Between February and April 2023.

The SARS-CoV-2 infection cases are increasing rapidly in neuro-intensive care units (neuro-ICUs) at the beginning of 2023 in China. We aimed to characterize the prevalence, risk factors, and prognosis of critically ill patients treated in neuro-ICUs. In the prospective, multicenter, observational registry study, critically ill patients with intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI) admitted to eight Chinese neuro-ICUs between Feb 16, 2023, to Apr 30, 2023 were enrolled for the study. Mortality and ICU stay day were used as the primary outcomes. 131 patients were finally included and analyzed (mean age 60.36 years [SD 13.81], 64.12% male, 39.69% SARS-CoV-2 infected). The mortality is higher in the SARS-CoV-2 infection group without statistical signification (7.69% vs 5.06%, p>0.05). The length of stay (LOS) in neuro-ICUs was significantly longer among the SARS-CoV-2 infection patients (7(1-12) vs 4(1-8), p<0.01), with increased viral pneumonia occurrence (58.54% vs 7.32%, p<0.01). SARS-CoV-2 infection, surgery, and low GCS scores were independent risk factors for prolonged LOS, and respiratory/renal failure were independent risk factors for death. Based on the present neuro-ICU cohort, SARS-CoV-2 infection was a significant risk for the prolonged LOS of neuro-critically ill patients. Registered with Chictr.org.cn (ChiCTR2300068355) at 16 February 2023, Prospective registration. https://www.chictr.org.cn/showproj.html?proj=188252.

Efficacy and safety of robotic-assisted knee reconstruction: a systematic review and meta-analysis.

Robotic-assisted surgery is increasingly being utilized in hip and knee reconstruction. However, the relative efficacy and safety of robotic-assisted total knee replacement (RATKR) compared to traditional surgery remained uncertain. This study aimed to systematically review the current literature comparing the outcomes of RATKR to traditional procedures. Comprehensive literature searches were conducted in major databases to identify studies comparing RATKR with traditional surgeries. The primary outcomes were functional scores and post-operative complications. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random effects model. A total of 12 studies were considered for inclusion. The pooled functional scores of The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), hospital for Special Surgery (HSS) score, visual analogue score (VAS) pain score showed no significant differences between the two groups (MD = -0.99, 95% CI -2.32 to 0.34, p-value = 0.14). The subgroup analysis for hip and knee reconstructions also revealed no significant difference in terms of functional scores. However, for post-operative complications, while there was no significant difference in terms of blood loss (MD = -1.62, 95% CI -4.42 to 1.17, p-value = 0.25), the readmission rates were significantly higher in the RATKR group (MD = 0.94, 95% CI 0.77 to 1.11, p-value < 0.00001). The overall heterogeneity was extremely high (I² = 93%), particularly in the analyses of post-operative complications. The findings suggested that robotic-assisted knee reconstruction did not significantly improve functional outcomes compared to traditional surgery. The safety profile was similar except for a higher readmission rate following RATKR. Given the high heterogeneity, further large-scale, well-designed, randomized controlled trials are needed to conclusively determine the efficacy and safety of robotic-assisted hip and knee reconstruction.

Estimulación del ganglio de Gasser para dolor neuropático del trigémino refractario

Background and objectivePainful trigeminal neuropathy is a complex clinical entity due to its severity and refractoriness to pharmacological and interventional management. We describe our experience in treating refractory painful trigeminal neuropathy (RPTN) with Gasserian ganglion stimulation (GGS). Materials and methodsSix patients with RPTN were treated with GGS in our unit between 2019 and 2022. The following data were collected: socio-demographic characteristics, triggering event, duration of the disease and treatment received prior to surgery, pre- and post-intervention visual analogue scale score, follow-up time, and pre- and post-intervention functionality and quality of life. ResultsAll patients were women who had received aggressive first-, second-, and third-line pharmacological, non-pharmacological, and interventional management before being referred for GGS. Patients reported a 50-72% decrease in pain on visual analogue scale and improved functionality during follow-up. ConclusionsGGS is a promising therapeutic alternative for patients with RPTN. Although the initial outcomes and experience are encouraging, RPTN is recommended on the basis of safety, reproducibility, and trends observed in clinical practice.

Using Claims Data to Predict Pre-Operative BMI Among Bariatric Surgery Patients: Development of the BMI Before Bariatric Surgery Scoring System (B3S3).

Lack of body mass index (BMI) measurements limits the utility of claims data for bariatric surgery research, but pre-operative BMI may be imputed due to existence of weight-related diagnosis codes and BMI-related reimbursement requirements. We used a machine learning pipeline to create a claims-based scoring system to predict pre-operative BMI, as documented in the electronic health record (EHR), among patients undergoing a new bariatric surgery. Using the Optum Labs Data Warehouse, containing linked de-identified claims and EHR data for commercial or Medicare Advantage enrollees, we identified adults undergoing a new bariatric surgery between January 2011 and June 2018 with a BMI measurement in linked EHR data ≤30 days before the index surgery (n=3226). We constructed predictors from claims data and applied a machine learning pipeline to create a scoring system for pre-operative BMI, the B3S3. We evaluated the B3S3 and a simple linear regression model (benchmark) in test patients whose index surgery occurred concurrent (2011-2017) or prospective (2018) to the training data. The machine learning pipeline yielded a final scoring system that included weight-related diagnosis codes, age, and number of days hospitalized and distinct drugs dispensed in the past 6 months. In concurrent test data, the B3S3 had excellent performance (R2 0.862, 95% confidence interval [CI] 0.815-0.898) and calibration. The benchmark algorithm had good performance (R2 0.750, 95% CI 0.686-0.799) and calibration but both aspects were inferior to the B3S3. Findings in prospective test data were similar. The B3S3 is an accessible tool that researchers can use with claims data to obtain granular and accurate predicted values of pre-operative BMI, which may enhance confounding control and investigation of effect modification by baseline obesity levels in bariatric surgery studies utilizing claims data.

Validation of Korean Olfactory Questionnaire for Perioperative Olfactory Assessment in Endoscopic Endonasal Skull Base Surgery.

Objective: To analyze changes in olfactory function after endoscopic endonasal skull base surgery and compare performance of the olfactory questionnaire with those of conventional psychophysical tests. Methods: Patients were classified into 5 categories for olfactory function evaluation (normal, mild hyposmia, moderate hyposmia, severe hyposmia, and anosmia) based on a self-assessment. Patients also underwent the butanol threshold test (BTT), Cross-Cultural Smell Identification Test (CCSIT), and 11-item olfactory questionnaire. Subjects with normosmia preoperatively and who were followed up at least 6 months after surgery were analyzed. Receiver operating characteristic curves and confusion matrix analysis were performed for BTT, CCSIT, and olfactory questionnaire to compare their diagnostic abilities. The effects of age, preoperative olfaction, septal flap, tumor pathology, and tumor size on postoperative olfaction were evaluated using multivariate linear regression analysis. Results: Data from 108 patients were analyzed. Postoperative changes in the olfactory questionnaire were significantly associated with changes in the BTT and CCSIT. The area under the curve for postoperative self-olfactory function classification was highest for olfactory questionnaire (0.894), followed by BTT (0.767) and CCSIT (0.688). Patient age at the time of surgery and preoperative BTT score were significantly related to postoperative olfactory outcomes. Conclusion: The olfactory questionnaire correlated well with conventional psychosomatic olfactory function tests. In combination with clinical parameters and preoperative psychosomatic olfactory function tests, the olfactory questionnaire is suitable for assessing subjective olfactory function after endoscopic endonasal skull base surgery.

The Outcomes of Cardiac Surgery in Children With DiGeorge Syndrome in a Single Center Experience: A Retrospective Cohort Study.

Background DiGeorge syndrome, a common genetic microdeletion syndrome, is associated with multiple congenital anomalies, including congenital cardiac diseases. This study aims to identify the short and midterm outcomes of cardiac surgery performed on children with DiGeorge syndrome. Methods A retrospective cohort study was conducted between the period of 2018-2022, which included children divided into two groups with a 1:2 ratio. Group one included DiGeorge syndrome patients who were diagnosed using fluorescence in situ hybridization (FISH). Group two included the control group of patients who were clear of genetic syndromes. The two groups were matched based on similar cardiac surgery, age of surgery, and Risk Adjustment in Congenital Heart Surgery (RACHS-1) score. The two groups were compared based on the demographical data and postoperative complications. Results The study consisted of 81 children; 27 were DiGeorge syndrome patients, and 54 were in the control group. DiGeorge syndrome patients showed an increase in mechanical ventilation duration (p=0.0047), intensive care unit (ICU) length of stay (p=0.0012), and hospital length of stay (p=0.0391). Moreover, they showed an increased risk for bacteremia (p=0.0414), ventilator-associated pneumonia (VAP; p=0.0036), urinary tract infections (UTI; p=0.0064), and surgical site infection (SSI; p≤0.0001). They were also more susceptible to postoperative seizures (p=0.0049). Furthermore, patients with DiGeorge syndrome had a higher prevalence of congenital renal anomalies. However, there was no mortality in either group. Conclusion This study shows a variability in the postoperative outcomes between the two groups. The study demonstrates that patients with DiGeorge syndrome have higher risks of infections and longer hospital stayduring the postoperative period. Further research with a larger sample is needed to confirm our findings.

Preliminary study on implementation of modified tubular gastric side-overlap anastomosis in laparoscopic proximal gastrectomy

Objective: To investigate the feasibility and safety of implementing modified tubular gastric side-overlap anastomosis in laparoscopic proximal gastrectomy. Methods: In this retrospective, descriptive case series, we analyzed clinical data of seven patients who had undergone laparoscopic proximal gastrectomy and gastrointestinal reconstruction with modified tubular gastric side-overlap anastomosis from October 2022 to March 2023 in the Second Affiliated Hospital of Fujian Medical University. The study patients comprised five men and two women aged 57-72 years and of body mass index 18.5-25.7 kg/m2. All seven patients had preoperative gastroscopic and pathological evidence of esophagogastric junction cancer and all were found by preoperative enhanced computed tomography and/or endoscopic ultrasonography to have stage CT1-2N0M0 tumors. The main steps in the reconstruction of a modified tubular gastric side-overlap anastomosis are as follows: (1) mobilizing the lower esophagus and opening the left pleura to expand the space; (2) severing the esophagus with a linear cutter stapler; (3) creating a 3-cm-wide tubular stomach along the greater curvature; (4) creating a 5-cm guide line on the lesser curvature of the anterior wall of the tubular stomach and a small opening below the guide line; (5) rotating the esophageal stump 90° counterclockwise and making a small opening on the right posterior wall of the esophageal stump, along with using a 45-mm linear cutter stapler for esophagogastric side-to-side anastomosis under the guidance of the gastric tube and guide line ; (6) closing the common opening using barbed sutures; (7) embedding the cut edge of the esophageal stump such as to closely oppose it to the esophagus; (8) using barbed sutures to continuously suture the lower esophagus bilaterally to the anterior wall of the tubular stomach; and (9) closing the opened esophageal hiatus and pleura. The main outcome measures were intraoperative (operation time, digestive tract reconstruction time, closing the common opening time, intraoperative blood loss, and number of dissected lymph nodes), postoperative (time to passage of flatus , time to liquid diet, time to ambulation, length of postoperative hospital stay, and postoperative complications), pathological (maximum diameter of the tumor and pathological stage) and findings on follow-up. Results: Laparoscopic proximal gastrectomy with reconstruction of a modified tubular gastric side-overlap anastomosis was successfully completed in all seven patients; no conversion to laparotomy was required and there were no postoperative complications. The operation time, digestive tract reconstruction time, and closing of common opening time were 187-229, 61-79, and 7-9 minutes, respectively. Intraoperative blood loss was 15-23 ml and the number of dissected lymph nodes was 14-46 per case. Time to passage of flatus, time to liquid diet, time to ambulation, and postoperative hospital stay were 1-2, 2-3, 3-4, and 6-7 days, respectively. Postoperative pathological examination showed that the maximum tumor diameters were 1.6-3.3 cm in four patients with stage IA disease and three patients with stage IB. The seven patients were followed up for 6-11 months, during which none required routine use of proton pump inhibitors or gastric mucosal protective agents and there were no deaths or tumor recurrence/metastasis. No patients had anemia or hypoproteinemia 3 and 6 months after surgery. Six months after surgery, NRS2002 and GERDQ scores were 1-2 and 2-3, respectively. Gastroscopy showed narrow anastomoses in 6 patients with Los Angeles grade A and one patient with grade B disease. No evidence of significant bile reflux was found and no anastomotic stenosis or reflux was detected on upper gastrointestinal angiography. Conclusion: It is safe and feasible to implement modified tubular gastric side-overlap anastomosis for digestive tract reconstruction in laparoscopic proximal gastrectomy.

High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players

PurposeTo analyze the rate of return to play, changes in athletic level, recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability that underwent an arthroscopic Latarjet procedure. MethodA multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of two years were included. Rugby players were grouped according to their competitive level in their country (recreative, regional, national, and international level). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated. ResultsA total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 years ±2.6. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (p=0.012) for not returning to sport, with 67% of patients not returning to rugby who initially played at a recreational level, and 33% at a regional league level. All national and international players returned to play. Of the 12 non returning rugby players, only 30% did not return because of their shoulder. Mean SSV was 90% ± 9. Recurrence rate was 7%. ConclusionOur study confirmed the efficacy of Arthroscopic Latarjet procedure in managing recurrent anterior instability in rugby players, leading to patient satisfaction. Return to play was achieved in almost all cases with low recurrence rate. Despite high global return to the same level of sports, the higher the level of competition is, the harder it is to resume sport at the same level for rugby players. Level of EvidenceLevel IV, therapeutic case series.

Clinical outcome and survival rate of condylar constrained knee prosthesis in revision total knee arthroplasty: an average nine point sixyear follow-up.

Condylarconstrained knee prostheses (CCK) are increasingly used in revision total knee arthroplasty (rTKA), but the clinical effectiveness and long-term survival remain a debate. The purpose of this study is to report the long-term clinical and radiographicoutcome, implant survival rate, and surgical safety of revision total knee arthroplasty with condylar constrained knee prosthesis. A retrospective cohort study was performed on patients undergoing rTKA with CCK. The cases who received rTKA with CCK from January 2005 to January 2022 were selected. The duration of operation, theestimated perioperative blood loss, and theintraoperative blood transfusion rate were recorded to evaluate surgical safety. The pain visual analog scale (VAS), range of motion (ROM), the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Oxford knee score (OKS) was recorded to assess clinical outcome. Standard anteroposterior, lateral, skyline and long-standing AP radiographs of the lower limbs were conducted to assessradiographicoutcome. Implant survival was analyzed by Kaplan-Meier survival estimates. Fifty-five cases were followed up for an average of 9.6years (1-18years), including 16 males and 38 females, with an average age of 66 and an average BMI of 26.9kg/m2. The mainreasons for revision were periprosthetic infection (32 knees, 58.2%) and aseptic loosening (13 knees, 23.6%). The duration of operation was 149 ± 56.2min. The perioperative blood loss was 973.6 ± 421.6ml. At the last follow-up, VAS (8.0 ± 1.1 to 1.3 ± 1.4), ROM (82.7° ± 26.1° to 108.4° ± 11.8°), HSS (45.0 ± 10.4 to 85.3 ± 8.6), KSKS (38.4 ± 12.1 to 88.5 ± 12.0), KSFS (19.6 ± 12.9 to 68.8 ± 15.1), WOMAC (67.9 ± 12.5 to 14.4 ± 9.5), and OKS (9.9 ± 4.2 to 41.6 ± 7.7) were significantly improved (P < 0.001). A total of five complications were observed, all of which were periprosthetic infection. Non-progressive radiolucent lines were observed in 26 knees (47.3%). The 10-year survival rate for no operation was 96.0%. The tenyear survival rate for no revision was 98.0%. The use of CCK prosthesis for rTKA can achieve good long-term efficacy and prosthesis survival.

Comparison of a novel hand-held retractor-assisted transforaminal lumbar interbody fusion by the wiltse approach and posterior TLIF: a one-year prospective controlled study

BackgroundThis study aims to compare the clinical outcomes and safety of a novel hand-held retractor system-assisted Wiltse TLIF with that P-TLIF and assess whether this hand-held retractor system assisted Wiltse TLIF can yield less paraspinal muscle injury.Methods56 patients (P-TLIF: 26, Wiltse TLIF: 30) were included in this one year prospective controlled study. The operation time, intraoperative blood loss, postoperative drainage, mobilization time, and discharge time were recorded. The clinical outcomes were evaluated by ODI, VAS, JOA, and SF-36 scores (7 days, 3, 6, and 12 months after surgery). Paraspinal muscle injury was assessed by postoperative MRI (6 months after surgery). CK and C-reaction protein were measured pre and postoperatively, and CT or X-ray (one year postoperatively) was used to assess bony union/non-union.ResultsThe Wiltse (study) group was associated with significantly less estimated blood loss (79.67 ± 28.59 ml vs 192.31 ± 59.48 ml, P = 0.000*), postoperative drainage (43.33 ± 27.89 ml vs 285.57 ± 123.05 ml, P = 0.000*), and shorter mobilization (4.1 ± 1.2 d vs. 3.0 ± 0.9 d, P < 0.05) and discharge times (7.7 ± 1.9 d vs. 6.1 ± 1.2 d, P = 0.002*) than the P-TLIF (control) group. Serum CK activity at 24 h postoperatively in the study group was significantly lower than in the control group (384.10 ± 141.99 U/L vs 532.76 ± 225.76 U/L, P = 0.018*). At 7 days after surgery, VAS (2.3 ± 0.6 vs 3.2 ± 0.7, P = 0.000*)and ODI scores (43.9 ± 11.9 vs 55.2 ± 12.9, P = 0.001*) were lower, while the JOA scores (18.4 ± 3.4 vs 16.3 ± 4.2, P = 0.041*) was higher in the control group than in the study group. Results observed at 3 months of follow-up were consistent with those at 7 days. After six months postoperatively, paraspinal muscle degeneration in the control group was more significant than in the study group (P = 0.008*).ConclusionOur study showed that this novel hand-held retractor system assisted Wiltse approach TLIF can significantly reduce paraspinal muscle injury, postoperative drainage, and intraoperative blood loss, mobilization and discharge time, as well as yield better short-term outcomes compared to P-TLIF.Trial registration25/09/2023 NCT06052579.

Does preoperative bone marrow edema affect clinical outcomes after medial open-wedge high tibial osteotomy?

PurposeThe aim of this study is to evaluate the results of high tibial osteotomy (HTO) in patients with bone marrow edema (BME) and assess the effect of factors on the subsequent results.MethodsA total of 138 patients who underwent medial open-wedge HTO using locking plate were included in this study. BME was observed in 108 patients using preoperative magnetic resonance imaging. Clinical results were evaluated before HTO and postoperatively at 12 months. Moreover, we evaluated the factors affecting the clinical results.ResultsThe clinical scores were all significantly improved regardless of the presence of BME. There were no differences in improvement of clinical scores between patients with BME and without BME. Patients with BME showed higher postoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) stiffness scores than patients without BME. Furthermore, patients with BME on both the femur and tibia showed lower Knee Society function scores than patients with BME on either the femur or the tibia. Patients with large BME lesions exhibited a lower Hospital for Special Surgery score and WOMAC pain scores, postoperatively. In patients with BME, patients with undercorrection showed significantly lower improvement in WOMAC pain scores compared with patients with acceptable correction.ConclusionsThe clinical improvement after HTO in patients with varus and medial osteoarthritis was not different regardless of the presence or absence of BME. However, accurate alignment should be considered essential for achieving better clinical outcomes in patients with preoperative BME.

Acceptance of Surgical and Non-surgical Cosmetic Procedures: A Cross-Sectional Study From Jazan, Saudi Arabia.

Background and objective Cosmetic surgery is a field that primarily focuses on the preservation, rebuilding, or improvement of the physical appearance of an individual through surgical and therapeutic methods. This specialization encompasses various interventions, both surgical, such as blepharoplasty, rhinoplasty, and breast augmentation, and non-surgical, including procedures such as chemical peeling, Botox injections, and dermal fillers. This study aims to assess the acceptance of cosmetic surgeries and non-surgical cosmetic procedures and the reasons for non-acceptance in a population from Jazan, Saudi Arabia. Methods This cross-sectional survey study was conducted in the general population of Jazan, Saudi Arabia, between July and August 2023. An online self-administered questionnaire was created using Google Forms and distributed through social media. The acceptance was measured using the Arabic translation of the Acceptance of Cosmetic Surgery Scale (ACSS). Results The mean cosmetic surgery acceptance score was 62.1 ± 25.9, whereas the mean non-surgical procedure acceptance score was 63.7 ± 24.5. Engaged and widowed participants had a higher mean acceptance score for cosmetic surgery, whereas divorced participants had a higher mean acceptance score for non-surgical cosmetic procedures. Higher age was associated with higher acceptance of cosmetic surgery (95% CI: 1-15), while having higher income was associated with lower acceptance (95% CI: -14 to -0.32). A higher level of parental education was associated with lower acceptance of surgical and non-surgical cosmetic procedures (95% CI: -23 to -3.5). The perceived lack of a need for cosmetic procedures was the most commonly cited reason for not accepting these procedures, while religious beliefs were the second most common reason. Conclusion Non-surgical cosmetic procedures generally had higher acceptance than cosmetic surgeries. Age, sex, marital status, income level, familial influence, and prior experience all played significant roles in shaping these attitudes. The perceived lack of a need for the procedures and religious beliefs were common reasons for not accepting cosmetic procedures.

Combination of Gukang Capsule and Vitamin D2 Accelerates the Recovery of Knee Function in Elderly Patients with Knee Osteoarthritis

This study assessed the effectiveness of the combined use of the Gukang capsule and vitamin D2 for treating elderly patients with knee osteoarthritis. A total of 126 patients admitted to the Second Hospital of Tangshan between March 2021 and March 2023 were recruited. All patients were treated with loxoprofen sodium tablets. Additionally, group 1 was treated with a vitamin D2 soft capsule, group 2 with a Gukang capsule, and group 3 with a vitamin D2 soft capsule+Gukang capsule. The total effective rate in group 3 (95.23%) was significantly higher compared to groups 1 and 2 (76.19% and 73.80%, respectively; P &lt; 0.05). After treatment, the visual analogue scale score, inflammation level, and levels of cartilage metabolic factors in group 3 were significantly lower compared to groups 1 and 2 (P &lt; 0.05). After treatment, the Hospital for Special Surgery and Lysholm scores were elevated in all three groups, and those in group 3 were significantly higher than those in groups 1 and 2 (P &lt; 0.05). There was no difference in the incidence of adverse reactions among the three groups (P &gt; 0.05).Overall, Gukang capsule + vitamin D2 can reduce inflammation, improve cartilage metabolism, accelerate knee function recovery, and improve the clinical effect in elderly patients with knee osteoarthritis.

Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study

BackgroundWe aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH.MethodsThis study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events.ResultsAfter surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups.ConclusionCompared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.

Clinical and Radiographic Outcomes of Hip Revision Surgery and Cerclage Wires Fixation for Vancouver B2 and B3 Fractures: A Retrospective Cohort Study

Background: The number of patients presenting with periprosthetic hip fractures has increased in recent decades. Methods: Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study was to determine the reintervention-free survival rate. The secondary intended outcome was to determine clinical and radiographic assessment outcomes at the time of follow-up, and the correlation between time to surgery and postoperative Harris hip score (HHS). Results: A total of 49 patients with mean age of 71.2 ± 2.3 (37–88) years old were included. Overall, the Kaplan-Meier method estimated a survival rate of 95.8% (CI 84.2% to 98.9%) at one year, 91.1% (CI 77.9% to 96.6%) at two years, and 88.5% (CI 74.4% to 95.1%) at three, and up to 10, years. The mean limb length discrepancy (LLD) improved from −13.3 ± 10.5 (range −39 to +10) mm at the preoperative stage to −1.16 ± 6.7 (range −17 to +15) mm, p &lt; 0.001 postoperative. The mean HHS improved from 31.1 ± 7.7 (range 10 to 43) preoperative to 85.5 ± 14.8 (range 60 to 100), p &lt; 0.001 postoperative. Postoperative HHS was not affected by preoperative time to surgery. Conclusions: Revision arthroplasty is an effective treatment for Vancouver type B2 and B3 fractures.

Postoperative intra-abdominal hypertension predicts worse hospital outcomes in children after cardiac surgery: a pilot study†.

Our goal was to determine the incidence and characteristics of postoperative intra-abdominal hypertension (IAH) in paediatric patients undergoing open-heart surgery. This single-centre study included consecutive children (aged <16 years) who underwent open-heart surgery between July 2020 and February 2021. Patients who entered the study were followed until in-hospital death or hospital discharge. The study consisted of 2 parts. Part I was a prospective observational cohort study that was designed to discover the association between exposures and IAH. Postoperative intra-abdominal pressure was measured immediately after admission to the intensive care unit and every 6 h thereafter. Part II was a cross-sectional study to compare the hospital-related adverse outcomes between the IAH and the no-IAH cohorts. Postoperatively, 24.7% (38/154) of the patients exhibited IAH, whereas 3.9% (6/154) developed abdominal compartment syndrome. The majority (29/38, 76.3%) of IAH cases occurred within the first 24 h in the intensive care unit. Multivariable analysis showed that the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score [odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.23-2.83, P = 0.004], right-sided heart lesion (OR = 5.60, 95% CI 2.34-13.43, P < 0.001), redo sternotomy (OR = 4.35, 95% CI 1.64-11.57, P = 0.003), high baseline intra-abdominal pressure (OR = 1.43, 95% CI 1.11-1.83, P = 0.005), prolonged cardiopulmonary bypass duration (OR = 1.01, 95% CI 1.00-1.01, P = 0.005) and deep hypothermic circulatory arrest (OR = 5.14, 95% CI 1.15-22.98, P = 0.032) were independent predictors of IAH occurrence. IAH was associated with greater inotropic support (P < 0.001), more gastrointestinal complications (P = 0.001), sepsis (P = 0.003), multiple organ dysfunction syndrome (P < 0.001) and prolonged intensive care unit stay (z = -4.916, P < 0.001) and hospitalization (z = -4.710, P < 0.001). The occurrence of a composite outcome (P = 0.009) was significantly increased in patients with IAH. IAH is common in children undergoing cardiac surgery and is associated with worse hospital outcomes. Several factors may be associated with the development of IAH, including basic cardiac physiology and perioperative factors. This study was registered in the Chinese Clinical Trial Registry (Trial number: ChiCTR2000034322)URL site: https://www.chictr.org.cn/hvshowproject.html?id=41363&v=1.4.

Serum levels of neuregulin-1 in patients with coronary artery disease: clinical and pathogenetic aspects

Aim. To determine the relationship between the serum level of neu-regulin-1 (NRG-1) and the severity of coronary artery (CA) atherosclerosis and clinical and paraclinical characteristics of patients with coronary artery disease (CAD).Material and methods. The study included 264 people, of which 220 were patients diagnosed with coronary CAD. The patients underwent coronary angiography using the Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score and echocardiography. The patients were divided into groups according to SYNTAX score: group 1 — with moderate CA atherosclerosis (≤22 (n=124); group 2 — with severe CA atherosclerosis (23-32) (n=53); group 3 — with extremely severe CA atherosclerosis (≥33) (n=43). Group 4 was represented by healthy volunteers (n=44). All subjects underwent a study of the serum NRG-1 (ng/ml) level. Statistical processing of the results was carried out using Statistica 10.0 software. Differences were considered significant at p&lt;0,05.Results. Significantly higher NRG-1 values were obtained in the control group compared to patients with CAD (p&lt;0,001). An inverse correlation was found between the NRG-1 concentration and the severity of CA atherosclerosis (p&lt;0,001). A decrease in NRG-1 concentration is associated with a high functional class of = heart failure (p&lt;0,01) and low left ventricular ejection fraction (p&lt;0,001). The significance of NRG-1 differences between groups of patients with a history of myocardial infarction (p&lt;0,001), angina pectoris (p&lt;0,01), permanent atrial fibrillation (p&lt;0,01), chronic left ventricular aneurysm (p&lt;0,01) and repeated myocardial infarction (p&lt;0,05) in comparison with patients without these pathologies.Conclusion. The identified correlations between the NRG-1 concentration and CAD, as well as the clinical and paraclinical characteristics of patients, makes it possible to consider NRG-1 as a reliable biomarker of CA and heart failure severity and may form the basis for the development of novel diagnostic approaches.

Endovascular rotational atherectomy for multivessel coronary calcification involving the main trunk of left coronary artery and the left anterior descending artery

The revascularization strategy for severe calcification is one of the most pressing problems of modern percutaneous coronary interventions, since it is observed more and more often and significantly complicates traditional endovascular treatment. Currently, the method of choice for severe coronary calcification is rotational atherectomy, which allows modification of atheromatous mass with an increase in the vessel lumen to allow satisfactory balloon angioplasty and stenting. This article presents a case of a patient at very high cardiovascular risk with a burdened coronary history and severe clinical symptoms of exertional angina while receiving the optimal multiagent therapy. The examination revealed a multivessel coronary calcification, but the patient was denied coronary artery bypass grafting due to high perioperative risks. SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery score) score I – 25,5 points, SYNTAX score II — 40,4% and 70,1% for percutaneous coronary intervention and coronary bypass surgery, respectively, European System for Cardiac Operative Risk Evaluation (EuroSCORE II) — 4,95%. Attempts at traditional percutaneous intervention were unsuccessful and the patient underwent endovascular rotational atherectomy followed by stenting of affected coronary segments, against the background of which there was an improvement in exercise tolerance with a decrease in angina class.

Comparison of different degrees of varus deformity correction with open-wedge high tibial osteotomy: a retrospective study over 5 years

ObjectiveThis study aims to investigate the clinical efficacy and complications associated with open-wedge high tibial osteotomy (OWHTO) in the treatment of medial compartment knee osteoarthritis. Additionally, the compensatory changes in the hip, patellofemoral, and ankle regions will be assessed through imaging.MethodsA retrospective analysis of clinical data pertaining to 86 patients who underwent OWHTO at the Affiliated Hospital of Qingdao University from January 2015 to September 2018 was conducted. The weight-bearing line ratio (WBLR) was measured postoperatively, and patients were categorized into a normal group (50% < WBLR ≤ 62.5%, n = 67) and an overcorrection group (WBLR > 62.5%, n = 19). Various parameters, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS), were measured before surgery and at the last follow-up to assess lower limb line correction. The compensatory changes in adjacent joints were evaluated by measuring hip abductor angle (HAA), tibial plafond inclination (TPI), talus inclination angle (TIA), Carton–Deschamps index, lateral patellar tilt (LPT), lateral patellar shift (LPS), medial patellofemoral space, and lateral patellofemoral space in both groups. The American Hospital for Special Surgery (HSS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the affected knee were assessed before surgery and at the last follow-up, and the incidence of complications in both groups was analyzed.ResultsPostoperative complications occurred in 26.32% (five cases) of the overcorrection group and 5.97% (four cases) of the normal group, with a statistically significant difference (χ2 = 4.548, p = 0.033). No significant differences were observed in HSS and WOMAC between the two groups at the last follow-up. HAA was − 2.44 ± 1.98° in the overcorrection group and − 1.16 ± 2.1° in the normal group, with a statistically significant difference (t = 2.32, p = 0.023). There were no significant differences in other imaging indexes.ConclusionOvercorrection of varus deformity may not significantly impact clinical outcomes within 5 years post-OWHTO but may elevate the incidence of postoperative complications and lead to increased compensatory adduction of the hip.