Shorter Hospitalization Period Research Articles

Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction

To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages. Between July 2016 and July 2022, 60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed, including 26 males and 34 females, with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group, including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old, the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification, there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group, including 14 males and 16 females, with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification, there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time, intraoperative and postoperative blood loss, hospital stay, radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion. All patients were followed up for 12 months. There was no significant difference in operation time, VAS of low back pain, slip angle and slip rate between two groups (P>0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P<0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P<0.05).The intervertebral space height, slip angle, slip rate, ODI, VAS and JOA scores were significantly improved in the two groups at the final follow-up (P<0.05). There were significant differences in ODI [(9.93±1.11)% vs (10.93±1.11)%] and JOA [ (26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P<0.05). In the treatment of spondylolisthesis, preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma, less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique.

Comparison of Outcomes of Edge-to-Edge Mitral Valve Repair Versus Surgical Mitral Valve Repair for Functional Mitral Regurgitation.

Patients affected by functional mitral regurgitationrepresent an increasingly high-risk population. Edge-to-edge mitral valve repair (TEER) has emerged as a promising treatment option for these patients. However, there is limited research on the comparative outcomes of TEER versus surgical mitral valve repair (SMVr). This study seeks to compare the demographics, complications, and outcomes of TEER and SMVr based on a real-world analysis of the National Inpatient Sample (NIS) database. In theNIS database, from the years 2016 to 2018, a total of 6233 and 2524 patients who underwent SMVr and TEER were selected, respectively. The mean ages of the patients were 65.68 years (SMVr) and 78.40 years (TEER) (p < 0.01). The mortality rate of patients who received SMVr was similar to that of patients who were treated with TEER (1.7% vs. 1.9%, p = 0.603). Patients who underwent SMVr more likely suffered from perioperative complications including cardiogenic shock (2.3% vs. 0.4%, p < 0.001), cardiac arrest (1.7% vs. 1.1%, p = 0.025), and cerebrovascular infarction (0.9% vs. 0.4%, p = 0.013).The average length of hospital stay was longer (8.59 vs. 4.13 days, p < 0.001) for SMVr compared to TEER; however, the average cost of treatment was higher ($218 728.25 vs. $215 071.74, p = 0.031) for TEER compared to SMVr. Multiple logistic regression analysis showed that SMVr was associated with worse adjusted cardiogenic shock (OR, 7.347 [95%CI,3.574-15.105]; p < 0.01) and acute kidney injury (OR, 2.793 [95%CI,2.356-3.311]; p < 0.01). Patients who underwent TEER demonstrated a notable decrease in postoperative complications and a shorter hospitalization period when compared to those who underwent SMVr.

A Comparative Study between Laparoscopic Varicocelectomy and Open Varicocelectomy in the Treatment of Varicocele

Background: Varicocele is a vein anomaly affecting 15% of adult males, with prevalence increasing to 35% in men seeking infertility evaluation and 81% in those with secondary infertility. It is primarily due to a prevalent and remediable factor. Objective: The objective of this study is to do a comparative analysis of the post-operative outcomes between open inguinal varicocelectomy and laparoscopic varicocelectomy. Methods: The present investigation was undertaken within the surgical department of (Hospital name) over a duration of two years, spanning from December 2019 to December 2021. This study employed a prospective design and involved the inclusion of a cohort comprising 50 patients diagnosed with clinically severe varicocele. The participants were allocated into two distinct groups. Group A consisted of 25 individuals who underwent laparoscopic surgery, while Group B consisted of 25 individuals who received an open approach. Results: In our study comprising a cohort of 50 patients, we observed a range of ages from 20 to 49 years. Among these patients, 19 reported experiencing scrotal pain, 25 exhibited testicular swelling, and 7 presented with infertility. The mean operation time for laparoscopic varicocelectomy was 48 minutes, while for open surgery it was 57 minutes. Interestingly, we found that the postoperative analgesic requirement was similar in both groups. Furthermore, the average duration of hospital stay was 35.6 hours for laparoscopic procedures and 50.6 hours for open procedures. The duration of the operative procedure in Laparoscopic Varicocelectomy was found to be 17.25 ± 2.1 minutes in cases where the condition was unilateral, whereas it was 29.32 ± 2.8 minutes in situations where the condition was bilateral. The average length of surgery for unilateral cases in Open Varicocelectomy was found to be 42.5 ± 3.4 minutes, whereas for bilateral presentations, it was 67.25 ± 2.5 minutes. The observed difference between the two groups was found to be statistically significant, with a p-value of less than 0.001 . The recurrence rate was higher in laparoscopic group. Conclusion: Laparoscopic varicocelectomy offers similar outcomes to open techniques, with minimal morbidity and shorter hospitalization periods. It treats bilateral varicoceles without extra incisions and has a higher recurrence rate, but overall patient satisfaction makes it a preferred surgical technique. Keywords: laparoscopic varicocelectomy, Open varicocelectomy, Infertility.

The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Differences between repeated lipid profile measurements in a tertiary hospital over a short time period

BackgroundMeasurement of the plasma lipid profile, mainly low-density lipoprotein cholesterol (LDL-C), is widely used in the management of hospitalized patients as part of their cardiometabolic risk assessment. In common practice, LDL-C is calculated indirectly by the Friedewald equation. For many years, fasting of 8–14 h is needed to obtain an accurate lipid profile measurement, although recent guidelines do not necessitate it. The aim of this study was to find patients with two consecutive LDL-C measurements taken over a short time period on the same admission to see if a significant difference exists and to suggest reasons that may explain it. We also aim to define whether the difference between LDL-C calculated by the Friedewald equation is diminished while using the newer Martin/Hopkins, de Cordova or Sampson/NIH equations.MethodsThis was a retrospective cohort study performed in one medical center in Israel. In a five-year time period, 772 patients with two repeated LDL-C measurements taken on the same admission were found. The median time gap between tests was 2 days. Correlations between laboratory results and LDL-C measurements were determined.ResultsA total of 414 patients (53.6%) had a difference greater than the acceptable total error of 8.9% in LDL-C calculation using the Friedewald equation, with a mean 25.8% difference between the two tests. Newer LDL-C calculations showed less diversity. Non-HDL-C was found as the only variable with a major correlation with LDL-C results in all equations. A weaker correlation was found with HDL-C. Triglycerides showed an even weaker correlation, and glucose differences had no correlation with LDL-C differences.ConclusionsRepeated LDL-C measurements can vary widely, even during a short period of hospitalization. In this study, more than half of the patients had a significant difference between their consecutive LDL-C results. This wide difference between two consecutive tests was diminished using newer calculations, yet not well explained. The fasting state likely has no effect on LDL-C levels. The results of this study might emphasize that many factors influence LDL-C calculation, especially in the disease state. Further research is needed, especially in looking for a more accurate LDL-C calculation from existing formulas.

Evaluation of Etiological Causes and Factors Affect Length of Hospitalization in Neonates Hospitalized with Lower Respiratory Tract Infection.

This study aims to determine the risk factors by examining the sociodemographic characteristics of infants hospitalized in the neonatal intensive care unit (NICU) due to lower respiratory tract infection (LRTI), to determine the factors that affect the duration of hospitalization, and to determine the underlying microbial factors and evaluate them in the light of the literature. This study evaluated the data of newborns hospitalized with LTRI between 01 October 2022 and 31 March 2023. Demographic characteristics of the patients detected viral agents, duration of hospitalization and risk factors were recorded in the study form. Babies divided viral LRTI and non-viral LRTI, and then compared with each other. Additionally, the facts that might affect the duration of hospitalization were investigated. The study included 57 babies. Viral agent was detected in 50.9% of the babies, the most frequently viral agent was respiratory syncytial virus (RSV) (48.2%). Other viral factors, in order of frequency; Adenovirus, SARS-CoV-2, Influenza A and B. There is no demographic difference between the viral agent positive and negative groups. The patients were evaluated according to length of hospitalization, it was seen that the hospital stay was longer in babies who were found to be viral positive and needed oxygen therapy (p=0.02, p=0.03, respectively). The male gender ratio was higher in the group with longer hospital stays, but this difference was not statistically significant. Although the rate of exclusive breastfeeding was higher in the group with a short hospitalization period, this difference was not statistically significant (p>0.05). RSV is currently the most frequently detected viral agent in lower respiratory tract infections in newborns. The hospital stay of babies diagnosed with RSV is longer than those with non-RSV viral agents. So struggling with RSV is important in preventing lower respiratory tract infections in newborns. It is necessary to develop a vaccine or immunoglobulin application against RSV infection not only for preterm babies but also for all newborn babies.

Evaluating patient outcomes and quality of life following laparoscopic extended totally extraperitoneal repair for ventral hernia: A prospective study

Abstract BACKGROUND: Various laparoscopic techniques have been developed for the repair of ventral and incisional hernias. There is a never-ending debate regarding the best procedure for hernia repair. Moreover, very few studies have studied the Quality of Life (QOL) in these patients. This study is aimed at analyzing the various perioperative outcomes following the laparoscopic extended totally extraperitoneal (eTEP) approach for ventral hernias and QOL. MATERIALS AND METHODS: This prospective study was conducted in the Department of Surgical Gastroenterology at a tertiary care hospital in India. The study analyzed patient demographics, hernia characteristics, perioperative outcomes, postoperative complications, and QOL measured by the Carolinas Comfort Scale. RESULTS: The study enrolled 34 patients and analyzed hernia characteristics and perioperative outcomes. QOL scores, measured by the Carolinas Comfort Scale, were assessed at 1-month and 6-month intervals post-surgery. At 1 month, scores for mesh sensation, pain, movement limitation, and the total score were 8.85, 4.26, 0.06, and 13.18, respectively. At 6 months, these scores improved significantly to 0.76, 0.18, 0, and 0.94. CONCLUSION: eTEP is associated with less postoperative pain, short hospitalization periods, and low recurrence rates. Furthermore, it offers cost-effectiveness by employing a standard prolene mesh without requiring fixation. eTEP improves the QOL in patients undergoing repair for ventral hernias.

Application of Dural Suturing in Reconstruction of Sellar Floor for Cerebrospinal Fluid Leakage During Neuroendoscopic Intranasal Approach Surgery: A Meta-Analysis.

To assess the safety and efficacy of utilizing dural suturing as an adjunctive procedure for saddle floor reconstruction in patients undergoing endoscopic surgery in the sellar region. According to the PRISMA guidelines, we searched the literature on sellar floor reconstruction in endoscopic sellar surgery. Fixed- or random-effects meta-analysis was used to pool the rate of return to postoperative cerebrospinal fluid (poCSF) leakage, repair operations, postoperative hospitalization, complete resection, infection, lumbar drainage (LD), and operative duration. A total of six studies involving 723 participants were included in the current meta-analysis. The pooled results demonstrated that patients in the dural suturing group had a lower incidence of poCSF leakage [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.07 - 0.44; p=0.0002] and repair operation [OR, 0.24; 95% CI, 0.07 - 0.78; p=0.02], as well as a shorter hospitalization period [standardized mean difference (SMD), -0.45; 95% CI, -0.62 - -0.28; p < 0.00001]. There was no significant difference between the two groups in terms of the complete resection [OR, 1.06; 95% CI, 0.62 - 1.80; p=0.84], postoperative infection [OR, 0.49; 95% CI, 0.21 - 1.15; p=0.10] and lumbar drainage (LD) [OR, 0.28; 95% CI, 0.06 - 1.23; p=0.09]. Additionally, the dural suturing group may require a longer operative duration [SMD, 0.29; 95% CI, 0.02 - 0.56; p=0.03]. The results suggest that dural suturing can be advantageous in reducing postoperative complications and shortening postoperative hospitalization following neuroendoscopic surgery in the sellar region without increasing the risk of infection.

The Role of Vitamin D in Prevention, Treatment, and Health Recovery of COVID-19 Patients (Literature Review)

One non-pharmacological treatment for COVID-19 involves the consumption of vitamin D, which has been shown to positively impact the body's immune system. It can lower the risk of infection and contribute to both specific and non-specific immunity, including enhancing physical barriers, natural cellular immunity, and the adaptive immune system. However, further evidence is necessary to elucidate vitamin D's exact role in preventing, treating, and aiding recovery in individuals with COVID-19. This study aims to explore the role of vitamin D in preventing, treating severity, and promoting the recovery of individuals with COVID-19. Conducted through a literature review utilizing a summarized methodology, the study examines the findings regarding vitamin D's impact on the health outcomes of COVID-19 patients. The analysis of 11 relevant articles suggests that vitamin D does indeed play a crucial role in preventing, treating, and aiding recovery in individuals with COVID-19. It appears to reduce the severity of respiratory infections, strengthen the immune systems of COVID-19 patients, and potentially expedite recovery, as evidenced by shorter hospitalization periods among those supplemented with vitamin D.

Endoscopic Ultrasound-Guided Naso-gallbladder Drainage Using a Dedicated Catheter for Acute Cholecystitis After Transpapillary Metal Stent Placement for Malignant Biliary Obstruction.

Acute cholecystitis is a significant adverse event after self-expandable metal stent (SEMS) placement for malignant biliary obstruction (MBO); however, no appropriate treatment strategy has been established for its management. This study aimed to examine the feasibility and utility of endoscopic ultrasound-guided naso-gallbladder drainage (EUS-NGBD) for the management of acute cholecystitis occurring after SEMS placement. This retrospective study investigated consecutive patients with acute cholecystitis after SEMS placement for unresectable MBO, in whom EUS-NGBD was attempted. The study outcomes included technical success, clinical success, procedure time, adverse event, and cholecystitis recurrence, associated with the procedure. During the study period, EUS-NGBD was performed for SEMS-related acute cholecystitis in 30 patients with MBO. The technical and clinical success rates were 96.7% (29/30) and 96.6% (28/29), respectively. The median procedure time was 15min, and rate of procedure-related adverse event was 3.3% (1/30). The median duration from the procedure to tube removal was 9days. No adverse events were observed after removal. The median hospitalization duration after the procedure was 14days, and the median duration to the (re-)start of chemotherapy from cholecystitis onset was 13days. The median overall survival after EUS-NGBD was 123days, and the rate of cholecystitis recurrence until death was 4.2% (1/28). This study demonstrated that EUS-NGBD possesses good technical and clinical feasibility with an acceptable adverse event rates and short hospitalization and chemotherapy withdrawal period. Therefore, EUS-NGBD may be a good option for the treatment of SEMS-related cholecystitis in patients with MBO.

Laparoscopic versus open appendectomy in the management of chronic appendicitis

Background The term ‘chronic appendicitis’ (CA) is still clearly undefined. However, once established, it necessitates appendectomy, which could be performed via open or laparoscopic approaches. Comparisons between the two approaches have been made in acute appendicitis cases, with no previous trials including CA patients. That is why we conducted this study to compare these two approaches in the management of CA patients. Methodology 50 CA were included in our prospective trial, and they were randomly assigned into two groups; the OA group (25 open appendectomy patients) and the LA group (25 laparoscopic appendectomy cases). Results The statistical analysis revealed no significant differences between the two groups regarding most preoperative characteristics. The laparoscopic approach was associated with significant prolongation in operative time that had an average of 1 h in the LA group, while it ranged between 0.5 and 1 h in the OA group (P = 0.005). Nonetheless, laparoscopy led to a significantly better postoperative recovery profile, manifested in the shorter hospitalization period (1 vs. 2 days in the open approach) and less postoperative pain (all patients with mild pain compared with moderate pain in the open group). Only 2 (8%) casesexperienced temporary vomiting in the OA group. Conclusion Laparoscopy is superior to the open approach in the management of chronic appendicitis patients. It is associated with a better analgesic profile, a shorter hospitalization period, and a better chance of detecting other concomitant intraabdominal pathologies. However, the increased operative time should be considered.

The effectiveness of surgical treatment of lung cancer in Polish academic and nonacademic centers.

The theoretical advantage of academic hospitals over nonacademic are: more qualified surgeons, adequate diagnostic facilities and infrastructure, including intensive care units. The aim of the study was to compare the effectiveness of surgical lung cancer treatment in academic (ACA) and nonacademic (non-ACA) centers. This was a retrospective analysis of data from 31,777 patients surgically-treated for lung cancer during the period from 2007 to 2020 in 9 ACA and 21 non-ACA centers. The analysis considered the clinical data of patients, the effectiveness of preoperative diagnostics, the type of procedures performed, the complications, the postoperative mortality and the long-term survival. The median number of anatomical lung resection procedures was 1,218 for ACA and 550 for non-ACA centers. In the ACA group, resection using the video-assisted thoracic surgery (VATS) technique was performed significantly more often than in the non-ACA group (23.6% vs. 14.2%, P<0.001). The pN feature analysis showed significantly lower proportions of pNX (9.2%) in the ACA group than those in the non-ACA group (17.1%) (P<0.001). The rates of postoperative complications in the ACA and non-ACA groups were 30.7% and 33.8%, respectively (P<0.001). There were no significant differences in 5-year survival between the ACA and non-ACA groups (56% and 56%, respectively) (P=0.2). The present study showed that ACA centers are characterized by better preoperative diagnostics, a higher percentage of VATS lobectomies, a lower percentage of postoperative complications and a shorter hospitalization period than non-ACA centers, but there was no impact on 5-year survival.

Success Rate and Complications of Extracorporeal Shock Wave Lithotripsy in Patients Referring to the Kowsar Hospital in Semnan

Background and Objective: Treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) is a low-cost method with a short hospitalization period. However, several complications have been reported for this method. This study was designed to investigate the efficiency and side effects of ESWL. Materials and Methods: In a cross-sectional study, all available files of cases in the stone crusher unit were evaluated according to the inclusion and exclusion criteria from April 2013 to April 2016. Preliminary information before lithotripsy, including patients' demographic characteristics and also treatment success, and complications, was assessed. Results: The success rate of ESWL was 81.4%, which had no significant relationship with gender, age, and body mass index. The mean size of the stones was 10.9±5.4 mm, which was associated with the success rate. In terms of stone location, the highest frequency was observed in the right lower calyx, followed by the left pelvis. The most common complications were ecchymosis (84.3%), hematuria (20.6%), and severe pain (15.3%). There was a significant difference in the incidence of complications in patients with different stone sizes (p&lt;0.01). The occurrence of complications had a significant relationship with the location of the stone (p&lt;0.01). Stones located in the pelvis and lower calyces caused the most complications. Conclusion: The results showed that ESWL had a high success rate and was a suitable method for the treatment of urinary stones. The success rate was associated with the stone size, which, therefore, is an important factor in choosing this approach.

Výsledky robotické kolorektální chirurgie na III. chirurgické klinice 􀍷. LF UK

Introduction: Robotic surgery is a rapidly developing field both in our country and abroad. The beginnings of robotic surgery dated back to the 1980s, but development took place after 2000, especially with the robotic systems from the company Intuitive. In the Czech Republic, the first robotic surgery was performed in October 2005, whereas at our surgical department, it was in June 2018. Robotic surgery techniques are now part of the standard procedures of our workplace. Method: Retrospective analysis of patients from our results database. We included all 150 patients operated between June 2018 to October 2022. Results: The operation technique is almost identical to laparoscopic or open surgery. The difference is so-called docking of the robotic system and the correct placement of the robotic arms. Now in the databases are 150 patients with colon and rectal resection. Most patients underwent rectal resection. 9.4% of the patients had anastomosis leak, which is a figure comparable to foreign literature. The conversion was necessary for 2.4% of patients. The length of hospitalization was reduced to a median of 6 days. Conclusion: Robotic surgery is certainly the future of surgery as such. The advantage over classic operations is a shorter hospitalization period, faster recovery, less painful surgical wounds, fewer wound infections, a lower risk of hernia in the scar and fewer conversions. The disadvantage is certainly the lack of tactile perception and the high purchase price as well as higher costs for the operation. Keywords colorectal surgery, robotic surgery, robotic resection, miniinvasive surgery

Zrýchlené formy rehabilitácie po mini-invazívnych zákrokoch v neurochirurgii

The development of spinal surgery makes it possible to perform minimally invasive interventions in the treatment of LDD (lumbar disc degeneration). The lumbar spine is most often indicated for surgery. At present, several types of operations (decompression, fusion, dynamic stabilization) are performed in the surgical solution of vertebrogenic problems in the lumbar spine. What type of operation and operative technique the operator chooses depends on the graphic documentation of the affected section of the spine and the clinical picture. At present, the minimally invasive surgical technique called minimally invasive spinal surgery (MISS). The procedure allows less tissue damage, less blood loss, earlier verticalization and a shorter hospitalization period. this fact points to the necessity of accelerated forms of rehabilitation in spinal surgery. We followed 250 patients whose average length of hospitalization after mini-invasive procedures at NCHK in Ružomberok in 2022 was 4.84±0.81 days. We appeal to the need for preoperative preparation, which will speed up postoperative rehabilitation.

683 TWO IS BETTER THAN ONE!

Abstract Patients suffering from atrial fibrillation (AF) and severe aortic stenosis thus undergoing transcatheter aortic valve implantation (TAVI) have a worse prognosis than those in sinus rhythm. One of the reasons of this is related to the augmented bleeding risk associated with oral anticoagulation (OAC). Left atrial appendage occlusion (LAAO) represents a therapeutic choice to avoid this drug intake and to reduce this kind of adverse outcome. So, a combined procedure of TAVI and LAAO could be an option for TAVI candidates with AF to omit the need for OAC. The clinical case concerns an 85-year-old man with hypertension and dyslipidemia with a history of recent syncope and permanent atrial fibrillation in therapy with antithrombotic drug. Brain MRI performed during hospitalization showed numerous hemosiderin deposits with microhemorrhagic foci thus contraindicating oral anticoagulation. Severe aortic stenosis has also been found to the transthoracic echocardiogram with a mean gradient of 35 mmHg and confirmed by transesophageal echocardiogram with a planimetric area of 0.8 sq.cm. Furthermore, given the finding of significative left circumflex artery disease, after Heart Team discussion and the execution of CT scan that demonstrated the feasibility of transcatheter approach, it was decided to perform in a single session percutaneous coronary intervention (PCI) plus TAVI plus left atrial appendage closure (LAAO). This kind of approach allowed a quick recovery to the patient after a short period of hospitalization. After six months from interventional procedure his NYHA (New York Heart Association Functional Classification) status improved abutting on I/II class. As described above, it can be deduced that combined approach (TAVI+LAAO) is feasible for certain kind of patients thus avoiding surgical approach and long hospitalization. Furthermore, multimodality imaging is of critical importance to plan a complex procedure and an accurate step-by-step pre-procedural strategical planning is the key for procedural success.

Mortality Risk Factors of Early Neonatal Sepsis During COVID-19 Pandemic.

This study aimed to determine predisposing factors for negative outcome in infants with early neonatal sepsis during COVID-19. A prospective cohort study of 172 newborns up to 4 days diagnosed with neonatal sepsis was carried out in Karaganda (Kazakhstan). The microbiological examination was used to identify a causative agent of bloodstream infection. ELISA was performed to determine the total anti-SARS-CoV-2 antibodies. Gestational age, mode of delivery, birth weight, C-reactive protein and procalcitonin levels, comorbidities, type of pathogen, duration of hospitalization and mother's infection diseases were used for statistical analysis. Mortality in infants with neonatal sepsis was 22% (38/172). Anti-SARS-CoV-2 antibodies were detected in 68.3% of the newborns. Culture-negative ELBW infants have a 5.3-fold higher risk of death (p<0.001). Low gestational age and a shorter period of hospitalization were statistically associated with fatality. CRP is generally higher in deceased children (p=0.002). Necrotizing enterocolitis (p<0.001), pneumonia (p=0.009) and anemia (p=0.016) were significantly associated with negative outcome. And, 31.4% of the infants with sepsis had positive blood cultures. The leading cause of sepsis in newborns was CoNS - 57%. During COVID-19 pandemic neonatal sepsis mortality was associated with low birth weight, gestational age, and comorbidities as in non-pandemic time. The relationship between COVID-19 in the mother and neonatal mortality was not found. However, anti-SARS-CoV-2 antibodies were detected in more than half of newborns.

Comparison of endoscopic submucosal resection with ligation and endoscopic submucosal dissection for small rectal neuroendocrine tumors: A multicenter retrospective study.

ObjectivesEndoscopic submucosal resection with band ligation (ESMR‐L) and endoscopic submucosal dissection (ESD) are both standard endoscopic resection methods for rectal neuroendocrine tumors (NETs) <10 mm in size. However, there is no definitive consensus on which is better. Here, we compared the efficacy of ESMR‐L and ESD for small rectal NETs.MethodsThis was a multicenter retrospective cohort study including 205 patients with rectal NETs who underwent ESMR‐L or ESD. Treatment outcomes were compared by univariate analysis, multivariate analysis, and inverse probability treatment weighting (IPTW) using propensity scores. Subgroup analysis evaluated the impact of the endoscopist's experience on the technical outcome.ResultsEighty‐nine patients were treated by ESMR‐L and 116 by ESD. The R0 resection rate was not significantly different between the two (90% vs. 92%, p = 0.73). The procedure time of ESMR‐L was significantly shorter than for ESD (17 min vs. 52 min, p < 0.01) and the hospitalization period was also significantly shorter (3 days vs. 5 days, p < 0.01). These results were confirmed by multivariate analysis and also after IPTW adjustment. The procedure time of ESD was significantly prolonged by a less‐experienced endoscopist (49 min vs. 70 min, p = 0.02), but that of ESMR‐L was not affected (17 min vs. 17 min, p = 0.27).ConclusionsFor small rectal NETs, both ESMR‐L and ESD showed similar high complete resection rates. However, considering the shorter procedure time and shorter hospitalization period, ESMR‐L is the more efficient treatment method, especially for less‐experienced endoscopists.

Efficacy and safety of outpatient based therapy in childhood acute lymphoblastic leukemia.

e22001 Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. With the improvements in effective antileukemic drugs and the risk stratification treatment approach, the cure rate for pediatric ALL has increased to &gt;90%. The effect of outpatient treatment and developing supportive care have a very important role in this success. We evaluated the disease outcomes and severe complications (complication causes hospitalization in ICU, encephalitis) of children who had been treated with the Children’s Oncology Group (COG) protocols, and follow-up protocol during a 20-year study period. Methods: From 1999 to 2020, 134 patients who had been diagnosed with ALL in the Department of Pediatric Hematology-Oncology at the Istanbul University Oncology Institute were included in the present study. Nine patients excluded from all analysis that 5 of them admitted with relapse, 2 had been diagnosed with mature aggressive B-cell acute leukemia, and 2 had been diagnosed with mixed phenotype and 7 who had been lost to follow-up were also excluded from survival analyses. Results: Mean age was 7.7±4.89 years old in 125 patients (Table). The 5- and 10-year and 20-year Event Free Survival (EFS) rates were 90.2% (standard error [SE], 4.2%) in standart risk B-ALL (n=54) and Overall Survival (OS) rates were 100%, 96% and 96% ([SE], 3.9%), respectively. In high risk group B-ALL (n=53) 5-year EFS was 80.7% (standard error [SE], 5.8%) and 78.2% ([SE], 6.1%) for both 10 and 20 year period and OS rates were 76.9% ([SE], 5.9%) for all periods. Although the number of patients is low in T-ALL (n=11), 5- and 10-year and 20-year EFS and OS rates were 63.6% (standard error [SE], 14.5%) for all periods. Fifteen severe complication recorded in 12 patients (10 B-ALL, 2 T-ALL). One patient hospitalized in ICU due to gram negative sepsis for 3-times and epidural hemorrhage. Conclusions: The survival rate for pediatric ALL has increased in recent years according to improvements of treatment.In our cohort, 20-year OS rate is 96% for standart risk B-ALL and 76.9% for high risk B-ALL. Additionally, regularly and closely monitored patients, complications can be effectively prevented, treated, and eliminated. In our study, the short hospitalization period, rapid analysis of laboratory tests, continuous supportive care, efficient education given to the parents of children increased the success of the therapy and ensured low complication rates. [Table: see text]

Application of omental interposition to reduce pancreatic fistula and related complications in pancreaticoduodenectomy: A propensity score-matched study

BACKGROUNDThe life-threatening complications following pancreatoduodenectomy (PD), intra-abdominal hemorrhage, and postoperative infection, are associated with leaks from the anastomosis of pancreaticoduodenectomy. Although several methods have attempted to reduce the postoperative pancreatic fistula (POPF) rate after PD, few have been considered effective. The safety and short-term clinical benefits of omental interposition remain controversial.AIMTo investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODSIn total, 196 consecutive patients underwent PD performed by the same surgical team. The patients were divided into two groups: An omental interposition group (127, 64.8%) and a non-omental interposition group (69, 35.2%). Propensity score-matched (PSM) analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTSFollowing PSM, the clinically relevant POPF (CR-POPF, 10.1% vs 24.6%; P = 0.025) and delayed postpancreatectomy hemorrhage (1.4% vs 11.6%; P = 0.016) rates were significantly lower in the omental interposition group. The omental interposition technique was associated with a shorter time to resume food intake (7 d vs 8 d; P = 0.048) and shorter hospitalization period (16 d vs 21 d; P = 0.031). Multivariate analyses showed that a high body mass index, nonapplication of omental interposition, and a main pancreatic duct diameter < 3 mm were independent risk factors for CR-POPF.CONCLUSIONThe application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.