Short Recovery Period Research Articles

Modern Views on the Treatment of Hemorrhoid Disease Complicated by Post Hemorrhagic Anemia

Research purpose: to improve the surgical treatment results of patients with bleeding hemorrhoids complicated by posthemorrhagic anemia through the development of rational methods of surgical treatment. Patients and methods: A method of operation by first ligating blood vessels to the internal hemorrhoids without any instruments with simultaneous removal of external hemorrhoids has been developed. Research design: The study included 56 patients operated on for chronic bleeding hemorrhoids complicated with posthemorrhagic anemia from 2018 to 2022. All patients underwent a method to ligate blood vessels to internal hemorrhoids without any instruments along with simultaneous removal of external hemorrhoids. In the postoperative period in these patients, the pain syndrome was less pronounced, the patients behaved relatively actively, reflex urinary retention was not noted, postoperative bleeding and postoperative stricture of the anal canal were not observed, the patients were in the hospital for an average of 11.08 hospital days, and closed hemorrhoidectomy was 16.09 bed days. Findings: The operation is low-cost; there is no need for expensive high-tech equipment; it is effective for all stages of hemorrhoids; the surgical field is wide; visibility is unlimited; the operation is performed by all proctologists without special training. Low trauma; there is no open wound in the anal canal, i.e., “X”-shaped and interrupted sutures are applied for transanal hemorrhoidal ligation of blood vessels to internal hemorrhoids and mucopexy. Conclusion: short recovery period, low intensity of postoperative pain, absence of postoperative urinary retention, postoperative bleeding, and anal stricture.

Adaptation of plantations to drought events in arid and semi-arid regions: Evidence from tree resilience

Increasing drought frequency and severity pose a significant risk to global forest plantations, particularly in arid and semi-arid regions. Developing drought-adaptive plantations is particularly important for vegetation restoration in the context of climate warming. Despite the importance of drought response and adaptation, systematic research on these aspects for major tree species remains limited. Here, we collected 467 tree ring cores from eight paired sites of Robinia pseudoacacia L. (a broad-leaved species) and Pinus tabulaeformis C. (a coniferous species) plantations across a typical semi-arid region of the Loess Plateau (LP) to discern the climate-growth patterns of both species using linear mixed models. We employed hypothesis testing to analyze the differences in tree resilience metrics, including drought resistance and recovery ability, and linear mixed models combined with partial least squares path analysis to clarify the driving factors of tree resilience between R. pseudoacacia and P. tabulaeformis. Our findings demonstrated that Palmer Drought Severity Indices is the key limiting climate factor, without spatial variation, on the growth of R. pseudoacacia and P. tabulaeformis, explaining 47.7 % and 69.8 % of the variables effect percentage, respectively. Compared to P. tabulaeformis, R. pseudoacacia is more limited by atmospheric drought stress and soil moisture, with 11.0 % and 17.9 % of the explained effect percentage, respectively. R. pseudoacacia exhibited lower drought resistance ability, evidenced by a lower resistance (the average value is 0.62) and a higher average growth reduction (0.20) than P. tabulaeformis (0.85 and 0.17, respectively). In contrast, R. pseudoacacia had higher drought recovery ability, evidenced by a higher recovery (the average value is 1.19), a shorter recovery period (1.0), and a faster average recovery rate (0.14), than P. tabulaeformis (1.07, 2.0, and 0.08, respectively). Importantly, all tree resilience metrics for both species exhibited spatial consistency across the LP. Tree characteristics had a stronger effect on drought resistance and recovery ability in R. pseudoacacia than in P. tabulaeformis. Soil properties improved R. pseudoacacia drought resistance ability and reduced its drought recovery ability, but had weaker effects on P. tabulaeformis. Additionally, tree size and age strongly influence tree resilience in R. pseudoacacia through preceding year tree growth of drought events and climate sensitivity. These findings underscore the complementary drought resilience of broad-leaved and coniferous species, emphasizing the necessity for adaptive plantations and diversified tree species plantations as a strategic response to the anticipated increase in drought frequency and severity in arid and semi-arid regions.

Efficacy and Complications Comparison Between Emergent and Elective Laparoscopic Cholecystectomy Surgery

Background: Laparoscopic cholecystectomy (LC) is the preferred surgical procedure for treating symptomatic gallstone (GS) disease. Objectives: This study aimed to evaluate and compare the outcomes of emergent and elective LC, focusing on complications, conversion rates, duration of surgery (DOS), length of hospital stay, and post-operative pain. Methods: A total of 166 patients who underwent LC surgery at Baqiyatallah Hospital, Tehran, Iran, between 2021 and 2022 were included in the study. Of these, 64 patients underwent emergent LC, and 102 underwent elective LC. The groups were compared for complications, conversion rates, DOS, length of hospital stay, and post-operative pain. Results: The study revealed that while intraoperative complications did not differ significantly between the two groups (P = 0.14), there was a significant difference in the conversion of surgical methods from three to four trocars (P = 0.007). Additionally, more patients in the emergent group required drain insertion during surgery (P = 0.003). Regarding post-operative outcomes, no significant differences were observed between the emergent and elective LC groups in terms of local (P = 0.77) and systemic complications (P = 0.37). However, patients in the elective LC group experienced a significantly shorter post-operative hospital stay (P = 0.002). Pain levels one day (1.02 ± 0.80) and one week (0.14 ± 0.43) after surgery were lower in the elective LC group. Furthermore, patients in the elective group returned to daily activities earlier (3.77 ± 1.21 days). Conclusions: The findings of this study indicate that emergent LC is as safe as elective LC. However, patients undergoing elective LC may benefit from a shorter recovery period and reduced post-operative pain. Overall, LC remains a low-risk and safe option for managing emergent gallstone cases.

Primary division of annular pancreas: a surgical technique.

The authors presented a case of duodenal obstruction in a 61-year-old man, resulting from an annular pancreas diagnosed on imaging (computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound). The patient underwent a diagnostic laparoscopy. Intraoperatively, given a straightforward appearance and anatomy of the annular pancreas overlying the second part of the duodenum, and due to extensive adhesions in the abdomen, a primary division of the annular pancreas was performed, instead of a bypass procedure such as gastrojejunostomy. He had some residual symptoms 1 week postoperatively which was treated with duodenal dilatation endoscopically. On review and follow-up at 1 year, he has remained well with resolution of symptoms, supported by radiological improvement on a computed tomography performed at 4months post-operatively. We believe this approach has resulted in less morbidity and a shorter period of recovery as compared to a bypass procedure and represents a reasonable therapeutic option for annular pancreas.

Protective Effect of Allergen Immunotherapy in Patients With Allergic Rhinitis and Asthma Against COVID-19 Infection: Observational, Nationwide, and Multicenter Study.

Allergic diseases are associated with an increased susceptibility to respiratory tract infections. Although allergen immunotherapy (AIT) alters the course of allergies, there is limited evidence from clinical practice demonstrating its ability to enhance the host defense against pathogens. The aim of this study was to investigate the protective effect of AIT against viral infection in patients with allergic rhinitis (AR) and allergic asthma (AS) based on clinical evidence. A multicenter, questionnaire-based survey was conducted during a tremendous surge in COVID-19 cases between February 10, 2023, and March 15, 2023, in 81 centers across China recruiting healthy volunteers and patients with AR and AS to investigate the clinical outcomes of COVID-19 infection. Of 10,151 participants recruited in the survey, 3654 patients and 2192 healthy volunteers who tested positive for COVID-19 were included in this analysis after screening. Overall, no significant differences in COVID-19 outcomes were observed between patients and healthy volunteers. An additional 451 patients were excluded due to their use of biologics as the sole add-on treatment, leaving 3203 patients in the further analysis. Of them, 1752 were undergoing routine medication treatment (RMT; the RMT group), whereas 1057 and 394 were receiving AIT and a combination of AIT and omalizumab (OMA) as adjunct therapies to RMT, respectively (AIT+RMT and AIT+OMA+RMT groups). The AIT group showed milder COVID-19 symptoms, shorter recovery periods, and a lower likelihood of hospitalization or emergency department visits than the RMT group (all P<.05). After adjusting for confounding factors, including demographic characteristics and COVID-19 vaccination, AIT remained a significant protective factor associated with shorter recovery time (adjusted odds ratio [OR] 0.62, 95% CI 0.52-0.75; adjusted P<.001) and a lower incidence of hospitalization or emergency department visits (adjusted OR 0.73, 95% CI 0.54-0.98; adjusted P=.03). Furthermore, the AIT+OMA+RMT group showed greater protection with a shorter recovery time (adjusted OR 0.51, 95% CI 0.34-0.74; adjusted P<.001) than the AIT+RMT group. Our multicenter observational study provides valuable clinical evidence supporting the protective effect of AIT against COVID-19 infection in patients with AR and AS.

Response of cool‐season turfgrass monocultures and two‐way mixtures to sequential acute drought periods

AbstractTurfgrass seeds are often sold as mixtures of several species to increase the probability of positive responses toward abiotic and biotic stresses, a response to drought being one of these. Several species of turfgrass are already thought to be better suited for drought, such as hard fescue (Festuca brevipila Tracey) and tall fescue [Schedonorus arundinaceus (Schreb.) Dumort]. However, little is known about the benefit of these species in mixtures with drought‐intolerant and/or drought‐avoiding species during drought. Understanding species mixture composition during establishment, before and after drought stress periods, could help develop more resilient mixtures for this stress condition. We compared monocultures and mixtures of hard fescue, Kentucky bluegrass (Poa pratensis L.), and perennial ryegrass (Lolium perenne L.) during sequential short drought and recovery periods in controlled conditions. We observed that the composition of most mixtures remained similar during drought and recovery periods; however, perennial ryegrass was often less prevalent after drought stress. We found that hard fescue monocultures had better green leaf coverage than Kentucky bluegrass and perennial ryegrass during drought stress. However, the presence of hard fescue in mixtures was not an indicator of greater drought tolerance, and variable fluorescence to maximal fluorescence data indicated that hard fescue was just as physiologically stressed as perennial ryegrass and Kentucky bluegrass during the drought periods. These results indicate that while hard fescue seems visually drought tolerant, it is still physiologically stressed and improved drought tolerance could be achieved through focusing on physiological indicators of stress in this species rather than visual indicators.

In vivo tetraploid induction of mono-embryonic citrus genotypes by colchicine treatment

Polyploid holds great significance in citrus breeding, to produce dwarf tetraploid rootstocks with wide adaptability and triploid scion varieties bearing seedless fruits. In citrus, tetraploids have been generated through somatic hybridization and autonomous chromosome doubling of nucellar embryos. However, most tetraploids were recovered from poly-embryonic (apomictic) citrus, while tetraploids of mono-embryonic (non-apomictic) citrus were seldomly reported. Herein, we developed an in vivo tetraploid induction method by colchicine treatment, which is especially high-efficient in mono-embryonic citrus. The epicotyl of citrus seedling was decapitated and incubated in dark for different time durations (0–15 d) to induce callus formation on the epicotyl wound. The callus on wound was then immersed in different concentrations (0.0125 %-0.100 %) of colchicine for 2 h, enabling regeneration of tetraploid shoots. We achieved high tetraploid induction rate (20.69 %) but low mixoploid induction rate (1.72 %), when 0.025 % colchicine was applied on wound cultured in dark for 9 d By using this method, 147 tetraploids were recovered from mono-embryonic mandarin, tangerine, sweet orange, pummelo and citron. Our method exhibited high tetraploid induction efficiency (14.28 %-20.69 %), low rate of mixoploid (1.72 %-5.30 %), short recovery period (45 d), and no need of tissue culture. The majority (75 %-100 %) of the recovered tetraploids maintained stable ploidy during subsequent growth, and the mono-embryonic nature of the tetraploids was identified by InDel marker analysis. The mono-embryonic tetraploids obtained herein enriched polyploid germplasm pool for citrus breeding.

Primer on Embolic Agents and Sclerosants for the Treatment of Vascular Malformations.

Vascular malformations (VMs) are a heterogeneous group of arterial, venous, capillary, and/or lymphatic networks that typically are present at birth and grow with the patient. Signs and symptoms associated with VM range from absent to severe, with a broad spectrum of pain, cosmetic disfigurement, and local tissue destruction. Treatment options for these malformations extend from observation to surgical reconstruction. Each treatment modality has a role in the management of vascular anomalies, but also has specific challenges. Observation is not always sufficient, medical therapies may only be available for a subset of patients and are ultimately not curative, and surgical excision may itself be disfiguring or incomplete/not definitive. Sclerotherapy and/or embolotherapy have become a cornerstone of treatment for many types of VMs. These techniques are applicable to a wide range of VMs, are less invasive, have a shorter recovery period, and are repeatable. Although some VMs may not be amenable to percutaneous or endovascular treatment given their location, and multiple sessions may be required for select large and complex VMs, these minimally invasive treatments are often first line and may be definitive in treating VMs. Various agents may be used in sclerotherapy and embolotherapy, each with their own risks and benefits. Although there is a paucity of Level 1 evidence supporting the superiority of one agent over another, longstanding case series and expert experience exist, informing our knowledge of the safety and efficacy of sclerotherapy and embolotherapy. A brief overview of the most used sclerotherapy and embolotherapy agents and their uses is provided.

Evaluating the protective effectiveness and risk factors of ursodeoxycholic acid on COVID-19 among outpatients.

Objective: This study aimed to assess the chemopreventive effect of ursodeoxycholic acid (UDCA) against COVID-19 and to analyze infection risk factors, symptoms, and recovery in outpatients with UDCA exposure. Methods: The study enrolled outpatients prescribed UDCA from the Second Affiliated Hospital of Chongqing Medical University, China, between 01 July 2022, and 31 December 2022. Data on demographics, comorbidities, and drug combinations were collected using electronic medical records. COVID-19 infection, symptoms, severity, prognosis, vaccinations, and UDCA administration were surveyed by telephone interviews. UDCA non-users served as controls and were matched in a 1:2 ratio with UDCA users using propensity score matching with the nearest neighbor algorithm. Infection rates, symptomatology, severity, and prognosis were compared between matched and control cohorts, and risk factors and infection and recovery symptoms were analyzed in UDCA-exposed outpatients. Results: UDCA-exposed outpatients (n = 778, 74.8%) and matched UDCA users (n = 95, 74.2%) showed significantly lower SARS-CoV-2 infection rates than control patients (n = 59, 92.2%) (p < 0.05). The matched UDCA group exhibited substantially lower fever, cough, sore throat, and fatigue rates than controls (p < 0.05). Participants with UDCA exposure generally experienced mild symptoms, while those without UDCA had moderate symptoms. The matched UDCA group also had significantly shorter durations of fever and cough (p < 0.05). Risk factors such as age over 60, less than 1month of UDCA administration, diabetes mellitus, and coronary artery disease significantly increased SARS-CoV-2 infection rates (p < 0.05), while smoking led to a decrease (p < 0.05). Hypertension was associated with a prolonged COVID-19 recovery (p < 0.05), while smoking, vaccination, and fatty liver disease were associated with shorter recovery periods (p < 0.05). The main symptoms in the full UDCA cohort were fever, cough, and sore throat, with fatigue, cough, and hyposthenia being the most persistent. Conclusion: UDCA demonstrated chemopreventive effect against SARS-CoV-2 in outpatients by significantly reducing infection incidence and mitigating COVID-19 symptoms, severity, and recovery duration. Old age, short UDCA course, and comorbidities such as diabetes mellitus and CAD increased infection rates, while hypertension prolonged recovery. Smoking, vaccination, and fatty liver disease reduced infection rates and shortened recovery. UDCA had minimal impact on symptom types. Larger and longer-term clinical studies are needed further to assess UDCA's effectiveness in COVID-19 prevention or treatment.

Increasing Energy Efficiency in Agricultural Product Processing Enterprises Based on the Use of Hybrid Power Systems

The aim of the study was to prove the economic and environmental advantages of installing pho-tovoltaic sources in the power supply systems of some agricultural product processing enterprises. In order to achieve the aim, the performance in terms of how to install, connect and meter the pho-tovoltaic system for green electricity generation was analyzed. As an example, agricultural product processing enterprises were selected and the basic parameters of the electrical installations in the premises of these enterprises were established, and the choice of the type of photovoltaic installati-on was technically and economically justified according to the required power. Thus, the advantages of installing such a power supply system, which allows a significant increase in energy efficiency and has a short investment recovery period, were proved.

Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections

BackgroundThe main objective of this study was to determine whether virtual reality (VR) reduces procedure-related pain and other outcomes for epidural steroid injections (ESI). Randomized controlled study was undertaken in academic centers in the U.S. and Thailand where 146 patients with lumbosacral radiculopathy undergoing an ESI were allocated to immersive VR with local anesthetic, sedation with midazolam and fentanyl + local anesthetic, or local anesthetic alone.The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a >2-point decrease in average leg pain coupled with a score >5/7 on a Patient Global Impression of Change scale. FindingsProcedure-related pain scores with both VR (mean 3·7 (SD 2·5)) and sedation (mean 3·2 (SD 3·0)) were lower compared to control (mean 5·2 (SD 3·1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3·7 (SD 0·9)) compared to the VR group (mean 4·1 (SD 0·5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group. InterpretationVR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period. FundingFunded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV

The first experience of applying microwave ablation in primary hyperparathyroidism

The OBJECTIVE of this article was to present a clinical demonstration of the successful experience of using minimally invasive surgical treatment of a patient with primary hyperparathyroidism (PHPT) by percutaneous microwave ablation (MWA) of parathyroid adenoma, under ultrasound guidance. This method provides maximum effectiveness with minimal invasiveness, a shorter recovery period after surgery, and a better cosmetic effect. After the minimally invasive intervention, the patient had complaints related to hypocalcemia, which develops practically after any form of radical PHPT treatment. No other complications were observed. Further dynamic observation was carried out by an endocrinologist at the place of residence. The obtained positive results demonstrated a good perspective of PHPT treatment by using MWA.

Extracorporeal shock wave lithotripsy versus laser lithotripsy in the treatment of post-SWL steinstrasse: a randomized comparative study.

To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3-4weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. The success rate was higher in the ureteroscopy group than in the SWL group (p = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group (p = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group (p = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30h in the ureteroscopy group. SWL was performed without the need for hospital admission. Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

Efficacy of Laser Treatment in Pilonidal Disease: A Single-Arm Meta-Analysis.

Objective: This study aimed to collate all published studies on laser therapy for pilonidal disease and demonstrate the safety and effectiveness of minimally invasive techniques. Methods: A comprehensive literature search, with no language limitations, was performed using PubMed, Embase, and Web of Science from inception to April 23, 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and evaluated the bias risk of included studies. Meta-analysis was performed using RevMan software (version 5.4). (PROSPERO Registration ID Number CRD42023420803). Results: The analysis included 1214 patients from 13 studies, who fulfilled the pre-defined inclusion criteria. With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment. The mean complication and recurrence rates were 12.7% and 7.6%, respectively. Conclusions: Laser ablation for pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low postoperative recovery, and shorter recovery periods following employment.

Hypoxia impairs cellular energy allocation in the juvenile horseshoe crab Tachypleus tridentatus

Although hypoxia is a serious environmental concern for marine ecosystems globally, its biological effects on the benthic biota remain mostly unclear for some endangered species. To provide an deep understanding of the possible effects of hypoxia on the tri-spine horseshoe crab Tachypleus tridentatus, the cellular energy allocation (CEA) approach was utilized to examine the cellular responses and adaption potential of horseshoe crabs. We examined the energetic responses of T. tridentatus under low dissolved oxygen level (2 mg O2/L). The horseshoe crabs first experienced 14 days of hypoxic stress, and then recovered in a normal dissolved oxygen environment for 7 days. On the 7th and 14th day of hypoxic exposure, the levels of available energy, electron transport system activity, protein, lipids, and carbohydrates were decreased in T. tridentatus (p < 0.05). All measured parameters in the hypoxic group partially or completely recovered after seven days of re‑oxygenation, reaching a level that was significantly up-regulated (p < 0.05) compared with the 14th day and non-significantly different from the 0th day exposure (p ˃ 0.05). In conclusion, hypoxic stress has adverse effects on the energy balance of juvenile T. tridentatus, but these adverse effects can be alleviated in a short recovery period. As a result, our findings provide novel perspectives on the physiology of T. tridentatus under hypoxia acclimation, which is essential information for establishing ideal conditions for the cultivation of this endangered species.

Results of Modified Stenströms Technique Otoplasty and Patients' Satisfaction at King Fahad Armed Forces Hospital (KFAFH).

Background Globally, the prevalence of protruding ears is relatively frequent. Ear deformities manifest due to underdevelopment of the antihelical fold, conchal hypertrophy, and/or an obtuse conchoscaphal angle. The availability of multiple approaches proves that there isn't a single optimal accepted procedure. The Modified Stenström otoplasty technique supports the surgeon in the management of underdeveloped antihelix fold, conchal hypertrophy, and obtuse conchoscaphal angle among other deformities. We are the first to evaluate the clinical effects and measure the satisfaction rate post-otoplasty using the modified Stenström technique with a case series study. Methods Six patients were included in the study with a total of 12 ears operated on between February 2021 and July 2022. Utilizing the modified Stenström technique for bilateral protruding ears. All patients had six postoperative follow-up visits with fixed intervals; one week, three weeks, six weeks, three months, six months, and one year. During their one-year postoperative follow-up appointment, all patients completed thesatisfaction survey questions. Results Six individuals were studied, three males and three females with a mean age of 23.1 (range, 7-53 years old). There were no complications or recurrences observed. Based on the responses we collected, all patients reported a high satisfaction rate at one-year postoperative follow-up. Conclusion The modified Stenström technique yields good naturally appearing ears. It is an easy and safe technique to apply. It has a short recovery period, and no hospital stay is required. All contribute to a high satisfaction rate among studied patients.

Effectiveness of erector spinae plane block in children with pectus excavatum deformity during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex: a prospective randomized comparative study

BACKGROUND: Despite the widespread use of regional blocks in children, ensuring adequate perioperative pain control during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex remains a problem. The introduction of ultrasound navigation has allowed specialists to increasingly give preference to peripheral blockades; paravertebral anesthesia has proven to be effective in thoracic surgery. However, safer interfascial blocks, including erector spinae plane block, are rarely used in pediatrics, and there is no evidence base for the effectiveness of the method. OBJECTIVE: Our aim was to compare the effectiveness of erector spinae plane block with paravertebral blockade during minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex in children. MATERIALS AND METHODS: A prospective randomized comparative study of children who underwent minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex was conducted from September 2022 to April 2023. According to the inclusion criteria, the selected 39 children were divided into groups: I — paravertebral blockade, and II — erector spinae plane block. The mean arterial pressure, heart rate during the perioperative period stages, postanesthesia recovery by Aldrete scale and pain intensity by the Wong–Baker scale, and stress response markers (cortisol and lactate) were assessed. RESULTS: No significant differences were observed in the study groups when comparing mean arterial pressure and heart rate at any of the measurement points of the perioperative period (p 0.05). Further, no significant differences were noted between the groups when comparing cortisol and lactate levels (p 0.05). The awakening level was characterized by a short recovery period and did not differ between the groups (p 0.05). The intensity of pain during the observation period did not exceed 5 points on the verbal rating scale in both groups, and the severity of pain was significantly higher in the group with blockade of the erector spinae plane block only 2 hours after surgery (p 0.05).Postoperative nausea and vomiting were more common in children with erector spinae plane block (p 0.05). No other adverse events were recorded. CONCLUSION: Erector spinae plane block is an effective and simple method of regional anesthesia for minimally invasive thoracoplasty with osteosynthesis of the sternocostal complex and can be used as an alternative to paravertebral blockade in children.

Cutting-Edge Innovations in Minimally Invasive Techniques for Skin Cancer Treatment

Skin cancer is a common and possibly deadly disease that requires immediate and efficient treatment. Conventional surgical methods, although successful, frequently lead to the formation of scars and extended periods of recuperation. In recent years, there have been significant developments in minimally invasive treatments for treating skin cancer. These techniques provide patients with alternative options that result in better cosmetic outcomes and shorter recovery periods. This article is a comprehensive summary of state-of-the-art advancements in minimally invasive procedures, including as laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We analyze the benefits of these procedures, including minimized scarring, improved cosmetic outcomes, and faster healing periods, while also examining the difficulties and factors involved in their application. We showcase the concrete advantages that patients receive when they undergo minimally invasive therapy for skin cancer, using case studies and success stories as evidence. In addition, we examine potential future paths in research and development, anticipating a favorable outlook for the ongoing use of minimally invasive methods in the treatment of skin cancer. The global prevalence of skin cancer is a substantial health issue, leading to continuous progress in treatment strategies aimed at enhancing patient results. Conventional surgical techniques, however efficient, can lead to conspicuous scarring and extended recuperation periods. Recent advancements in minimally invasive procedures have significantly transformed the treatment of skin cancer, providing patients with alternative options that yield better esthetic results and shorter recovery periods. This article offers a comprehensive analysis of state-of-the-art advancements in minimally invasive procedures, encompassing laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We use case studies and success stories to demonstrate the concrete advantages that patients gain from these operations, such as minimized scarring and improved cosmetic outcomes. In addition, we explore the difficulties and factors to take into account when putting these methods into practice, along with potential areas for further investigation and advancement. Our goal is to emphasize the hopeful future of minimally invasive treatments in skin cancer care, which will ultimately enhance patient experiences and outcomes.

The temporal expression pattern of classical MHC class I in sleep-restricted mice: Generalizations and broader implications

The intricate relationship between sleep and leukocyte trafficking has garnered intense attention, particularly their homing dynamics to secondary lymphoid organs under normal and restricted sleep (SR). Considering the scarcity of information regarding circadian rhythms in major histocompatibility class I (MHC-I) expression in SR, we designed a study that assessed the temporal expression of MHC-I in murine lymph nodes and spleen and the subsequent effects of sleep recovery. Male C57BL/6, housed in 12:12 light/dark cycle, were grouped into control (C) and SR. SR was carried for one week before lymphoid tissues were sampled at selected time points and assessed for leukocyte number and MHC-I expression.SR resulted in 21% decrease in granulocyte and 24% increase in agranulocyte numbers.In C, MHC-I expression pattern in lymph nodes was bimodal and relatively higher than splenocytes during the animal’s active phase (110.2 ± 1.8 vs 81.9 ± 3.8, respectively; p = 0.002). Splenocytes; however, showed a bimodal pattern upon SR, with higher protein levels during the rest than the activity period (154.6 + 36.2 vs 99.5 + 15.9, respectively; p = 0.002), suggesting preparedness for a potential infection. Furthermore, SR caused a significant drop in MHC-I expression at the onset of rest with 57% and 30% reduction in lymph nodes and splenocytes, respectively. However, the overall protein expression collectively taken from both lymphoid tissues remained stable, emphasizing its indispensable role in immunological homeostasis. This stability coincided with the restoration of protein levels to baseline after a short sleep recovery period, resembling a reset for MHC-I antigen presentation following a week of SR.Understanding the interplay between MHC-I expression and contextual factors could enhance treatment protocols, refining the efficacy and time precision of glucocorticoid-based therapies in immune modulation.

Retroceso del glaciar del Carihuairazo y sus implicaciones en la comunidad de Cunucyacu

The retreat of glaciers is a reality throughout the Andes Mountain range, especially in low-altitude mountains. One of these cases is the loss of the remaining ice mass in Carihuairazo (Tungurahua, Ecuador), which in recent years has experienced a considerable retreat. This research aims to characterize the retreat of this glacier and its implications for the nearby community (Cunucyacu) through the application of a multi-source methodology, which includes the collection of glacier aerial photographs, data from nearby meteorological stations, the use of global climate reanalysis data, interviews with community members, and mountaineers who work and frequent the area. To characterize the glacier’s mass evolution, a hydroglaciological model was applied, using input data from meteorological series, and its parameters were calibrated with the photographic record of the glacier’s outline. The results show a glacier loss of 99% of its surface in 1956 (0.34 ) by 2021. The model successfully simulates the glacier area variation over 67 years, revealing a continuous decrease since 1978, with short periods of recovery and equilibrium, where temperature is the variable that best explains the glacier’s retreat. However, the model fails to consider the effect of external factors, such as the eruption of the Tungurahua volcano that could enhance the glacier retreat. The Carihuairazo glacier is in a situation of inevitable disappearance, highlighting the vulnerabilities of communities facing this phenomenon as a consequence of climate change.