Short Time Research Articles

Subconjunctival trypsin injection for anterior chamber fibrin exudates in eyes with globe rupture following vitrectomy

AIM: To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone (DEX) injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy. METHODS: A retrospective analysis included 42 males and 10 females (mean age 46.0±6.0y, range 34 to 58y) who underwent primary wound sutures and vitrectomy for globe rupture. Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated. On the first postoperative day, subconjunctival injections of either 5000 units (0.4 mL) of trypsin solution (n=25) or 0.5 mL (1 mg) DEX (n=27) were administered to accelerate exudate absorption. Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane. Safety and comfort were evaluated by monitoring intraocular pressure (IOP), allergy, pain, and foreign body sensation. RESULTS: Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane, but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group (P<0.05). Trypsin treatment was also less irritating to patients. No adverse reactions were reported, and IOP remained stable. Visual acuity improved in both groups without statistical difference. CONCLUSION: Compared to DEX, trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.

Comparison of the outcomes between ultrasonic devices and clamping in hepatectomy: a meta-analysis.

Recent advances in ultrasound technology have led to widespread adoption of ultrasonic energy devices in liver resections. While various studies have assessed the comparative advantages of ultrasonic devices and traditional clamp-crushing, their findings vary. Moreover, a specific systematic review on this topic has not yet been conducted. This study aims to present a comprehensive, up-to-date analysis comparing outcomes between ultrasonic devices and conventional clamp-crushing methods in liver resection, based on currently available literature. We conducted a systematic literature search in databases such as PubMed, Embase, Web of Science, and CNKI up to November 2023. Studies that compared the efficacy or safety of ultrasonic devices against traditional clamp-crushing methods in hepatectomy were included. The analysis covered intraoperative outcomes like operating time, blood loss, and transfusion rate, as well as postoperative outcomes such as complication rate, mortality, postoperative bleeding, and bile leakage. Review Manager version 5.3 (Cochrane Collaboration, Oxford, UK) and Stata 17.0 (Stata Corp, College Station, TX, USA) were used for data analysis. Thirteen studies, involving a total of 1,417 patients (630 using ultrasonic devices and 787 using clamp-crushing methods), were included. The clamp-crush method resulted in a shorter operation time. Contrarily, the ultrasonic device group experienced reduced blood loss and lower transfusion rates. Postoperatively, there was no significant difference in mortality or postoperative bleeding between the groups. However, the ultrasonic group had a lower overall complication rate, particularly a reduced incidence of bile leakage. Overall, the ultrasonic devices were associated with improved perioperative outcomes. The findings suggest that ultrasonic devices provide better outcomes in hepatectomy compared to traditional clamp-crushing techniques. Nonetheless, large-scale randomized controlled trials are needed to confirm these results due to potential heterogeneity and biases. The choice of using ultrasonic devices should consider the surgeon's experience and individual patient circumstances.

An Analysis and Comparison of the Hydrodynamic Behavior of Ships Using Mesh-Based and Meshless Computational Fluid Dynamics Simulations

This paper presents a comparison of two turbulence models implemented in two different frameworks (Eulerian and Lagrangian) in order to simulate the motion in calm water of a displacement hull. The hydrodynamic resistance is calculated using two open-source Computational Fluid Dynamics (CFD) software packages: OpenFOAM and DualSPHysics. These two packages are employed with two different numerical treatments to introduce turbulence closure effects. The methodology includes rigorous validation using a Wigley hull with experimental data taken from the literature. Then, the validated frameworks are applied to model a ship hull with a 30 m length overall (LOA), and their results discussed, outlining the advantages and disadvantages of the two turbulence treatments. In conclusion, the resistance calculated with OpenFOAM offers the best compactness of results and a shorter simulation time, whereas DualSPHysics can better capture the free-surface deformations, preserving similar accuracy.

Electrochemical Reactions Affected by Electric Double Layer Overlap in Conducting Nanopores.

When a potential is applied to an electrode immersed in an electrolyte solution, ions with opposite charges accumulate around the electrode, forming an electrical double layer (EDL). Unlike flat electrodes, nanoporous electrodes with pore sizes comparable to the EDL thickness experience overlapping EDLs, altering the electrochemically effective surface area. Although previous research has primarily examined the ion charging dynamics and EDL formation in nanoporous electrodes, the impact of EDL overlap on Faraday reactions remains underexplored. In this study, we examined the influence of EDL overlap on electrochemical reactions within nanoporous electrodes using chronoamperometry and DC and AC voltammetry. We used the electrolyte concentration, measurement duration, overpotential, and electrode material as variables to determine the relationship between the extent of EDL overlap and the electrochemical reaction. The electrolyte concentration-dependent electrochemical reaction due to the EDL overlap was more pronounced for electrodes with faster potential changes, shorter measurement times, lower overpotentials, and slower catalytic activity. This is a unique nanoporous electrochemical phenomenon that is not observed on flat electrodes. These findings provide insight into the utilization of nanoporous electrodes in catalytic and sensor applications.

Comparison of the smiley face rod method versus intervertebral fusion for the treatment of L5 spondylolysis in adults

PurposeFor patients who suffered from L5 spondylolysis and fail to improve using conservative treatment, the best surgical strategy remains controversial. This study compares the efficacy of the treatment of L5 spondylolysis using the smiley face rod (SFR) method versus intervertebral fusion (IF).MethodsWe analyzed 38 patients with L5 spondylolysis who underwent surgery in our department between January 2017 and June 2019. Of these, 32 patients were included in our study: 14 patients in the SFR group and 18 patients in the IF group. The operation time, intraoperative blood loss, postoperative drainage time, length of stay and postoperative complications were compared. The pain visual analog scale (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 3 months, 6 months, and 1 year postoperatively. The changes in range of motion (ROM) in L4/5 and L5/S1 in these two groups before and after surgery were measured through imaging examinations and the bone graft fusion rate was assessed according to the Brown standard.ResultsThe operation time of the SFR group was much shorter than that of the IF group (98.8 ± 8.3 vs. 113.8 ± 8.6 min, P < 0.05), and the blood loss of the SFR group was significantly lower than that of the IF group (90.0 ± 43.9 vs. 175.0 ± 81.2 ml, P < 0.05). Length of stay in the SFR group was less than that of the IF group (9.5 ± 2.5 vs. 12.6 ± 3.2 d, P < 0.05). No difference was found in the VAS and ODI scores between the two groups at 3 months, 6 months, and 1 year after surgery. In the IF group, the ROM in L4/5 showed an obvious increase after surgery compared to that before surgery, and it was much bigger than that of the SFR group (P < 0.05). A notable reduction of ROM was seen in L5/S1 in the IF group compared to the SFR group (P < 0.05). The fusion rate of the isthmus in the SFR group was 79% at 3 months and 86% at 6 months after surgery. In the IF group, one patient suffered from adjacent segment degeneration (ASD), which caused compression symptoms in the lower extremity, and one patient suffered from an internal fixation fracture; these complications were not seen in the SFR group.ConclusionThe SFR and IF both improve the clinical symptoms and quality of life of patients with L5 spondylolysis. However, the SFR technique had the advantages of a shorter operation time and less blood loss than IF; it could also preserve the ROM of the surgical segment and had little influence on adjacent segments in short-term follow-ups.

Comparison of clinical outcomes, complications and patient satisfaction following deep anterior lamellar keratoplasty and penetrating keratoplasty.

Keratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia. This retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher's exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05. A total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures. The findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

The digitalization of emergency department triage: the perspectives of health professionals and patients.

Digitalization in the healthcare sector offers several organizational advantages, ranging from enhanced service quality to cost savings. However, its adoption often progresses slowly and faces challenges, especially in critical settings like emergency departments, requiring prompt, clear, and efficient communication. As such, this study aims to comprehensively assess the factors influencing the preference for digitalized tools over traditional methods from the perspectives of both service providers and users. We employ two ad hoc stated preference surveys in which we ask respondents to reveal their preference in simulated triage scenarios. Three main alternatives are proposed: traditional procedures, a fully digitalized solution with no direct patient-professional interaction, and a hybrid option that combines traditional and digital aspects. Scenarios and alternatives vary according to predetermined attributes, selected among the features acknowledged to impact the triage efficiency and efficacy: the possibility to communicate in a known language, the completeness of information retrieved from the patient, the time dedicated to triage activity, and the level of privacy. Responses are analyzed by means of discrete choice models. Our findings reveal a preference for the hybrid approach, wherein patients use digital tools to input relevant information, followed by an interview with healthcare professionals. Nevertheless, distinct alternative- and case-specific features can favor the preference toward other kinds of triage. Respondents prefer shorter triage times and the opportunity to interact in a known language, while the level of privacy does not significantly impact their choices. Interestingly, the presence of an algorithm assigning urgency code diminishes the probability that healthcare professionals select the fully digitalized option. This study provides important insight into the utilization of digital tools in emergency departments. The results can be used by hospital managers and policy makers to develop digital tools that meet the needs of both users and healthcare professionals. This, in turn, may result in cost savings and improved quality of service.

Transradial versus transfemoral access for mechanical thrombectomy: A single institution experience.

There has been debate in the literature regarding the adoption of a "radial-first" approach for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Conflicting reports suggest that transradial access (TRA) may allow for shorter times to reperfusion while others conclude that long-term functional outcomes may favor transfemoral access (TFA). Here, we report a single-institution experience with the adoption of TRA as the primary route for acute stroke intervention. We retrospectively reviewed a single-institution database of patients undergoing MT for AIS from March 2020 to April 2023. This time period was selected to capture the change in clinical practice at our institution from TFA to TRA. Primary and secondary outcomes included technical success, procedural complications, and long-term functional outcomes. Patients were stratified into two cohorts from initial access. Cohorts were compared utilizing inferential statistics. A total of 192 consecutive cases were identified, with 80 in the TFA cohort and 112 in the TRA cohort. There was no difference in outcomes with respect to time from puncture to recanalization, rates of successful recanalization (TICI ≥ 2b), number of passes, rates of symptomatic intracranial hemorrhage (sICH), modified Rankin scale (mRS) at discharge and 90 days, and 90-day mortality (p ≥ 0.05, all). The TRA had a higher rate of access conversion (p < 0.001), while the TFA cohort had a higher rate of access site complications (p < 0.05).

Impact of serial clinical swallow evaluations and feeding interventions on growth and feeding outcomes in children with long-gap esophageal atresia after anastomosis: a retrospective cohort study.

Children undergoing surgical anastomosis for long-gap esophageal atresia (LGEA) often suffer from complications related to delayed oral feeding, which may impair their early development. Clinical swallow evaluation (CSE) is an effective technique to improve feeding outcomes. However, there are limited evidences on the application of CSE in these children. Since 2020, serial CSEs have been consistently implemented for children undergoing anastomosis for LGEA in our hospital. We conducted a retrospective study comparing 19 children who received CSE with 31 historical controls who did not. Inverse probability of treatment weighting (IPTW) was applied to balance preoperative characteristics. We compared the time from surgery to full oral feeding and the rate of postoperative complications between the two groups. Growth curves for length-for-age Z score (LAZ) and weight-for-age Z score (WAZ) up to age 3 were fitted using generalized additive mixed models. The median time to full oral feeding was 1.1months [interquartile range (IQR), 0.8-2.4] in the CSE group and 1.5months (IQR, 0.6-5.7) for controls. After IPTW, CSE was associated with a shorter time to full oral feeding, with a weighted hazard ratio of 2.26 [95% confidence interval (CI), 1.21 to 4.24]. LAZ growth curves significantly differed between groups (P = 0.001). CSE was associated with the expedited achievement of full oral feeding and a more favorable growth pattern before 3years of age.

High 11-ketotestosterone linked to shorter time to castration resistance in recurrent non-metastatic prostate cancer.

The contribution of 11-oxygenated androgens to the progression of lethal prostate cancer (PCa) remains unresolved. We hypothesized that evaluating circulating levels of 11-oxygenated androgens, such as the androgen receptor agonist 11-ketotestosterone (11KT), could serve as a potential predictor of the onset of castration resistant prostate cancer (CRPC). We used mass spectrometry to quantify 11-oxygenated androgens in post-operative plasma samples acquired from 145 patients who subsequently received androgen deprivation therapy (ADT) for biochemical recurrence (BCR) and achieved castrated testosterone (T) levels. Kaplan-Meier survival analyses and multivariable Cox models were used to investigate relationships between steroids and CRPC. Of 145 patients, 31 developed CRPC with a median time to CRPC of 57 months. 11-oxygenated androgens levels were unaffected by ADT, which stands in contrast to the observed changes in T and other steroids. 11KT was the most abundant androgen but was not linked to clinical features. Kaplan-Meier analysis revealed that 11KT levels above the median of 273 pg/mL were associated with a shorter time to CRPC (P = 0.03). In multivariable analyses, this was supported with an adjusted hazard ratio of 2.17 (95% confidence interval (CI) 0.99-4.71; P = 0.05). 11KT is a key component of the hormonal profile predictive of earlier onset of CRPC. Enhancing our understanding of the specific role of 11KT in the progression to CRPC could help optimize hormonal therapy for castration sensitive PCa and CRPC patients.

Prior metabolic and bariatric surgery is an independent determinant of severity of decompensation in alcohol-associated liver disease.

Patients with a history of metabolic and bariatric surgery (MBS) are susceptible to developing alcohol use disorder, potentially resulting in end-stage liver disease, with a paucity of data on the evolution of cirrhosis. Our aim was to describe the demographics and mortality in hospitalizations over time in individuals diagnosed with cirrhosis due to alcohol-associated liver disease (ALD) in relation to prior MBS. We included patients hospitalized at the Ghent University Hospital between 1/1/2010 and 01/09/2023 with cirrhosis due to ALD. Data were retrieved retrospectively from all hospitalizations. 46/275 (16.7%) of individuals with cirrhosis admitted with ALD had a history of MBS; they were predominantly female (76.1%), in contrast to the non-MBS population (29.7%) (p<0.0001) and were significantly younger at the time of diagnosis (46 vs. 58years, p<0.0001). Liver disease evolved at a faster pace in the MBS group with a shorter time to first hospitalization (5 vs. 13months, p=0.036), and consecutive hospitalizations. The proportion with primary hospitalization due to acute-on-chronic liver failure (ACLF) was significantly larger in the MBS group (60.9% vs. 27.6%, p<0.0001), and throughout the following hospitalizations, ACLF remained more prevalent in the MBS group. Modeled transplant-free survival was lower in the MBS group (p=0.004), with ACLF as the main cause of death. The weekly amount of alcohol consumed during drinking periods and duration of use were significantly lower in the MBS group. MBS patients hospitalized with ALD develop acute decompensation at a faster pace, with more overall ACLF hospitalizations, and higher cumulative mortality, despite being 12years younger on average. Not applicable.

Relative Factor Analysis of Postoperative Complications in Infants Below 1 Year Undergoing Repair of Ventricular Septal Defect Combined with Other Procedures through a Right Axillary Incision

Background: Compared to the traditional surgical repair of isolated ventricular septal defects, the proportion of complex congenital heart diseases has been increasing due to advancements in diagnostic capabilities and surgical techniques. Concomitant surgeries to correct multiple congenital heart diseases have become the preferred choice. Therefore, the evaluation of the safety of the combined correction of ventricular septal defects with other cardiac anomalies in young children through a right axillary incision and the analysis of related factors of perioperative complications needs to be investigated. Methods: A retrospective study was conducted on a single-center patient sample from January 2018 to December 2022 to compare outcomes between infants undergoing isolated ventricular septal defect (VSD) repair via a right axillary thoracotomy (control group) and those undergoing VSD repair combined with other cardiac procedures (experimental group). Results: A total of 397 eligible infants were included. After baseline data were matched using propensity score matching, the experimental group (n = 181) and the control group (n = 107) showed no significant differences in intraoperative blood loss, postoperative total drainage, length of hospital stay, duration of ICU monitoring, Vasoactive-Inotropic Score (VIS), pre-discharge left ventricular ejection fraction, fractional shortening (FS), postoperative severe pulmonary infection, reoperation, mortality, postoperative atrioventricular block, chylothorax, cardiac arrest, pericardial effusion, pneumothorax, pulmonary atelectasis, tricuspid regurgitation, myocardial injury, abdominal effusion, and metabolic acidosis. However, the control group had shorter surgical time [28.00 (90.00, 196.00) vs. 140.00 (95.00, 658.00) min, p &lt; 0.05], shorter cardiopulmonary bypass time [58.00 (24.00, 114.00) vs. 66.00 (33.00, 422.00) min, p &lt; 0.05], shorter aortic cross-clamp time [32.00 (17.00, 62.00) vs. 37.00 (15.00, 142.00) min, p &lt; 0.05], and shorter postoperative mechanical ventilation time [22.00 (0, 99.00) vs. 23.00 (3.00, 193.00) h, p &lt; 0.05]. The rate of abdominal effusion was lower in the experimental group than in the control group (p = 0.044). In the analysis of postoperative complication-related factors, the preoperative grade of tricuspid regurgitation, postoperative mechanical ventilation time, and VIS were positively correlated with abdominal effusion and satisfied the variable (p &lt; 0.05) in each of three established models. In the single-factor analysis, both VIS and preoperative lymphocyte count were (p &lt; 0.1) related to pericardial effusion; however, in the multi-factor analysis, only VIS met the threshold (p &lt; 0.05). Gender, height, and VIS were each associated with pleural effusion (p &lt; 0.05). Conclusion: The combination of ventricular septal defect repair with other cardiac procedures via a right axillary thoracotomy did not significantly differ from isolated VSD repair in terms of postoperative complications, monitoring, and length of hospital stay. However, increased surgical complexity was associated with longer surgical and mechanical ventilation times. Factors such as tricuspid regurgitation severity, duration of postoperative mechanical ventilation, and VIS were identified as relative factors for postoperative effusion. Additionally, the risk of postoperative pericardial effusion increased with higher VIS, while gender, height, and VIS were identified as relative factors for postoperative chylothorax.

Extent of abscess development in cervical abscesses and pathogenic bacteria related to swallowing function

Background Deep neck infections (DNIs) in the cervical fascial planes can cause severe complications such as airway obstruction, mediastinitis, and sepsis. Aims/objectives This study examines cervical abscess development, its relationship with postoperative swallowing function, and hospital stay duration. Material and methods A retrospective case series of 55 DNI patients was divided by hospital stay (<30 days: Group A, ≥30 days: Group B) and swallowing recovery (<6 days: Group C, ≥6 days: Group D). Swallowing was assessed using FOIS; abscesses were categorized via CT and surgery. Results Longer hospital stays (Group B) were associated with tracheostomy (p = .027) and thoracoscopic mediastinal drainage (p = .038), shorter time between symptom onset and surgery (p = .016), and abscesses in the anterior cervical (p = .007), retropharyngeal space (p = .026), and mediastinal spaces (p = .002). Dysphagia (Group D) was linked to longer hospital stays (p = .006), more abscesses in the anterior cervical (p = .049) and retropharyngeal spaces (p = .009), and higher cases of intubated feeding (p < .001). Streptococcus constellatus was more prevalent in Group D (p = .04), whereas Staphylococcus aureus was less common (p = .043). Conclusions and significance Dysphagia is associated with abscesses in the anterior cervical and retropharyngeal spaces and higher Streptococcus constellatus prevalence, indicating delayed oral intake recovery. Thoracoscopic mediastinal drainage and shorter time to surgery were linked to prolonged hospital stays.

BN SO43 - The impact of dedicated “hot cholecystectomy lists” on rates of early cholecystectomy and its outcomes

Abstract Background Surgical management of gallstone disease is evolving with NICE guidelines emphasising on early cholecystectomy following an index admission with biliary symptoms. Despite an attempt at adhering to these recommendations, many centres find operating theatre capacity as a potential significant constraint to offer a same admission or early cholecystectomy. We assess the impact of a dedicated theatre capacity provided by a specialist upper gastrointestinal surgical team on rates of early cholecystectomy and its outcomes. Method A pathway for patients presenting with symptomatic gallstone disease was designed and implemented trust wide, with two theatre lists per week dedicated to performing “hot cholecystectomies”. Retrospective analysis was performed from a prospectively maintained database of patients with symptomatic gallstone disease admitted to a district general hospital over two equal (30 days) but chronologically independent time periods. Data was collected from prior and after service reconfiguration and analysed with descriptive statistics. Results 19 patients (F:M ratio 0.82:1) were referred for the consideration of receiving a hot cholecystectomy. Nine of the 12 patients (75%) who were deemed to be suitable as per NICE guidelines underwent a cholecystectomy within the recommended time frame. There was a significant difference in the number of admissions over the two time periods with a shorter time from index admission to surgery (median 62 days to 5 days (P&amp;lt;0.01)); with correspondingly fewer re-admissions from 14 to 2 (P&amp;lt;0.01) following service reconfiguration. Conclusion With adequate theatre resources together with surgical expertise, early laparoscopic cholecystectomy can be proved to be an effective and sustainable model for the management acute biliary disease. Continue ahead, we aim to improve our computer-based referral system which will be better suited to record referrals, and the patient pathway. This data will be developed into a dashboard, thereby keeping a contemporaneous record of acute admissions and their management; subsequently improving the number and quality of referrals.

HPB SO19 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEONTM stapler

Abstract Background In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUSTM liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA). Method January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUSTM ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEONTM endovascular stapler was used from early 2021. Results 86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEONTM stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEONTM demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295). Conclusion The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEONTM endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.

VS 10 - HPB Pancreas preserving total duodenectomy, How I do it

Abstract Background Patients with duodenal polyps particularly patients with familial adenomatous polyposis syndrome (FAP) are at increased risk of developing duodenal cancer. Pancreas preserving total duodenectomy is an alternative to pancreaticoduodenectomy. Advantages over pancreaticoduodenectomy include: shorter operative time, fewer and safer anastomoses, allowing future endoscopic surveillance and preserving the entire pancreas with both exocrine and endocrine functions. The complication rate is comparable if not fewer than pancreaticoduodenectomy. Here, we present our standardised operative technique for this procedure. Method This a video presentation of the technique of this novel procedure. The video has been edited with added narrative comments on the different steps of the procedure. Results This is a video presentation of the technique of pancreas preserving total duodenectomy in a patient with familial adenomatous polyposis syndrome to treat Spiegelman IV duodenal polyps. Conclusion The PPTD provides a feasible and probably favourable if not better alternative to classical pancreaticoduodenectomy particularly in patients with FAP syndrome.

Decompression and reconstruction the spinal TB lesion of a single vertebra through thoracoscopy alone or combined with foraminal endoscopy.

This study aimed to compare the clinical efficacy of thoracoscopy combined with transforaminal endoscopy and thoracoscopy alone in the treatment of thoracic tuberculosis. Patients with thoracic tuberculosis who visited our hospital from February 2018 to October 2022 were retrospectively analyzed. The patients were divided into thoracoscopic combined transforaminal endoscopic surgery group (group A) and thoracoscopic surgery alone group (group B) according to the surgical methods. Surgery-related information, VAS score, ODI score, degree of spinal cord function improvement, fusion time, and progression of kyphotic deformity were compared. A total of 37 patients were included, 16 in group A and 21 in group B. Postoperative follow-up time was 10-48 months, with an average of 28.62 ± 10.53 months. All patients had significant improvement in chest and back pain and spinal cord function after the operation. There were statistical differences in operation time, intraoperative blood loss, incidence rate of complications, and JOA score at 1 week and 3 months after operation between the two groups (P<0.05). There was no significant difference in VAS, ODI score, kyphotic angle correction, kyphotic correction loss angle, postoperative drainage volume, and fusion time between the two groups (P>0.05). All patients had no recurrence of thoracic tuberculosis during follow-up. Thoracoscopy combined with transforaminal endoscopy produce equivalent long-term results with shorter operation time, less intraoperative blood loss, less complications and higher surgical safety comparing to thoracoscopy alone. And thoracoscopy combined with transforaminal endoscopy can fully decompress and facilitate the early recovery of spinal cord function.

Polyurethanes Made with Blends of Polycarbonates with Different Molecular Weights Showing Adequate Mechanical and Adhesion Properties and Fast Self-Healing at Room Temperature

Dynamic non-covalent interactions between polycarbonate soft segments have been proposed for explaining the intrinsic self-healing of polyurethanes synthesized with polycarbonate polyols (PUs) at 20 °C. However, these self-healing PUs showed insufficient mechanical properties, and their adhesion properties have not been explored yet. Different PUs with self-healing at 20 °C, acceptable mechanical properties, and high shear strengths (similar to the highest ones reported in the literature) were synthesized by using blends of polycarbonate polyols of molecular weights 1000 and 2000 Da (CD1000 + CD2000). Their structural, thermal, rheological, mechanical, and adhesion (single lap-shear tests) properties were assessed. PUs with higher CD1000 polyol contents exhibited shorter self-healing times and dominant viscous properties due to the higher amount of free carbonate groups, significant carbonate–carbonate interactions, and low micro-phase separation. As the CD2000 polyol content in the PUs increased, slower kinetics and longer self-healing times and higher mechanical and adhesion properties were obtained due to a dominant rheological elastic behavior, soft segments with higher crystallinities, and greater micro-phase separation. All PUs synthesized with CD1000 + CD2000 blends exhibited a mixed phase due to interactions between polycarbonate soft segments of different lengths which favored the self-healing and mobility of the polymer chains, resulting in increased mechanical properties.

Association between physical activity patterns of working-age adults and social jetlag, depressive symptoms, and presenteeism.

This study aimed to evaluate the association of physical activity with social jetlag, depressive symptoms, and presenteeism. This cross-sectional study included 8,247 working-age adults (females, 44.6%; age, 20-64 years). Social jetlag was defined as the absolute difference between the midpoint of bedtime and wake time on workdays and free days. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and presenteeism was evaluated using the Work Functioning Impairment Scale. Exercise habits were classified into four groups based on the World Health Organization guidelines: non-active (NA; n=4,223), insufficiently active (IA; n=3,009: exercise below guideline levels), weekend warriors (WW; n=220: exercise 1-2 times per week meeting guideline levels), and regularly active (RA; n=793: exercise at least 3 days per week meeting guideline levels). Using multiple and Poisson regression analyses, we examined the association between exercise habits and each outcome. Social jetlag, depression, and presenteeism were more favorable with shorter sedentary times and longer durations of moderate- and vigorous-intensity exercise. Compared with the RA group, the NA group had a significantly higher prevalence of social jetlag (prevalence ratio [PR]=1.30), depression (PR=1.31), and presenteeism (PR=1.35). The IA group had a significantly higher prevalence of depression (PR=1.33) and presenteeism (PR=1.38). Exercising with a certain frequency and intensity may help prevent symptoms of depression and social jetlag, and consequently prevent presenteeism.

BS SO03 - Revisional bariatric surgery following sleeve gastrectomy, a meta-analysis comparing RYGB and OAGB

Abstract Background The number of bariatric operations is on the rise each year. Sleeve gastrectomy is the most popular procedure however often requires a revision surgery because of insufficient weight loss, weight regain or GERD. The most popular procedures are RYGB and OAGB. Our primary outcome was to look at the effect on weight loss in patients undergoing revision surgery and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak Method A systematic electronic search was undertaken using PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ according to PRISMA. Initial search identified 2,546 articles, after screening seven papers met the inclusions criteria, six retrospective studies and one RCT. Results There were a total of 802 patients that fit the inclusion criteria. 390 patients had a OAGB and another 412 had a RYBG. All patients previously had sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in %EWL between OAGB and RYGB (p=0.11). The incidence of post-operative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p&amp;lt;0.003). Operative time was statistically significantly lower in the OAGB group (p=0.04). Conclusion Our meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedure for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GERD while OAGB had a significant shorter operative time.