Short Time Research Articles

Procedural outcomes of the transradial versus transfemoral approach for diagnostic cerebral angiograms according to BMI: a propensity score-matched analysis.

BMI has been shown to affect choice of access site in coronary intervention procedures, with lower complications reported during transradial (TR) access. To the authors' knowledge, the effect of BMI on outcomes in patients undergoing diagnostic cerebral angiography remains undescribed. This study compares outcomes for BMI subgroups based on access site (TR vs transfemoral [TF] access). The authors conducted a single-center retrospective study of patients who underwent diagnostic cerebral angiography between December 2019 and January 2024. Propensity score matching was used to create two similar cohorts (TR and TF). These cohorts were subdivided based on BMI: underweight (BMI < 18.5), normal (BMI 18.5-25.0), overweight (BMI 25.1-29.9), and obese (BMI ≥ 30). Linear regression analysis and the chi-square test were used to compare outcomes. Nine hundred thirty-six patients were stratified into two groups of 468 patients each. Procedure time was significantly shorter for TR access for all BMI subgroups, with a 13-minute reduction in procedure time among underweight patients. Patients with normal BMI, overweight patients, and obese patients experienced a reduction in procedure time of approximately 11, 10, and 13 minutes, respectively. Obese patients experienced significantly shorter length of stay (LOS; 1.33 days) with TR access. There were no significant differences between each BMI subgroup in access site complications, postoperative complications, and conversion of access from TR to TF. TR access in diagnostic cerebral angiography is associated with shorter procedure times and no increased risk of complications compared to TF access across all BMI subgroups. Obese patients experienced shorter LOS with TR access. This study adds to the literature on the safety and efficacy of TR access across all BMI subgroups. Further studies are necessary to validate these preliminary results.

Feasibility and Improved Diagnostic Yield of Intracoronary Adenosine to Assess Microvascular Dysfunction With Bolus Thermodilution.

Bolus thermodilution and intravenous adenosine are established methods for coronary microcirculatory assessment. Yet, its adoption remains low, partly due to procedural time and patient discomfort associated with intravenous adenosine. We investigated differences between intracoronary and intravenous adenosine using bolus thermodilution in terms of microcirculatory indices, procedural time, and side effects associated with adenosine in patients with myocardial ischemia and nonobstructive coronary arteries. In this prospective, observational study, 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries underwent measurements of mean transit time, coronary flow reserve, index of microcirculatory resistance, procedure time and patient tolerability with low-dose intracoronary adenosine, high-dose intracoronary adenosine (HDIC), and intravenous adenosine. HDIC induced greater hyperemia compared with low-dose intracoronary IC adenosine and intravenous adenosine with a shorter hyperemic mean transit time, P<0.0001. Coronary flow reserve was higher and index of microcirculatory resistance lowest with HDIC, compared with low-dose intracoronary IC adenosine and intravenous adenosine, P<0.05. Low coronary flow reserve was downgraded from 21% with intravenous adenosine to 10% with HDIC adenosine (P=0.031); high index of microcirculatory resistance was downgraded from 23% with intravenous adenosine to 14% with HDIC (P=0.098). Intracoronary adenosine was associated with lower procedural times (P<0.0001). More patients experienced chest pain with intravenous adenosine (P<0.01) and the chest pain intensity was higher compared with intracoronary adenosine (P<0.0001). In patients with suspected myocardial ischemia and nonobstructive coronary arteries undergoing coronary microcirculatory assessment with bolus thermodilution, the use of HDIC compared with intravenous adenosine was associated with enhanced induction of hyperemia. The use of intracoronary adenosine allowed for a shorter procedure time and was better tolerated. URL: clinicaltrials.gov; Unique Identifier: NCT04827498.

Combined Laparoscopic Cholecystectomy and Transcystic Common Bile Duct Exploration for Choledocholithiasis

Abstract Background: There is no consensus on the ideal approach for managing patients with common bile duct (CBD) stones. The combined approach is less popular, possibly due to the complexity of the surgical technique and the availability of choledochoscope. Aim: We aim to assess the safety and feasibility of transcystic (TC) CBD exploration using the flexible bronchoscope for choledocholithiasis. Methods: Forty patients with symptomatic calculus gallbladder with concomitant CBD stones were randomized into two groups. Single-session laparoscopic cholecystectomy (LC) and laparoscopic TC CBD exploration were performed for one group using the flexible bronchoscope. Endoscopic retrograde cholangiopancreatography followed by LC after 4–6 weeks was conducted for the other group. Results: Twenty patients were randomized to each group. The clearance rate of CBD stones was significantly higher in the single-session Group A (95%) than in the two-session Group B (70%). Group B was associated with a significantly prolonged operative (P = 0.01). The total hospital stay and operative time were significantly longer in Group B than in Group A (P = 0.004). There was no significant difference between both groups regarding the intraoperative or postoperative complications. Conclusion: Combined LC and TC CBD exploration is a safe and feasible approach and is associated with significantly shorter operative time and length of hospital stay.

A Prospective Observational Study to Evaluate the Effectiveness of Platelet-Rich Plasma Therapy for Complex Wounds: Influential Clinical Variables on Wound Healing Outcomes.

Objective: Autologous platelet-rich plasma (PRP) has shown promising outcomes in treating wounds, but the profile of patients benefiting most from this therapy is not known. This study aimed to identify influential variables in the success of this therapy, analyzing its personalized therapeutic potential for complex wounds. Approach: A prospective observational study was conducted in elderly patients with complex wounds receiving autologous PRP. Patient's data about sociodemographic parameters, comorbidities, frailty (FI-VIG score), complete blood count including albumin, wound depth, location, chronicity, and etiology were collected at the beginning of the study. The wound area was monitored weekly. The data were analyzed using descriptive and inferential statistics, longitudinal data analysis, and survival analysis. Results: Ninety-seven elderly patients were included. The FI-VIG, baseline wound area, depth, and etiology were significantly correlated with wound outcome. Strong differences in wound area variation from treatment initiation were observed in healed wounds (13% reduction/week) compared with stagnant and complicated wounds (1 and 2% reduction/week, respectively). The healing time analysis showed that nearly 80% of patients required at least 15 weeks for complete healing. In addition, patients with smaller wound sizes, younger age, or lower FI-VIG scores had shorter healing times. Innovation: This is the first study that identifies prognostic indicators for wound outcomes to guide clinician decision-making for using autologous PRP. It also highlights the relevance of patient health baseline and wound features and evolution for the success of this therapy. Conclusion: This study demonstrates that personalizing autologous PRP therapy to treat complex wounds in elderly patients is possible.

Effect of Lidocaine on Ciprofol Dosage and Efficacy in Patients Who Underwent Gastroscopy Sedation.

BACKGROUND Intravenous ciprofol is a short-acting sedative with minimal respiratory and circulatory suppression and limited analgesia. Intravenous lidocaine provides analgesia during surgical procedures. This study included 70 patients who underwent gastroscopy with analgesia and aimed to evaluate the effects of intravenous lidocaine on the dose of ciprofol required to produce 50% of the maximal effect (ED50). MATERIAL AND METHODS Seventy patients scheduled for elective painless gastroscopy were randomly assigned into 2 groups: group L (n=35, received ciprofol and 1.5 mg/kg lidocaine) and group S (n=35, received ciprofol and normal saline). The primary outcomes measured were the ED50 and the 95% effective dose (ED95) of ciprofol, determined using the modified up-down sequential method and Probit analysis. Secondary outcomes included induction, operation, and recovery times; monitoring of vital signs such as mean arterial pressure, heart rate, and oxygen saturation; and evaluation of postoperative adverse reactions, including sore throat, nausea, vomiting, abdominal pain, and satisfaction scores from endoscopists and anesthesiologists. RESULTS The ED50 of ciprofol in group L was 0.315 mg/kg (95% CI, 0.291-0.342 mg/kg), which was significantly lower than that in group S, 0.42 mg/kg (95% CI, 0.371-0.491 mg/kg). Additionally, group L exhibited shorter induction and recovery times, a lower incidence of postoperative sore throat, and a temporary drop in blood pressure following induction. CONCLUSIONS Intravenous lidocaine during painless gastroscopy reduces the required ciprofol dose, shortens induction and recovery times, and lowers the incidence of postoperative complications, such as sore throat. These findings support its effective role in improving sedation quality and patient outcomes during gastroscopy.

Temperature guided high and very high-power short duration ablation for atrial fibrillation treatment - The peQasus multicentre study.

Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective and faster procedures. The peQasus study is a large European multicenter study set up to assess safety, acute efficacy and outcomes of temperature-controlled HPSD based PVI. The primary endpoints were safety, efficacy and 12-months freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90W for 4 seconds) only and a hybrid approach (HPSD with maximum of 50W and vHPSD) were compared. A total of 1,023 AF patients in 15 centers from 9 European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%) the vHPSD only approach (vHPSD group) and in 324/(31.7%) patients the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4±37.4 min (vHPSD: 88.2±34.9min, hybrid: 117.4±32.7min, p<0.001). The first pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, p=0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, p=0.746). 12-month arrhythmia-recurrence free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, p=0.241). In this large multicentre study temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time no differences in terms of safety and freedom from arrhythmia-recurrence were found irrespective of utilizing vHPSD or the hybrid approach.

Improving the Measurement of Gender in Surveys: Effects of Categorical Versus Open-Ended Response Formats on Measurement and Data Quality Among College Students

Abstract While researchers have some recommendations for measuring gender identity in surveys based on research and other sources that are summarized in a series of working group and panel reports, we continue to refine our understanding and practices. Gender identity is usually measured in surveys using a categorical selection response format with a small number of response options (e.g., “female,” “male,” “nonbinary”) and an open text response field to capture additional responses (“not listed, please tell us”). There is limited research guiding researchers on the use of other response formats. This study reports results from a between-subjects experiment embedded in a campus climate survey about university students’ attitudes about their campus and their behaviors and experiences related to inclusion and belonging at a large Midwestern university in 2021. Over 13,000 students were asked “What is your gender?” and subsequently randomly assigned to respond using either a categorical selection response format or an open response format (i.e., a place to specify their gender with no response options listed). We examine the distribution of responses, item nonresponse, response times, and concurrent validity (in terms of the association between gender and relevant survey outcomes) across the two response formats. Findings indicate the categorical selection response format is preferred for this population. While results show similar distributions in the categorization of responses across the formats and similar relationships with other survey outcomes, the selection format is associated with less item nonresponse and shorter response times.

The Power of Thermosonication on Quality Preservation and Listeria Control of Blueberry Juice

Due to the increasing consumer demand for healthy, beneficial foods, natural fruit juices have gained popularity for their rich nutritional value and appealing flavor. However, traditional thermal processing can compromise these quality attributes. This study investigates using pulsed thermosonication, a novel mild thermal processing method, on Listeria innocua inactivation in blueberry juice, chosen for its high phenolic and anthocyanin content. Ultrasonication was applied at 60% and 100% amplitudes combined with heat treatments at 45 °C and 55 °C and compared to control heat treatments. The Weibull model effectively described the inactivation kinetics, showing that the thermosonicated samples required significantly shorter times (1 and 25 min) for a 5-log reduction compared to the heated samples (10 and 60 min). While pH, total soluble solids, and water activity remained unaffected, color parameters improved, and the best retention of phenolics and anthocyanins was observed at 100% amplitude and 45 °C. Rheological properties were unchanged. The findings demonstrate that thermosonication at milder temperatures is more effective than conventional heat treatment for microbial inactivation and quality retention in blueberry juice, suggesting it is a superior processing method for preserving fruit juices’ nutritional and sensory attributes.

Significance of the local largest bipolar voltage for the optimized ablation strategy using very high-power short duration mode.

Very high-power short-duration (vHPSD) ablation creates shallower lesions, potentially reducing efficacy. This study aims to identify factors leading to insufficient lesions during pulmonary vein antral isolation (PVAI) with vHPSD-ablation and to develop an optimized PVAI strategy using this technology. PVAI was performed on 41 atrial fibrillation patients using vHPSD-ablation (90 W/4 s). Lesion parameters were recorded and analyzed to identify predictors of insufficient lesions. An optimized PVAI strategy, based on these predictors, was tested in subsequent 42 patients. In total, 3099 RF-applications, including 103(3.3%) insufficient lesions, were analyzed. First-pass PVAI was achieved in 19/40(47.5%) right PVs and 24/41(58.5%) left PVs. Multivariate analysis identified significant predictors of insufficient lesions: local largest bipolar voltage (Bi-V), average contact force, baseline impedance, impedance drop, temperature rise, inter-lesion distance (ILD), and anatomical location (carina or not). An ILD:4-6 mm increased the risk of insufficient lesions 2.2-fold, and lesions at the carina increased it 3.6-fold for both ILD < 4 mm and ILD:4-6 mm. Local largest Bi-V was the strongest predictor for insufficient lesions. The optimized PVAI approach, utilizing vHPSD-ablation with an ILD < 4 mm in non-carinal areas with Bi-V < 4 mV, and high-power ablation-index guided ablation (HPAI, 50 W, ablation-index:450-550) in remaining areas, achieved first-pass PVAI in 92.7% of right PVs and 88.1% of left PVs, using vHPSD-ablation in approximately 65% of total RF-applications. The optimized PVAI achieved significantly higher first-pass PVI rate (p < .0001) with shorter ablation time (p = .04). Appropriate use of vHPSD and HPAI, based on local largest Bi-V and anatomical information, may achieve high first-pass PVAI rates in shorter ablation time with minimal energy delivery.

Mechanical vascular anastomoses

Mechanical anastomoses of blood vessels represent amajor advance in modern surgery. Highly specialized instruments ensure the precise connection of blood vessels, enabling the immediate restoration of blood flow. Ring coupler systems for venous anastomoses, in particular, have proven themselves in clinical practice due to their convenience and reliability and are now an indispensable part of surgical routines. Precise and functionally proper anastomosis of blood vessels; shortening of the anastomosis time; minimization of perfusion disorders in the affected tissue; reduction of intraoperative and postoperative complications. Replantation of extremities after amputations and injuries; defect reconstruction using free flaps; microsurgical vascular bypass procedures. Severe vascular pathologies such as vascular aneurysms, arteriosclerosis or severe inflammation in the area of the anastomosis; large differences between the vessel lumina; too small or too large vessels. Clamping of both vessel ends; selection of the appropriate ring coupler size based on the vessel diameter; mobilization of at least 1 cm at each vessel end; functional testing of the coupler device; threading the vessels, securely joining the rings and removing the holding device; removing clamps, inspection of the anastomosis. Regular blood circulation checks; avoiding pressure on the anastomosis; adequate anticoagulation. Precise anastomoses; reduction in operating time.

Spatiotemporal kinematics during top speed sprinting in male intercollegiate track and field and team sport athletes

ABSTRACT We investigated spatiotemporal kinematics during top speed sprinting and biomechanical running strategies in 98 male intercollegiate athletes from a range of athletic backgrounds in track and field (TF, n = 28) and team sports (TS, n = 70). Participants completed 40 m running trials with sagittal plane motion analyses of high-speed video captured from 30 m to 40 m. Across the entire sample, measures of contact time, step rate, step length, flight length and duty factor (ratio of contact duration to stride duration) were meaningfully correlated with top speed (p < 0.05, 0.51 ≤ |r or ρ| ≤ 0.78). Flight time and contact length were weakly correlated with top speed (p < 0.05, 0.27 ≤ |r or ρ| ≤ 0.34). When comparing sub-groups of Slow TF (n = 14) and Fast TS athletes (n = 22) with similar top speeds (~9.3 m/s), Fast TS athletes clearly demonstrated a more ground-based strategy, with longer ground contact times and contact lengths, shorter flight times and flight lengths, and larger duty factors. Therefore, the results of this study suggest that existing technical models and normative metrics based on data from TF athletes could require modification when evaluating and coaching sprinting performance with TS athletes.

Design Optimization of a Plate‐Fin Heat Exchanger With Metaheuristic Hybrid Algorithm

ABSTRACTThis paper introduces a novel approach to enhance the heat transfer efficiency of a plate‐fin heat exchanger. The metaheuristic hybrid approach combines particle swarm optimization (PSO) with the genetic algorithm (GA). Seven critical design parameters are used as variables. The research demonstrates the effectiveness of this hybrid method through a case study based on existing literature. The numerical results show the superior performance of the hybrid genetic algorithm particle swarm optimization over conventional GA and PSO techniques. The hybrid method achieves an optimal configuration with increased accuracy in a shorter computational time, offering significant time and cost savings in the design process.

The clinical application value of mixed reality in robotic laparoscopic partial nephrectomy

PurposeRobot-assisted laparoscopic partial nephrectomy (RAPN) has become a key technology in the treatment of renal tumors. Effective preoperative planning and precise intraoperative navigation are critical to a successful surgical outcome. This study aimed to evaluate the clinical application value of mixed reality (MR) in robotic nephron-sparing partial nephrectomy for patients with renal tumors of different complexity based on the R.E.N.A.L. score.Patients and methodsA retrospective analysis was conducted on 68 eligible patients with renal cancer who underwent RAPN at The Second Affiliated Hospital of Nanchang University from January 2021 to December 2023, with postoperative pathology confirmation. Patients were divided into two groups: the MR group, with 28 cases, and the traditional imaging (control) group, with 40 cases. All patients underwent mid-abdominal CT plain scans and enhancements. The MR group utilized three-dimensional reconstruction of CT data and employed 3D tablets and HoloLens glasses for preoperative discussions, surgical planning, and intraoperative guidance. Collect clinical data and metrics to assess surgical outcomes, as well as evaluate performance in areas such as preoperative discussions, doctor-patient communication, surgical planning, and intraoperative navigation.ResultsCompared to robot-assisted partial nephrectomy in the control group, the MR group experienced a reduction in operation time by approximately 30 min [(135.89 ± 23.494) min vs. (165.00 ± 34.320) min, P&amp;lt; 0.001)] and a decrease in ischemia time by around 2.5 min [(20.36 ± 3.956) min vs. (23.80± 6.889) min, P = 0.02)]. Within the subgroup with a R.E.N.A.L. score of less than 7 points, the MR group only showed a significant reduction in operation time [(134.55 ± 150.190) min vs. (150.19 ± 28.638) min, P = 0.045], with no notable differences in other parameters. For the subgroup with a R.E.N.A.L. score of 7 points or higher, the MR group exhibited shorter operation time [(140.83 ± 25.183) min vs. (195.77 ± 23.080) min, P&amp;lt; 0.001] and reduced warm ischemia time [(21.17 ± 2.714) min vs. (28.85 ± 7.570) min, P = 0.029]. Additionally, there was less estimated blood loss [(53.33 ± 5.164) min vs. (114.62 ± 80.376) min, P = 0.018]. All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.ConclusionIn comparison to traditional RAPN, MR technology demonstrates the ability to decrease operation time and warm ischemia time all the while maintaining equivalent curative outcomes. Additionally, it enhances preoperative discussions, doctor-patient interactions, preoperative strategizing, and intraoperative navigation, particularly excelling in complex renal tumor cases of RAPN, where its benefits are most pronounced.

Outcomes and prognostic factors in pediatric orbital trapdoor fracture: a multi-center study.

To evaluate clinical presentations, computed tomography (CT) findings, and various prognostic factors affecting the surgical outcomes of trapdoor fractures. This retrospective multi-center study reviewed medical records and orbital CT scans of patients under 21 years old, diagnosed with isolated trapdoor fractures. The study was conducted across multiple medical centers, including emergency and clinical departments in Isfahan, Shiraz, and Tehran-Iran. The characteristics and outcomes following surgical intervention were assessed. 45 patients with isolated trapdoor fractures were included in the study, with a mean age of 11.67 ± 4.69 years, predominantly male (84.4%). Vehicle accidents was the major cause of fractures (31.1%). 44 patients (97.8%) had orbital floor fracture, and one patient (2.2%) had medial wall involvement. Nausea/vomiting were reported in 41 patients (91.1%). Surgical intervention within 2 days, resulted in 85.0% of patients experiencing no postoperative diplopia. Delayed surgery beyond 2 days showed increased odds of diplopia, although not statistically significant. CT scan findings suggested a lower risk of diplopia in patients with soft tissue entrapment compared to muscle involvement (OR: 0.336, 95% CI: 0.077-1.462, p = 0.146). Shorter time to surgery (within 2 days) was significantly associated with normal postoperative eye movements (p = 0.002). Nausea/vomiting were more prevalent in patients with muscle entrapment (p < 0.05). Surgical intervention within 48h is crucial for improving ocular motility following trapdoor fractures. Extraocular symptoms, including nausea/vomiting, should raise suspicion for trapdoor fractures in cases of orbital trauma associated with ocular movement impairment. Not applicable.

ADVANCES IN LAPAROSCOPIC SURGERY

Laparoscopic surgery has established itself as an innovative and effective approach to treating acute abdominal diseases, revolutionizing traditional surgical practices. With the advancement of medical technologies and the growing demand for less invasive procedures, laparoscopy offers significant advantages, such as reduced postoperative pain, shorter recovery time and lower complication rates. This paper explores recent advances in the laparoscopic technique, highlighting its role in the future of minimally invasive surgery. This paper sets out to explore the main advances in laparoscopic surgery, its applications in the treatment of acute abdominal diseases and the future prospects of this minimally invasive approach, discussing how these developments can positively impact surgical practice and the patient experience. This is a literature review with a qualitative approach, using the PubMed, Google Scholar and Scielo databases. To refine the search, the health descriptors “laparoscopic surgery”, “minimally invasive surgery”, “surgical training”, and “inequalities in surgical access” were applied, with a time frame between 2020 and 2022. The methodology adopted for this analysis involves a comprehensive literature review of recent scientific articles, systematic reviews and clinical guidelines. The study examines innovations such as the use of robotics, advanced surgical instruments and improved visualization techniques, which have broadened the indications for laparoscopic surgery. In addition, the research highlights the importance of continuing education for surgeons, emphasizing the need for specific skills to successfully perform laparoscopic procedures. The data shows that laparoscopy not only improves clinical outcomes, but also promotes a more comfortable surgical experience for patients. Therefore, advances in laparoscopic surgery represent a significant milestone in the approach to acute abdominal diseases, establishing a promising future for minimally invasive surgery. The integration of new technologies and techniques, together with the proper training of professionals, is crucial to maximizing the benefits of this approach. Laparoscopy not only transforms surgical treatment, but also redefines patients’ expectations regarding recovery and quality of life. Continued development in this field promises not only better clinical results, but also a positive impact on the efficiency of health services.

Efficacy comparison of the S8 navigation-assisted correction versus manual correction in adolescent congenital scoliosis

Objective: Comparison of the efficacy of S8 navigation system-assisted correction versus manual correction in the treatment of adolescent congenital scoliosis (ACS). Methods: A cohort study. A retrospective analysis was conducted on the clinical and imaging data of 48 patients with congenital scoliosis who were treated at the Honghui Hospital Affiliated with Xi'an Jiaotong University between May 2021 and January 2023. Based on the auxiliary systems, the patients were divided into two groups: the S8 navigation system-assisted correction group (navigation group, n=20) and the C-arm-assisted manual correction group (manual group, n=28). The primary outcome measures were coronal balance (CB), sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch (PI-LL), and the Scoliosis Research Society-22 (SRS-22) questionnaire. The secondary outcome measures included surgery-related conditions and postoperative complications. Results: Of the 48 patients, there were 21 males and 27 females, with a mean age of (13.3±3.0) years. There was no statistically significant differences in preoperative distance of C7 plumb line to center sacral vertical line (C7PL-CSVL), SVA, LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). Postoperatively, the C7PL-CSVL and SVA in the navigation group were both better than in the manual group [(12.51±11.86) mm vs (19.64±1.33) mm, (15.72±3.64) mm vs (25.42±2.53) mm, both P<0.05]. There was no statistically significant differences in postoperative LL, PI, PT, PI-LL mismatch, or SRS-22 scores between the two groups (all P>0.05). The accuracy rates for Grade 0 and Grade 0+1 screw placements were 91.17% (93/102) and 95.09% (97/102) in the navigation group, respectively, which were higher than those in the manual group [84.45% (125/148) and 91.89% (136/148), respectively] (both P<0.05). The rates of adjacent facet joint violation in Grades A, B, and C were 88.23% (90/102), 11.76% (12/102), and 0 (0/102) in the navigation group, respectively, which were all better than those in the manual group [83.44% (121/145), 8.96% (13/145), and 7.58% (11/145)] (P=0.015). The navigation group had shorter operative time, single screw placement time, and total screw placement time, and the distance between the screws and the cortex was closer compared to the manual group (all P<0.05). Intraoperative blood loss in the manual group was higher than that in the navigation group (P<0.05). The average curve correction rate in the navigation group (74.68%±10.70%) was better than that in the manual group (59.60%±6.90%) (P<0.001). The intraoperative fluoroscopy dose in the navigation group was higher than that in the manual group [(416±70) mGy vs (360±81) mGy, P=0.015]. The incision length in the navigation group was longer than that in the manual group (P<0.05). There was no statistically significant difference in preoperative VAS pain score between the two groups (P>0.05). The postoperative visual analogue scale scores of pain on day 3 was better in the navigation group [(2.60±0.22) vs (3.10±0.32), P<0.001], while there was no statistically significant differences at other time points between the two groups (all P>0.05). No complications occurred in either group. Conclusion: The S8 navigation system demonstrates good corrective outcomes, high screw placement accuracy, low facet joint violation, and favorable clinical results in the treatment of adolescent congenital scoliosis, making it an ideal auxiliary tool.

Magnesium Stearate Fatty Acid Composition, Lubrication Performance and Tablet Properties

Magnesium stearate (MgSt) is a common tablet lubricant. As variations in MgSt properties are known to influence tablet attributes, the impact of MgSt fatty acid composition, particularly the significance of the stearate and palmitate contents, and its effects on tablet properties warrant further investigation. This study investigated the effect of MgSt with different stearate and palmitate contents but comparable physical properties (e.g. particle size, crystallinity, specific surface area and morphology) on lubrication performance and resulting tablet quality attributes, including mechanical strength, disintegratability and drug release. The influence of MgSt concentration and blending duration on the resulting tablet properties was also examined. Tablets produced using the lower stearate content MgSt had slightly higher tensile strength. The effect of MgSt stearate content was more apparent in the disintegration time and drug release, whereby MgSt of lower stearate content resulted in tablets with longer disintegration time and slower drug release. The lower stearate content also resulted in a lower lubrication performance, leading to a lesser reduction in tablet ejection force. As expected, a longer blending time of the tablet formulation blend with MgSt yielded tablets with reduced tensile strength, shorter disintegration time and slower drug release. Tablets with higher MgSt concentration showed a greater reduction in tensile strength, longer disintegration time and faster drug release. The study findings reinforced observations by other researchers and provided a better understanding of the fatty acid composition effects of MgSt on lubrication performance and the resulting tablet properties.Graphical

Impact of diversion ileostomy on postoperative complications and recovery in the treatment of locally advanced upper-half rectal cancer.

The efficacy of diversion ileostomy followed by radical surgery for locally advanced upper-half rectal cancer remains uncertain. This study seeks to compare the effectiveness of treatment with and without diversion ileostomy in preventing anastomotic leakage (AL) and to identify a subset who may benefit from diversion ileostomy after AL occurs in Chinese patients with stage II and III upper-half rectal cancer. A retrospective study enrolled a total of 809 patients with locally advanced upper-half rectal cancer between 2017 and 2021, with 27.6% (n = 223) treated with diversion ileostomy and 72.4% (n = 586) treated without diversion ileostomy. The Diversion(+) group (n = 172) and Diversion(-) group (n = 172) were compared for perioperative outcomes through 1:1 propensity score matching (PSM). The selection of variables for multivariable logistic regression was determined through bivariate logistic regression analysis. Additionally, optimal cutoff values for risk factors were identified using ROC curve analysis. Within the entire cohort, patients in the Diversion(+) group exhibited a lower distance from the anal verge (DAV) and higher rates of chemoradiotherapy (CRT), diabetes, cN2 stage, mrCRM positivity, EMVI positivity, and CEA elevation compared to those in the Diversion(-) group. Following PSM, a satisfactory balance of baseline variables was achieved between the two groups. There were no statistically significant differences in AL rates (7.0% vs. 5.8%, p = 0.659) or AL grade distribution (Grade A: 0.6% vs. 0%, Grade B: 5.2% vs. 4.1%, Grade C: 1.2% vs. 1.7%, p = 0.691) between the two groups. However, the Diversion(+) group demonstrated a higher incidence of postoperative complications (30.8% vs. 17.4%, p = 0.004), Clavien‒Dindo III-IV complications (2.9% vs. 2.3%, p = 0.013), particularly wound infections (8.1% vs. 1.2%, p = 0.002), and early postoperative inflammatory small bowel obstruction (EPISBO) (8.7% vs. 1.2%, p = 0.001) compared to the Diversion(-) group. Results from multivariate logistic regression analysis revealed that male gender (OR = 2.354, p = 0.014) was the only independent risk factor associated with AL, while the presence of diversion ileostomy (with vs. without, OR = 1.144, p = 0.686) did not show significant associations. In patients with AL, the onset of the AL was observed to occur later in the Diversion(+) group compared to the Diversion(-) group (7.0 ± 3.3 vs. 3.4 ± 1.4 days, p < 0.001), while the recovery time was significantly shorter (11.3 ± 4.7 vs. 20.3 ± 7.2 days, p < 0.001). Similarly, in Grade C AL patients, the occurence time was delayed in the Diversion(+) group compared to the Diversion(-) group (8.7 ± 4.7 vs. 3.2 ± 1.5 days, p = 0.008), with a shorter recovery time (19.3 ± 2.1 vs. 25.7 ± 6.7 days, p = 0.031). A trend was observed indicating a longer interval before ileostomy restoration in the AL patients compared to the non-AL patients (7.6 ± 4.9 months vs. 5.5 ± 2.9 months, p = 0.079). In addition, DAV (OR = 0.078, p = 0.002) was identified as the only independent factor associated with potential-diversion-benefit in patients with AL, with an optimal cutoff point of 8.6cm. The utilization of diversion ileostomy as a preventative measure for AL in cases of locally advanced upper-half rectal cancer is not universally endorsed due to potential complications such as small bowel obstruction and wound infection. Nevertheless, in the occurrence of AL, diversion ileostomy may prove advantageous for patient recuperation. Particularly, male patients with a DAV ranging from 7 to 8.6cm may experience benefits from undergoing diversion ileostomy subsequent to AL in cases of locally advanced upper-half rectal cancer.

Online video versus face-to-face patient-surgeon consultation: a systematic review.

Online video consultation (OVC) is increasingly used in patient-surgeon pre-surgical and follow-up consultation but a comprehensive review assessing its benefits and downsides as compared to face-to-face (F2F) consultation is currently lacking. This systematic review evaluated the effectiveness of OVC as compared to F2F consultation. A literature search (Ovid/Medline, Embase, and Clarivate Analytics/Web of Science Core Collection) was conducted including studies comparing efficacy, patient and surgeon satisfaction, and information recall between OVC and F2F patient-surgeon consultation (inception-December 4, 2023). Out of 1021 studies, 14 studies with 13,564 patients met the eligibility criteria, consisting of seven RCTs, three prospective, and four retrospective studies. Various types of surgical consultations were evaluated, including new referrals, routine follow-ups, postoperative follow-ups, and mixed consultations (both pre- and postoperative). None of the randomized trials exclusively compared OVC with F2F consultations in the high-demand preoperative setting, or assessed patient information recall. Efficacy outcomes were reported by seven studies. Among these, three RCTs showed that OVC improved efficacy in terms of waiting time (8.2 vs. 20.7 min, P = 0.01) and total appointment time (24 vs 71 min, P = 0.001, and 21.9 vs. 154.8 min, P = 0.001). Patient satisfaction was reported by 10 studies. Regarding patient satisfaction, one "mixed design" study favoured OVC (92% vs. 63%, P = 0.04), while eight studies reported similar outcomes. This systematic review identified some benefits of OVC such as shorter waiting and total appointment times as compared to F2F patient-surgeon consultation, although the true value of OVC remains unknown due to the limited available evidence. Future pragmatic RCTs are needed, which should include the pre-surgical consultation and assess patient information recall.

Time Spent Near Maximal Oxygen Uptake During Exercise at Different Regions of the Severe-Intensity Domain.

Faricier, R, Fleitas-Paniagua, PR, Iannetta, D, Millet, GY, Keir, DA, and Murias, JM. Time spent near maximal oxygen uptake during exercise at different regions of the severe-intensity domain. J Strength Cond Res XX(X): 000-000, 2024-This study applied the critical power (CP) model and several bouts of constant-power exercise within different regions of the severe-intensity domain to determine whether there exists an optimal intensity to maximize time spent near V̇o2peak. Subjects visited the laboratory 9 times. After a ramp-incremental test to determine V̇o2peak and peak power output (POpeak), 9 active individuals (5 females) performed 4 constant-power bouts to task failure between 65 and 100%POpeak to estimate CP and total finite work above CP (W'). Subjects then completed 4 additional exhaustive trials predicted to result in task failure in ∼3, 6, 9, and 12 minutes. Time spent at V̇o2peak was calculated as the duration at which V̇o2 ≥ 95% of the trial-specific V̇o2peak. The level of significance set for the study was p < 0.05. Mean CP and W' were 201 ± 48 W and 17.6 ± 8.4 kJ, respectively. For each bout, time to task failure was 2.7 ± 0.5, 6.3 ± 0.6, 9.5 ± 1.2, and 13.1 ± 3.1 minutes for the 3-, 6-, 9-, and 12-minute conditions. Time spent at V̇o2peak during the 3-minute trial (45 ± 22 seconds) was shorter than during the 9-minute (204 ± 104 seconds; p = 0.002) and 12-minute trials (260 ± 155 seconds; p < 0.001). The 6-minute trial (117 ± 46 seconds) had shorter (p = 0.005) time spent at V̇o2peak compared with the 12-minute trial. At least when performing single bouts of exercise, intensities closer to CP (i.e., those sustainable for ∼9 minutes or longer) seem preferable compared with POs in the upper regions of the severe-intensity domain to maximize time at V̇o2peak.