Significant Difference In Time Research Articles

High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency.

BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.

The Effects of Combined Use of Linaclotide and Polyethylene Glycol Electrolyte Powder in Colonoscopy Preparation for Patients With Chronic Constipation.

The purpose of this study is to evaluate the safety and efficacy of linaclotide and polyethylene glycol (PEG) electrolyte powder in patients with chronic constipation undergoing colonoscopy preparation. We included 260 patients with chronic constipation who were scheduled to undergo a colonoscopy. They were equally divided into 4 groups using a random number table: 4L PEG, 3L PEG, 3L PEG+L, and 2L PEG+L. The 4 groups were compared based on their scores on the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Quality Scale (OBPQS), adverse reactions during the bowel preparation procedure, colonoscope insertion time, colonoscope withdrawal time, detection rate of adenomas, and their willingness to repeat bowel preparation. In terms of the score of the right half of the colon, the score of the transverse colon, the total score using BBPS, and the total score using OBPQS, the 3L PEG (polyethylene glycol)+L group was superior to groups 3L PEG and 2L PEG+L (P<0.05), but comparable to the 4L PEG group (P>0.05). The incidence rate of vomiting was higher in the 4L PEG group than in the 2L PEG+L group (P<0.05). There was no statistically significant difference in the insertion time of the colonoscope between the 4 groups. The colonoscope withdrawal time in the 3L PEG+L group was shorter than in groups 4L PEG and 3L PEG (P<0.05) and comparable to that in the 4L PEG group (P>0.05). There was no statistically significant difference in the rate of adenoma detection among the 4 groups (P>0.05). The 4L PEG group was the least willing of the 4 groups to undergo repeated bowel preparation (P<0.05). The 3L PEG+L is optimal among the 4 procedures. It can facilitate high-quality bowel preparation, reduce the incidence of nausea during the bowel preparation procedure, and encourage patients to undertake repeated bowel preparation.

Influence Of Low-Temperature Degradation On Phase Transformation And Biaxial Flexural Strength On Different High-Translucent 4Y-PSZ, 5Y-PSZ, 6Y-PSZ Monolithic Zirconia

Objective: This study aimed to investigate the effect of low-temperature degradation (LTD) in phase transformation and biaxial flexural strength of high-translucent yttria partially stabilized zirconia (Y-PSZ) and yttria tetragonal zirconia polycrystalline (3-YTZP).&#x0D; Methods: A total of 120 new high-translucent 3-YTZP (NMS) and Y – PSZ (KST, KUT, NQ3MS) zirconia disc specimens were manufactured according to ISO 6872 for biaxial flexural strength (14 mm., 1.2 ± 0.02 mm). The specimens from each type of material were divided into 3 subgroups (n:30) according to the LTD in an autoclave at 134 C0 at 2 bar (n:10) (at 5, 20 hour (h)). Specimens without LTD served as the control. Data of the monoclinic phase changes (Xm) and flexural strength were analyzed using two-way ANOVA followed by post hoc MannWhitney U test. Weibull statistics were used to analyze strength reliability.&#x0D; Results: LTD increased the monoclinic content significantly for NMS and slightly for the KST group. A monoclinic phase was not detected for KUT and NQ3MS groups. The biaxial flexural strength of the NMS group was affected significantly and decreased with an increase in the 20 h aging. For flexural strength values, there was no significant difference in aging times for each of the KST, KUT, and NQ3MS groups. Weibull analysis showed the highest characteristic strength for NMS (1412.9), KST (750.1), NQ3MS(790.5) and KUT (615.2) groups. The Weibull modulus (m) increased in the NMS, KUT, and NQ3MS groups compared with the control group and decreased in the KST group.&#x0D; Conclusion: LTD caused a significant decrease in the biaxial flexural strength results of the NMS group but did not significantly affect the KST, KUT, and NQ3MS groups’ values.

Investigation of the Effect of Ramadan Fasting on Sleep Patterns, Nutritional Characteristics, and Physical Activity Levels in Young Individuals Doing Active Sports

Fasting during Ramadan causes significant changes in important features of human life, such as sleep behaviors, nutrition, and physical activity. This study aimed to investigate the effects of Ramadan fasting on sleep patterns, nutritional characteristics, and physical activity levels in young individuals doing active sports. Twenty-six individuals (14 males-12 females) between the ages of 19-25 and doing active sports participated in the study voluntarily. In the study, the athletes' sleep patterns, nutrition, and physical activity characteristics were determined using a questionnaire. Participants answered a questionnaire about their sleep patterns, nutritional characteristics, and physical activity levels one week before and during the first week of Ramadan. Comparisons between before and Ramadan answers were made by paired t-tests. Wilcoxon’s z was calculated for comparisons between the non-parametric variables. According to the statistical comparisons, the number of workouts per week, and daily training time, were significantly (p&lt;0.05) decreased during Ramadan. In addition, it has been determined that the sleeping and waking hours have changed. It is seen that there is no statistically significant difference in total sleep times. There was no significant difference was found in the high-intensity, moderate-intensity physical activity and sitting times of the athletes (p&gt;0.05). Significant decreases were found in walking and total calorie (MET) parameters (p&lt;0.001). Moreover, no significant difference was found in the total calorie, carbohydrate, fat, protein, and liquid consumption. Ramadan fasting was affected by the number of workouts per week, daily training number, bedtime, waking-up time, walking, and total calorie (MET) parameters.

Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials.

Traditional teaching has been to place patients in the left lateral decubitus starting position for colonoscopies. Recent randomized controlled trials (RCTs) have compared left lateral decubitus starting position to other approaches. The aim of this systematic review and meta-analysis was to compare different starting positions for colonoscopies and their effect on cecal intubation. MEDLINE, Embase, and CENTRAL were searched from inception to July 2023. Articles were eligible for inclusion if they were RCTs comparing at least two different starting positions for adults undergoing colonoscopy. The main outcome was cecal intubation time. Meta-analysis used an inverse variance random effects model. Risk of bias was assessed with the Cochrane Tool for RCTs 2.0. After screening 1523 citations, 14 RCTs were included. Four studies compared left lateral decubitus to right lateral decubitus, four studies compared left lateral decubitus to left lateral tilt-down, three studies compared left lateral decubitus to prone, and three studies compared left lateral decubitus to supine. There were no statistically significant differences in cecal intubation time in seconds across all comparisons: left lateral decubitus vs. right lateral decubitus (MD 14.9, 95%CI - 111.8 to 141.6, p = 0.82, I2 = 85%); left lateral decubitus vs. left lateral tilt-down (MD - 31.3, 95%CI - 70.8 to 8.3, p = 0.12, I2 = 82%); left lateral decubitus vs. prone (MD 17.2, 95%CI - 174.9 to 209.4, p = 0.86, I2 = 94%); left lateral decubitus vs. supine (MD - 149.9, 95%CI - 443.6 to 143.9, p = 0.32, I2 = 89%). The starting position for colonoscopies likely does not influence cecal intubation time. This study was limited by heterogeneity.

Lack of clinical utility of serum macrophage migration inhibitory factor (MIF) for monitoring therapy response and estimating prognosis in advanced lung cancer.

Lung cancer is a major burden to global health and is still among the most frequent and most lethal malignant diseases. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in a variety of processes including tumorigenesis, formation of a tumor microenvironment and metastasis. It is therefore a potential prognostic biomarker in malignant diseases. In this study, we investigated the applicability of MIF in serum samples as a biomarker in lung cancer. In a retrospective approach, we analyzed the sera of 79 patients with non-small-cell lung cancer (NSCLC) and 14 patients with small-cell lung cancer (SCLC) before the start of chemotherapy, as well as before the second and third chemotherapy cycle, respectively. Serum MIF levels were measured using a sandwich immunoassay with a sulfo-tag-labelled detection antibody, while pro-gastrin releasing peptide (proGRP) levels were determined with an enzyme-linked immunosorbent assay. No difference in serum MIF levels between responders and non-responders to chemotherapy was observed at all time points, while proGRP levels were significantly lower in responders before the second chemotherapy cycle (p = 0.012). No differences in biomarker levels depending on the histopathological classification of NSCLC patients was found. Moreover, in ROC curve analyses MIF was not able to distinguish between responders and non-responders to therapy. proGRP could differentiate between responders and non-responders before the second chemotherapy cycle (p = 0.015) with sensitivities of 43% at 90% and 95% specificity, respectively. Likewise, proGRP yielded significantly longer survival times of patients with low proGRP concentrations before the second chemotherapy cycle (p = 0.015) in Kaplan-Meier analyses, yet MIF showed no significant differences in survival times at all time points. Comparison with the biomarkers CEA and CYFRA 21-1 in the same cohort showed that these established biomarkers clearly performed superior to MIF and proGRP. From the present results, there is no indication that serum MIF may serve as a biomarker in prognosis and monitoring of response to therapy in lung cancer. Limitations of this study include its retrospective design, the inclusion of a larger NSCLC and a smaller SCLC subgroup, the classical chemotherapeutic treatment, the use of a non-diagnostic immunoassay (RUO-test) for MIF measurement and the lack of a validation cohort. Strengths of the study are its highly standardized procedures concerning sample collection, preanalytic treatment, measurements and quality control of the laboratory assays.

Meta-analysis of central and peripheral cannulation for type A aortic dissection.

Acute type A aortic dissection necessitates rapid and effective arterial cannulation techniques for optimal outcomes. This meta-analysis compares the safety and effectiveness of direct aortic cannulation (AoC) with peripheral cannulation (PC) via the femoral or axillary arteries in aortic surgery for acute type A aortic dissection. A systematic review following PRISMA guidelines identified 10 retrospective studies encompassing 2518 patients (961 AoC, 1557 PC). Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative complications including stroke and acute kidney injury. Short-term mortality did not significantly differ between AoC and PC (OR [95% CI] = 0.78 [0.61-1.01], p = .06). Likewise, postoperative stroke (OR [95% CI] = 0.86 [0.63-1.17], p = .33) nor acute kidney injury (OR [95% CI] = 1.11 [0.89-1.37], p = .35) showed no significant differences. AoC exhibited shorter operation time whereas there were no significant differences in aortic cross clamp time and cardiopulmonary bypass time between both groups. Our meta-regression analysis, considering the distal extent of aortic replacement, indicated that variations in aortic replacement rates did not significantly impact the observed outcomes. AoC is a viable alternative to PC for acute type A aortic dissection. While both approaches offer comparable outcomes, AoC's advantage in shorter operation time warrants thoughtful consideration in clinical practice.

Comparative analysis of perioperative and long-term outcomes of patients with hepatocellular carcinoma: Nonalcoholic fatty liver disease versus viral hepatitis.

Despite the accumulating evidence regarding the oncological differences between nonalcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC) and viral infection-related HCC, the short- and long-term outcomes of surgical resection of NAFLD-related HCC remain unclear. While some reports indicate improved postoperative survival in NAFLD-related HCC, other studies suggest higher postoperative complications in these patients. Patients with NAFLD and those with hepatitis viral infection who underwent hepatectomy for HCC at our department were retrospectively analyzed. The clinical, surgical, pathological, and survival outcomes were compared between the two groups. Among the 1047 consecutive patients who underwent hepatectomy for HCC, 57 had NAFLD-related HCC (NAFLD group), and 727 had virus-related HCC (VH group). The body mass index and serum glycated hemoglobin levels were significantly higher in the NAFLD group than in the VH group. There were no significant differences in operative time and bleeding amount. Moreover, the morbidity and the length of postoperative hospital stays were similar across both groups. The pathological results showed that the tumor size was significantly larger in the NAFLD group than in the VH group. No significant differences between the groups in overall or recurrence-free survival were found. In a subgroup analysis with matched tumor diameters, patients in the NAFLD group had a better prognosis after hepatectomy than those in the VH group. Surgical outcomes after hepatectomy were comparable between the groups. Subgroup analysis reveals early detection and surgical intervention in NAFLD-HCC may improve prognosis.

Delaying Suspension Syndrome Onset in Aerially Suspended Victims Through Leg Raising.

Suspension syndrome (SS) develops when venous blood pools in extremities of passively suspended individuals, resulting in presyncopal symptoms and potential unconsciousness or death independent of additional injuries. We investigated use of leg raising to delay onset of SS, as it can decrease venous pooling and increase cardiac return and systemic perfusion. Participants were suspended in rock climbing harnesses at an indoor climbing wall in a legs-dangling control position or a legs-raised interventional position to compare physiological outcomes between groups. Participants were suspended for a maximum of 45 min. Onset of 2 or more symptoms of SS, such as vertigo, lightheadedness, or nausea, halted suspension immediately. We recorded each participant's heart rate, blood pressure, oxygen saturation, lower leg oxygen saturation, pain rating, and presyncope scores presuspension, midsuspension, and postsuspension, as well as total time suspended. There were 24 participants. There was a significant difference in total time suspended between groups (43.05±6.7 min vs 33.35±9.02 min, p=0.007). There was a significant difference in heart rate between groups overall (p=0.012), and between groups, specifically at the midsuspension time interval (80±11 bpm vs 100±17 bpm, p=0.003). Pain rating was significantly different between groups (p=0.05). Differences in blood pressure, oxygen saturation, lower leg oxygen saturation, and presyncope scores were not significant. Leg raising lengthened the time individuals tolerated passive suspension and delayed symptom onset.

A Collaborative Multidisciplinary Trauma Program Improvement Team Improves VTE Chemoprophylaxis Guideline Compliance In Non-Operative Stable TBI.

Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hour) initiation of VTE prophylaxis and will decrease VTE events in TBI patients. We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation. A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24-48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs 4%; p < 0.001) with no increase in bleeding events (2% vs 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (aOR: 3.74; 95%CI: 1.45-6.16). A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24-48 hours of stable head CT is safe and effective. Level III, Therapeutic/Care Management.

(004) Retrospective Concomitant Nonrandomized Comparison of Testosterone Replacement Therapy Versus No Treatment for Erectile Function Post Radical Prostatectomy

Abstract Introduction Recent studies have shown that testosterone replacement therapy (TRT) can be safely applied in men with low-risk prostate cancer. Objective To assess TRT versus no TRT 2-year potency outcomes in hypogonadal men aged ≥ 60. Methods Retrospective concomitant nonrandomized comparison of 70 hypogonadal men, aged 60 or older, were stratified by TRT post-RP. Baseline demographics, total testosterone (TT) calculated free testosterone (cFT), and comorbidities prior to RP were measured from October 2016 – October 2020. Sexual function was assessed via the International Index of Erectile Function (IIEF-5) pre-and post-surgery. Potency (evaluated at 3-, 9-, 15-, and 24-months post-RP) was defined as erections sufficient for penetration and satisfying, and/or erection fullness &amp;gt;75%, and/or a score of 5 on Q1 (IIEF-5; confidence). T-tests, chi-square, and regression analyses were performed. Results Potency at 2 years was 63.6% (TRT) versus 35.1% (No TRT; p=0.017). Regression analysis showed that TRT was a predictor of potency outcomes 2 years post-RP (OR: 3.33; 95% CI: 1.16–10.3; p=0.029) after adjusting for age and Gleason Grade Group. There were no statistically significant differences in baseline factors between the TRT-receiving and no-TRT groups. BCR rates between the two groups were 12.1% (TRT) versus 27.0% (no TRT; p=0.12) with a mean follow-up time of 40.2 ± 13.6 months. Kaplan Meier analysis demonstrated a trend toward a significant difference in time to BCR (p=0.078). Conclusions In hypogonadal men aged ≥ 60, TRT significantly improved potency outcomes 2-years post-RP. The risk of BCR overall in men receiving TRT was lower but not statistically significant. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: FY – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(021) Eight-Dot Extended Corporotomy versus Conventional Corporotomy for Malleable Penile Prosthesis Implantation

Abstract Introduction To date, malleable type penile prosthesis implantation (MPPI) remains the more popular in developing countries, owing to its relative economic cost. Despite the simplicity of the procedure, there still may be areas of improvement and refinement to optimize procedure efficiency and accuracy subsequently improving postoperative outcomes while reducing complication risk. Objective We aimed to compare the eight-dot extended corporotomy and the conventional corporotomy techniques for MPPI with regard to operative time and postoperative complications. Methods We conducted a prospective randomized interventional clinical study on 51 subjects. Patients were randomized into 2 groups: the eight-dot group (n=27) and the conventional group (n=24). The eight-dot group underwent MPPI using the eight-dot extended corporotomy as previously described (VJPU - Eight-dot Extended Corporotomy: A More Secure, Aesthetic and Time Efficient Technique for Semirigid Penile Prosthesis Implantation, n.d.). The conventional group underwent MPPI using conventional limited corporotomies that were closed via continuous running sutures. We compared both groups in terms of corporotomy opening to closure time, overall procedure time, and perioperative complications. The follow-up period was 3 months. Results Upon timing in seconds (s), a significant time difference between the 2 groups was demonstrated for suture placement, corporotomy incision and implant placement, corporotomy closure, and total procedure duration. Although patients in the eight-dot group required a longer time for suture placement vs the conventional group (486 vs 201 s, respectively, p &amp;lt; 0.001), the durations for the remaining implantation steps, as well as the whole procedure, were significantly shorter for the former group. Corporotomy opening followed by implant placement took significantly less time for the eight-dot group (1090 s) vs the conventional group (1313 s), p &amp;lt;0.001. Moreover, insertion of implant rods was subjectively easier with no need for aggressive bending owing to the extended corporotomy length. Similarly, corporotomy closure using the 8-dot technique was 10.13 minutes swifter than the conventional group (220 s vs. 828 s, respectively, p &amp;lt; 0.001). The total procedure length was over 8 minutes shorter for the eight-dot group as opposed to the conventional group (2527 vs 3027 s, respectively, p &amp;lt; 0.001). In terms of postoperative complications in the form of pain, swelling, hematoma, and infection, there were no significant differences between both groups. Conclusions The eight-dot extended corporotomy technique is a safe and time-saving approach compared to the conventional limited corporotomy technique, making the MPPI procedure more efficient. A swifter procedure decreases both patient exposure to anesthesia and device exposure to air which in turn lowers the risk for potential postoperative complications. Disclosure No.

(102) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation Following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

Development of a Nomogram Using the Inflammatory Risk Score for Prognostication in Moderate and Advanced Hepatocellular Carcinoma Associated with Hepatitis B Virus.

The changes in risk scores of inflammatory markers among patients diagnosed with hepatocellular carcinoma (HCC) remain unknown. To investigate the relationship between the inflammation risk score and other contributing factors and the prognostic outcomes in patients with moderate and advanced hepatitis B virus (HBV)-related HCC. A retrospective cohort study. A total of 174 patients with moderate and advanced HBV related HCC were recruited to investigate the impact of stratified inflammatory risk scores and other associated risk factors on disease prognosis. Based on the optimal cut-off values calculated by the Youden index, the patients were divided into high-risk and low-risk groups based on their inflammation risk scores. The study found a significant difference in median survival time between the low-risk and high-risk groups based on the inflammation risk score. Furthermore, the inflammation risk score, alpha-fetoprotein levels, transarterial chemoembolization treatment, and Barcelona Clinic Liver Cancer stage were identified as independent prognostic factors. The four variables were used to construct a prognostic nomogram for HCC. Subsequent evaluations using time-dependent receiver operating characteristic analysis and calibration curve tests revealed the nomogram's commendable discriminatory ability. As a result, the nomogram proved to be an effective tool for predicting survival at 2- to 4-years. The inflammation risk score has been identified as a significant prognostic factor for HBV-related HCC. The development of nomogram models has provided a practical and effective tool for determining the prognosis of patients affected by HBV-related HCC.

A Comparison of Three Anesthetic Drug Combinations for Use in Inducing Surgical Anesthesia in Female Guinea Pigs (Cavia porcellus).

Guinea pigs are often used in translational research, but providing them with safe and effective anesthesia is a challenge. Common methods like inhalant anesthesia and injectable ketamine/xylazine induce surgical anesthesia but can negatively affect cardiovascular, respiratory, and thermoregulatory systems and complicate the interpretation of research outcomes. Several alternative anesthetic regimens have been investigated, but none have consistently achieved a surgical plane of anesthesia. Therefore, identifying an anesthetic regimen that achieves a stable state of the surgical plane of anesthesia while preserving cardiorespiratory function would be a valuable contribution. To address this issue, we compared the efficacy of 3 anesthetic combinations in female Dunkin-Hartley guinea pigs: 1) alfaxalone, dexmedetomidine, and fentanyl (ADF); 2) alfaxalone, midazolam, and fentanyl (AMF); and 3) alfaxalone, midazolam, fentanyl, and isoflurane (AMFIso). We monitored anesthetic depth, heart rate, oxygenation, respiratory rate, respiratory effort, blood pressure, and body temperature every 15 min from injection to recovery. We also recorded the time to loss of righting reflex, duration of anesthesia, and time to achieve a surgical plane. The results showed no statistically significant differences in induction and recovery times among the groups. In the AMFIso group, 100% of the animals achieved a surgical plane of anesthesia, whereas only 10% of the animals in the AMF group reached that level. None of the animals in ADF group reached a surgical plane of anesthesia. Respiratory rate was significantly lower in the AMFIso as compared with the ADF group (P < 0.001) but was not different between the AMF and ADF groups. Temperature was significantly lower in the AMFIso group as compared with both the ADF and AMF groups (P < 0.001). In conclusion, both combinations of solely injectable anesthetics assessed in this study can be used for short, nonpainful procedures without significant cardiorespiratory depression. However, for mildly to moderately painful surgical procedures, the addition of an inhalant anesthetic like isoflurane is necessary for female guinea pigs.

The Investigation of the Effects of Short-Term Body Weight Loss on Elite Wrestlers on Anaerobic Performance and Reaction Time in Tournament Conditions

Athletes, who engage in wrestling, perform weight adjustment before the competitions like all weight loss category sports. For this reason, weight management is a very important factor prior to matches. When the studies on weight loss are examined, it is seen that athletes lose weight in a short time close to the competition. This study aimed to investigate the effects of short-term body weight loss in elite wrestlers on anaerobic performance and reaction time during tournament conditions. Ten experienced international level male wrestlers participated as a volunteer in this study. Participants lost 5% of their body weight within 48 hours, in 72 hours; 1 kg tolerance was given over 5% of body weight. During this process, body composition measurement, Wingate anaerobic performance test (WAnT), Countermovement Jump (CMJ), and visual and auditory reaction tests were conducted. In this study, a randomized crossover design was used and applications lasted four days. Two-way ANOVA with repeated measures was used for statistical analysis. Due to short-term body weight loss in body composition, total body water (TBW) and fat-free mass (FFM) were significantly reduced. In contrast, there was no statistically significant difference in body fat percentage (BF %), visual and auditory reaction time, CMJ and average power (AP). However, there was a significant increase was seen in Peak power (PP) and fatigue index (FI). The results indicate that 5% loss of body weight within 48 hours caused significant changes in body composition and negatively affected the fatigue index. For this reason, athletes who lose weight should avoid rapid weight-loss practices that will cause sudden changes in body composition in order to maintain their athletic performance.

Endoscopic Versus Microscopic Transcanal Resection of Glomus Tympanicum: A Retrospective Comparative Study.

Comparison of outcomes of microscopic and endoscopic resection of glomus tympanicum (GT) tumors. Retrospective case review. Single tertiary referral center. All adult patients undergoing transcanal GT resection without mastoidectomy from 2007 to 2021. Surgical resection-endoscopic versus microscopic approach. Primary outcomes were tumor recurrence at 1 year and presence of residual tumor at conclusion of surgery. Secondary outcome measures included operative time, postoperative air-bone gap, postoperative symptom resolution, and surgical complications. Thirty-eight patients underwent resection of GT (74% female; mean age, 59 years). Twenty-nine cases were performed microscopically, and nine cases were performed endoscopically. Both endoscopic and microscopic approaches yielded high rates of complete tumor resection (27/29 microscopic cases, 7/9 endoscopic cases). There was no significant difference in mean operative time (2.3 hours for microscopic; 2.6 hours for endoscopic). On average, air-bone gaps (ABGs) decreased by 6.3 dB after endoscopic resection compared with 1.0 dB after microscopic resection ( p = 0.064). No patients were found to have tumor recurrence during an average follow-up interval of 21 months. These results suggest comparable outcomes with both endoscopic and microscopic approaches for GT resection, and decisions regarding preferred approach should be dictated by surgeon preference.

Concomitant use of hydroxyzine and haloperidol did not worsen delirium in patients with cancer: A multicenter, retrospective, observational study.

There is concern that hydroxyzine exacerbates delirium, but a recent preliminary study suggested that the combination of haloperidol and hydroxyzine was effective against delirium. This study examined whether the concomitant use of hydroxyzine and haloperidol worsened delirium in patients with cancer. This retrospective, observational study was conducted at 2 general hospitals in Japan. The medical records of patients with cancer who received haloperidol for delirium from July to December 2020 were reviewed. The treatments for delirium included haloperidol alone or haloperidol combined with hydroxyzine. The primary outcome was the duration from the first day of haloperidol administration to the resolution of delirium, defined as its absence for 2 consecutive days. The time to delirium resolution was analyzed to compare the haloperidol group and hydroxyzine combination group using the log-rank test with the Kaplan-Meier method. Secondary outcomes were (1) the total dose of antipsychotic medications, including those other than haloperidol (measured in chlorpromazine-equivalent doses), and (2) the frequencies of detrimental incidents during delirium, specifically falls and self-removal of drip infusion lines. The unpaired t-test and Fisher's exact test were used to analyze secondary outcomes. Of 497 patients who received haloperidol, 118 (23.7%) also received hydroxyzine. No significant difference in time to delirium resolution was found between the haloperidol group and the hydroxyzine combination group (log-rank test, P = 0.631). No significant difference between groups was found in either chlorpromazine-equivalent doses or the frequency of detrimental incidents. This study showed that the concomitant use of hydroxyzine and haloperidol did not worsen delirium in patients with cancer.

Comparison of Intramedullary Screw Fixation, Plating, and K-Wires for Metacarpal Fracture Fixation: A Meta-Analysis.

Metacarpal fractures are common injuries with multiple options for fixation. Our purpose was to compare outcomes in metacarpal fractures treated with intramedullary screw fixation (IMF), Kirschner wires (K-wires), or plating. A systematic literature review using the MEDLINE database was performed for studies investigating metacarpal fractures treated with IMF, plating, or K-wires. We identified 34 studies (9 IMF, 8 plating, 17 K-wires). A meta-analysis using both mixed and fixed effects models was performed. Outcome measures included mean Disabilities of the Arm, Shoulder, and Hand (DASH) scores, total active motion (TAM), grip strength, time to radiographic healing, and rates of infection and reoperation. Patients with IMF had significantly lower DASH scores (0.6 [95% confidence interval [CI], 0.2-1.0]) compared with K-wires (7.4 [4.8-9.9]) and plating (9.8 [5.3-14.3]). Intramedullary screw fixation also had significantly lower rates of reoperation (4%, [2%-7%]), compared with K-wires (11% [7%-16%]) and plating (11% [0.07-0.17]). Grip strength was significantly higher in IMF (104.4% [97.0-111.8]) compared with K-wires (88.5%, [88.3-88.7]) and plating (90.3%, [85.4-95.2]). Mean odds ratio time was similar between IMF (21.0 minutes [10.4-31.6]) and K-wires (20.8 minutes [14.0-27.6]), but both were shorter compared with plating (52.6 minutes [33.1-72.1]). There were no statistically significant differences in time to radiographic healing, TAM, or rates of reoperation or infection. This meta-analysis compared the outcomes of metacarpal fixation with IMF, K-wires, or plating. Intramedullary screw fixation provided statistically significant lower DASH scores, higher grip strength, and lower rates of reoperation, suggesting that it is a comparable method of fixation to K-wires and plating for metacarpal fractures.

Feasibility of robotic cholecystectomy at an academic center with a young robotic surgery program: a retrospective cohort study with umbrella review

Laparoscopic cholecystectomy (LC) has been standard of care for surgical treatment of benign gallbladder pathology for decades. With the advent of robotic surgical technology, robotic cholecystectomy (RC) has gained attention as an alternative to conventional laparoscopy. This study introduces a single-surgeon experience with laparoscopic versus robotic cholecystectomy and an umbrella systematic review of the outcomes of both approaches. A retrospective chart review was performed at a single institution on a prospectively maintained database of patients undergoing laparoscopic or robotic cholecystectomy for benign gallbladder pathology. An umbrella systematic review was conducted using PRISMA methodology. A total of 103 patients were identified; 61 patients underwent LC and 42 underwent RC. In the RC cohort, 17 cases were completed using a four-port technique while 25 were completed using a three-port technique. Patients undergoing RC were older compared to the LC group (44.78 vs 57.02 years old; p < 0.001) and exhibited lower body mass index (29.37 vs 32.37 kg/m2, p = 0.040). No statistically significant difference in operative time or need for postoperative ERCP was noted. Neither this series nor the umbrella systematic review revealed significant differences in conversion to open surgery or readmissions between the LC and RC cohorts. Three-port RC was associated with reduced operative time compared to four-port RC (101.28 vs 150.76 min; p < 0.001). Robotic cholecystectomy is feasible and safe at a young robotic surgery program in an academic center setting and comparable to laparoscopic cholecystectomy clinical outcomes.