Skin Incision Research Articles

Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block Versus Erector Spinae Plane Block in Pediatric Patients Undergoing Corrective Cardiac Surgeries: A Randomized Controlled Study.

Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block Versus Erector Spinae Plane Block in Pediatric Patients Undergoing Corrective Cardiac Surgeries: A Randomized Controlled Study.

Enhanced facial grimacing when laparotomy involves cutaneous and visceral tissue injury.

Laparotomy is a common surgical procedure that entails incision of the abdomen and is associated with varying degrees of postoperative pain. Laparotomies can be performed in mice and result in facial grimacing, which can be quantified using PainFace, a software platform that automates facial grimace analyses. We evaluated the extent to which incision of the ventral skin, peritoneum, and intestinal manipulation, all of which can occur as part of a laparotomy surgery, affects the magnitude and duration of facial grimacing in 2 strains of mice along with allodynia at the incision site in CD-1 mice. White-coated CD-1 male and female mice and black-coated C57BL/6 male mice (8-12 weeks of age) were split into groups (n = 20 per group) that underwent laparotomies with varying manipulations. Mouse grimace scale scores were higher in both strains after surgery when the small intestine was manipulated in 2 different ways compared to groups that received a cutaneous incision alone or cutaneous and peritoneal incision. These studies show that mice exhibit more pronounced facial grimacing when both cutaneous and visceral tissues are injured during laparotomy surgery. Consistent with clinical findings, our experiments suggest that postoperative pain could be reduced by minimizing visceral tissue injury during surgical procedures.

Effect of propofol combined with remimazolam besylate on blood pressure during general anesthesia induction in patients undergoing gynecological laparoscopic surgery: single-centre randomized controlled trial

BackgroundHypotension often occurs during intraoperative anesthesia induction in gynecological laparoscopic surgery. Remimazolam is reportedly associated with lesser intraoperative hypotension than propofol. This trial was conducted to evaluate the effect of propofol combined with remimazolam besylate on post-induction hypotension (PIH) in patients undergoing gynecological laparoscopic surgery.MethodsAll enrolled patients were randomly assigned to receive propofol (Group P), remimazolam besylate plus propofol (Group PR), or remimazolam besylate (Group R). Patients in group P received 2.0 mg/kg propofol, Sufentanil 0.4 μg/kg, and rocuronium bromide 0.8 mg/kg; Patients in group PR received remimazolam besylate 0.2 mg/kg, propofol 1.0 mg/kg, Sufentanil 0.4 μg/kg, and rocuronium bromide 0.8 mg/kg; Patients in group R received remimazolam besylate 0.4 mg/kg, Sufentanil 0.4 μg/kg, and rocuronium bromide 0.8 mg/kg; the anesthesia was maintained with propofol 4–10 mg/kg/h and remifentanil 0.1–0.3 μg/kg/min.The primary outcome was the incidence of hypotension after anesthesia induction. Hypotension was defined as a mean arterial pressure (MAP) reduced 30% or more from the baseline MAP value or MAP < 65 mmHg. Blood pressure was recorded five times during anesthesia. Time points T0, T1, T2, T3 and T4, were base line, before tracheal intubation, 1 min after tracheal intubation, 5 min after intubation, and immediately after surgical skin incision, respectively.The secondary outcomes were heart rate and bispectral index (BIS). Heart rate and BIS were measured from T0 to T4.ResultsOne hundred sixty-nine patients were included in this study. A total of 30 patients in the three groups developed hypotension after anesthesia induction, among which the incidence of PIH induced in group P was 31.6% (18/57), the incidence of PIH induced in group PR was 14.3% (8/56), and the incidence of PIH induced group R 7.1% (4/56), and there was a statistical difference in the incidence of PIH between the three groups (χ2 = 12.24, p = 0.0022).The heart rates in group R (70.53 ± 13.36 bpm, 88.48 ± 13.53 bpm, and 72.68 ± 13.42 bpm) were significantly higher than that in group P (63.68 ± 10.76 bpm, 80.25 ± 12.50 bpm, and 66.35 ± 11.56 bpm) at T1, T2 and T4 (p < 0.05, respectively). The heart rate in group R (88.48 ± 13.53 bpm) was significantly higher than that in group PR (80.00 ± 13.42 bpm) at T2 (p < 0.05). There was no statistically significant difference between group PR and group P (p > 0.05).BIS was significantly higher in group R than that in group P and in group PR at T3 and T4 (p < 0.05, respectively). There was no statistically significant difference between group PR and group P (p > 0.05).ConclusionsBoth Propofol plus remimazolam besylate and remimazolam besylate alone can reduce PIH, but propofol plus remimazolam besylate smooths the heart rate after general anesthesia undergoing gynecological laparoscopic.Trial registrationThis trial was retrospectively registered at http://www.chictr.org.cn (06/06/2024, ChiCTR-2400085401).

Nanocomposite Reinforced Powder With Fast Self-gelling and Robust Wet Adhesive Performances for Acute Hemostasis and Wound Repair.

Severe trauma and uncontrolled hemorrhage present significant challenges in achieving hemostasis. Considering the limitations of current hemostatic materials, such as inadequate wet tissue adhesion, prolonged hemostasis time, and insufficient antimicrobial properties, a robust adhesive double cross-linked nano-composite hydrogel powder is developed, consisted of polyacrylic acid (PAA), ɛ-Poly-L-lysine (PLL) and layered double hydroxides (Mg-Al LDH, hereinafter referred to as LDH). The obtained PLL-PAA/LDH composite hydrogel powder exhibited rapid gelation, strong mechanical properties, and superior wet adhesion. Additionally, it offered excellent biocompatibility and antimicrobial properties. In various injury models involving rats and rabbits, the hemostatic performance of the adhesive PLL-PAA/LDH hydrogel powder surpassed that of commercially available n-butyl-2-cyanoacrylate (NBCA) from 3m. Notably, the introduction of LDH enhanced the interfacial toughness of the gel system and significantly improved its adhesive properties, demonstrating remarkable hemostatic efficacy across different injury models. Furthermore, in models of rat skin incisions and full-thickness infected skin wounds, the composite hydrogel powder exhibited superior seamless suturing and repair effects compared to commercial products. Overall, this study aims to elucidate the biomedical potential of PLL-PAA/LDH composite hydrogel powder for applications in hemostatic sealing, seamless suture prevention of acute bleeding, and wound healing.

Intra-Articular Injection of Bupivacaine and Adrenaline Reduces Intraoperative and Postoperative Blood Loss in Total Knee Arthroplasty: A Retrospective Case-Control Study.

Objective: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. Methods: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. Results: The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; p = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; p = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; p = 0.038). Conclusions: Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty.

Cervical ventral surgical approach to the brachial plexus for resection of an extraskeletal osteosarcoma in a dog

The aim of this report is to describe a new surgical approach to the brachial plexus for resection of an extraskeletal osteosarcoma in a dog. A ventral midline cervical skin incision and blunt dissection of the cervical soft tissue were performed to expose the sternohyoid and sternocephalicus muscles. The trachea, esophagus and recurrent laryngeal nerve were exposed and laterally retracted. A blunt dissection was performed between the external jugular vein and the carotid sheath caudally to the left axillae at the levels of C6, C7, and T1 to expose the mass. Dissection was performed around the mass. The abnormal spinal nerves were transected just ventral to the vertebral body, allowing complete mass removal. The dog was bright and comfortable following surgery. Two weeks later, adjuvant chemotherapy was performed with carboplatin and piroxicam. The dog had a nine-month overall survival from diagnosis to death. The ventral cervical surgical approach to the canine brachial plexus, as described in this report, demonstrated feasibility, and provided satisfactory visualization and access with minimal muscle disruption. This surgical approach may be considered for cases involving neoplasia of the brachial plexus.

Simulators with Haptic Feedback in Neurosurgery: Are We Reaching the "Aviator" Type of Training? Narrative Review and Future Perspectives.

Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure-from skin incision to skin closure-while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary.

Effects of smoking on postoperative pain and opioid consumption in patients with major abdominal oncological surgery

Aims: Major abdominal oncologic surgeries cause serious postoperative pain because they contain extensive tissue damage and large skin incision. Therefore, major abdominal oncological surgeries require more opioid consumption. In addition, there is an association between smoking and opioid use. The objective of this study is to evaluate the potential relationships between smoking status and postoperative pain and opioid analgesic consumption in patients after major abdominal oncological surgery. Methods: For the study, the approval was obtained from the Ethics Committee of our instution. 130 patients between 18-75 years of age who underwent elective major abdominal oncological surgery under general anesthesia, had ASA I-III score and was planned for intravenous morphine-controlled analgesia for postoperative analgesia were included in the study. The patients were divided into two groups as smoking (65 patients) and non-smoking (65 patients). ASA scores, age, gender, height, weight, and additional diseases were recorded. Fagerström Test for Nicotine Dependence was applied to patients who had been smoking for at least 1 year. In the postoperative care unit, heart rate, blood pressure, Sp02, values, blood pressure values, Ramsey sedation scores were recorded at 0 hours, 2 hours, 6 hours, 12 hours, 24 hours and 48 hours. At these measurement times, the pain intensity of the patients was evaluated by a visual pain scale. Patients' additional analgesic requirement, total morphine consumption, demand from patient-controlled analgesia device, nausea-vomiting, itching, gas release times, hypotension and dry mouth were recorded. Results: In this study, postoperative 0 hour, 2nd hour, 6th hour, 12th hour, 24th hour and 48th hour VAS scores and the amount of morphine consumed were significantly higher in the smokers compared to non-smokers. In terms of additional analgesic use, it was found that the use of additional analgesics was significantly higher in the group of smokers. Dry mouth and the incidence of nausea/vomiting were significantly higher in smoking patients than in non-smoking patients. Conclusion: It has been found that smoking increases the severity of postoperative pain in patients who underwent major abdominal cancer surgery and these patients need more opioids. We are of the view that while planning postoperative analgesia, effective treatment strategies can be determined by considering that there may be more severe pain in smoking patients.

Dosage of epidural morphine analgesia after lower abdominal cancer surgery: a randomized clinical trial among the older adults

BackgroundEpidural morphine is considered one of the most potent drugs used for postoperative analgesia; however, its side effects are dose-related and exaggerated in elderly people. In this study, we aimed to determine which of three doses within that range (1.5 mg, 3 mg, or 4.5 mg) can provide adequate pain relief.MethodsA total of 102 patients were assessed for allocation into one of four groups to receive either placebo (group Morphine 0, N = 22), 1.5 mg of epidural morphine (Morphine 1.5, N = 22), 3 mg of epidural morphine (Morphine 3, N = 22), or 4.5 mg of epidural morphine (Morphine 4.5, N = 22) before skin incision, 24 h after surgery and 48 h after surgery. Cumulative intravenous IV-PCA morphine consumption, VAS pain scores, modified Ramsay Sedation Scores, nausea, vomiting, and pruritus were evaluated.ResultsThe VAS pain scores at activity of patients who received epidural morphine at doses of 3 mg and 4.5 mg were significantly lower than the placebo and 1.5 mg groups, VAS Score at 72 h was (2 ± 0.8) and (1.7 ± 1) vs (4.3 ± 1.1) and (4 ± 1) respectively, p value = 0.000. The mean total IV-PCA morphine consumption (mg) was significantly higher in patients who received received epidural 0.9% sodium chloride alone compared to 1.5 mg, 3 mg and 4.5 mg epidural morphine groups (38.1 ± 4.8 mg vs 27.2 ± 5.6 mg, 9.2 ± 3.5 mg, and 6.3 ± 3.3 mg respectively), p value = 0.000). However, the difference between the 3 mg and the 4.5 mg groups was not statistically significant in both of VAS scores and IV-PCA morphine consumption (P value > 0.05 for 3 mg vs. 4.5 mg).Patients who received 4.5 mg of epidural morphine experienced a significant increase in the level of sedation, measured by the Ramsay sedation scale, in comparison with 1.5 mg, 3 mg and placebo epidural morphine groups in the first 24 h, the Scale for this group was (2.5 ± 0.5) vs (2.1 ± 0.2, 2.1 ± 0.2, and 2.2 ± 0.5 respectively); p value = 0.000. No relationship between postoperative nausea and the dosage of epidural morphine was found.ConclusionEpidural morphine 3 mg as a bolus every 24 h with add on IV patient control analgesia (PCA) morphine, set to deliver 1.5 mg boluses on demand without background infusion with a lockout period of 45 min, could achieve effective and adequate analgesia lasting up to 72 h postoperatively without increasing in the level of sedation or other side effects in older adults after a lower abdominal cancer surgery.

Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study

BackgroundIntravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1–2 g) to weight-based protocols (e.g., 10–20 mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA).Materials and methodsThis retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1 g TXA before skin incision and a topical application of 1 g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20 mg/kg/h TXA intravenously and a topical application of 1 g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications.ResultsThe weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22 g/L versus 26.09 g/L, p < 0.001) and fixed-dose TXA (18.22 g/L versus 24.69 g/L, p < 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (p < 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (p = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (p = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all p > 0.05).ConclusionsWeight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements.Level of evidence: Level 3, non-randomized observational study.

Tissue Concentrations of Vancomycin Achieved by Regional Perfusion Versus Intravenous Prophylaxis in Upper Extremity Surgery: A Randomized Controlled Trial.

Tissue Concentrations of Vancomycin Achieved by Regional Perfusion Versus Intravenous Prophylaxis in Upper Extremity Surgery: A Randomized Controlled Trial.

The AAHKS Best Podium Presentation Research Award: Intraosseous Vancomycin Reduces the Rate of Periprosthetic Joint Infection Following Aseptic Revision Total Knee Arthroplasty.

The AAHKS Best Podium Presentation Research Award: Intraosseous Vancomycin Reduces the Rate of Periprosthetic Joint Infection Following Aseptic Revision Total Knee Arthroplasty.

Survey of management of ankle fracture blisters in Yorkshire among orthopaedic surgeons.

Survey of management of ankle fracture blisters in Yorkshire among orthopaedic surgeons.

Improvement of thenar bulk appearance in index finger pollicization with adipofascial flap fashioned from pouce flottant/rudimentary thumb.

Index finger pollicization is a surgical technique used for Blauth Types IIIB and IV thumb hypoplasia reconstruction. Traditionally, index finger pollicization techniques have not addressed management of the rudimentary thumb/pouce flottant; with no improvements made to the thenar eminence, it often remains flat and hypoplastic. This case series aims to contribute to the body of literature supporting the technique of index finger pollicization with use of the pouce flottant to create a vascularized adipofascial flap for reconstruction of the thenar eminence. From 2018 to 2024, a single surgeon performed a modified index finger pollicization technique on seven patients with Blauth Type IIIB and IV thumb hypoplasia. The skin incision technique incorporates the vascular pedicle to the pouce flottant to allow for creation of a vascularized adipofascial flap. This approach utilizes the soft tissue components of the remnant thumb to reconstruct the thenar eminence with a filet flap derived from portions of the typically discarded hypoplastic thumb. Cosmetic and functional outcomes were evaluated by the surgeon, the occupational therapist and the patients' parents. Functional outcomes assessed include evaluation of thumb opposition, stability, and pinch. The use of an adipofascial flap from the rudimentary thumb provided sufficient bulk to improve the appearance of the thenar eminence and hand without complications. All patients achieved satisfactory cosmetic results. All the parents were satisfied with the appearance of the hand. Two patients initially showed disfavor to utilizing the newly created thumb and restraint therapy was successfully employed to encourage use of the new thumb. The thenar eminence was maintained at latest follow-up for all patients. At one-year follow-up, all seven patients demonstrated opposition, strong pinch, flexion, and extension with continued satisfactory cosmetic results. For patients with Type IIIB and IV thumb hypoplasia, soft tissue components of the remnant thumb/pouce flottant can be used as an adipofascial flap to improve the cosmetic result of pollicization. All patients demonstrated satisfactory functional and cosmetic results with improved appearance of the thenar eminence. The technique was reproducible, suggesting its implementation should be incorporated into standard practice for treatment of Types IIIB and IV thumb hypoplasia.

Antimicrobial gel applied to the dermis after skin incision reduces postoperative positive cultures in primary total shoulder arthroplasty: A randomized-controlled trial

Antimicrobial gel applied to the dermis after skin incision reduces postoperative positive cultures in primary total shoulder arthroplasty: A randomized-controlled trial

A PROSPECTIVE COHORT STUDY TO STUDY THE EFFECTIVENESS OF SURGICAL BUNDLE IN REDUCING SURGICAL SITE INFECTION IN CAESAREAN DELIVERIES

OBJECTIVE To study the effectiveness of surgical bundle in reducing Surgical Site Infection following caesarean deliveries. METHODS: - A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology in Deen Dayal Upadhyay Hospital, New Delhi from April 2021 to June 2022 for and included 620 women undergoing emergency caesarean section. A surgical bundle comprising of: - (i)pre-operative antibiotic prophylaxis- Inj Ceftriaxone 1gm i.v after skin sensitivity testing at the time of skin incision. (ii) Preoperative vaginal cleaning with betadine 5% after Foleys catheterisation and before abdominal scrubbing. (iii) Chlorhexidine - alcohol solution (2.5% chlorhexidine + 70% ethanol) for skin preparation, was tried to be implemented in emergency caesarean deliveries. Patients were divided into two groups on the basis of surgical bundle adherence and implementation. Group 1(n=310; surgical bundle not used) and Group 2 (n=310; surgical bundle used). Data was collected in patient proforma and outcomes were observed for 30 days postoperative period for surgical site infection. RESULTS: - There was a significant decrease in number of surgical site infections in the group where the surgical bundle was used (all three measures applied). Rates of SSI in surgical bundle not used vs used were 41/310 (13.2%) vs 19/310 (6.1%) respectively with p-value &lt;0.001. CONCLUSION: - As there is more than 50% reduction in rates of surgical site infection it is concluded that use of a combination of evidence based surgical measures significantly reduce surgical site infection in caesarean deliveries.

Robotic-Assisted Lymphatic Supermicrosurgery for Breast Lymphedema-A Case Report and Literature Review.

Breast lymphedema, an often-overlooked complication of breast cancer treatment, affects nearly half of patients undergoing breast conservation surgery and responds poorly to conservative measures. While lymphaticovenous bypass (LVB) is a well-established intervention for extremity lymphedema, its application in breast lymphedema has been sporadic. We utilized microsurgical robot system in 1 patient to overcome the technical challenges of performing LVB in the breast.A 42-year-old woman developed progressive right breast swelling, heaviness, and pain following lumpectomy, sentinel lymph node biopsy, chemotherapy, and radiotherapy. Conservative measures failed to provide relief. Indocyanine green lymphography (ICGL) revealed normal lymphatic drainage in the arm but dermal backflow in the central and lower breast. Linear patterns in the upper outer quadrant, terminating near the axillary scar, were marked. Using a microsurgical robotic system, 2 end-to-end LVBs were performed through a single skin incision. Immediate postoperative decongestion was observed, with sustained symptomatic improvement at 6 months, evidenced by reduced pain scores and a significant decrease in the Lymphedema Life Impact Score. A literature review identified 6 reports describing 7 cases of LVB for breast lymphedema. The number of bypasses per breast ranged from 1 to 6, with 1 or 2 skin incisions, predominantly in the upper outer quadrant. All cases reported prompt subjective symptom relief, though objective measures were inconsistently applied.Our case demonstrates the first successful application of robotic-assisted LVB for breast lymphedema with significant improvement in clinical signs and symptoms as well as quality of life, based on validated patient-reported outcomes. Robotic assistance enhanced both the feasibility and ergonomics of performing supermicrosurgical LVB in the anatomically complex breast region.

Development and validation of a prediction model for post-induction hypotension in elderly patients undergoing non-cardiac surgery: a prospective cohort study

BackgroundsPost-induction hypotension (PIH) is prevalent in elderly surgical patients and associated with adverse outcomes; however, predicting PIH remains challenging. We aimed to develop a feasible and practical PIH prediction model for elderly patients undergoing non-cardiac surgery.MethodsIn this single-center prospective cohort study, 938 elderly patients undergoing non-cardiac surgery were enrolled from December 2022 to May 2023 (n = 657 in the development cohort) and from June 2023 to August 2023 (n = 281 in the temporal validation cohort), respectively. The study outcome was the occurrence of PIH, defined as hypotension during the first 15 min after anesthesia induction or until skin incision (whichever occurred first). Predictors were determined based on LASSO and logistic regression analyses. A nomogram and a dynamic application were used for model visualization. The internal and temporal validation were performed to evaluate the discriminability, calibration and clinical utility.ResultsThe median age was 71 years in both cohorts. The incidence of PIH was 51.6% and 50.5% in the development and validation cohorts, respectively. Cardiac function, baseline mean arterial pressure in the ward, etomidate use, and pre-induction mean arterial pressure were determined as predictors. The PIH prediction model was visualized as a nomogram and a dynamic application. The area under the receiver operating characteristic curve was 0.680 (95% confidence interval [CI]: 0.639 to 0.720) in internal validation and 0.697 (95% CI: 0.635 to 0.759) in temporal validation. The mean absolute errors were 0.012 and 0.029 for the internal and temporal validation calibration curves, respectively. The Brier score was 0.223. The decision curve analysis indicated that the model had a gain in predicting PIH.ConclusionA PIH prediction model with four predictors was developed and validated for elderly patients undergoing non-cardiac surgery. This model provides a foundation for future refinements to enhance its value of assisting clinical decision-making across diverse healthcare settings.Trial registrationThis study was registered at the Chinese Clinical Trial Registry (ChiCTR2200066201).

Therapeutic Potential of Lobelia inflata in Promoting Wound Healing in Male Wistar Rat

Aim: To evaluate the wound-healing properties of Lobelia inflata extract through in-vivo assessments using incision and excision wound models in Wistar rats. Objective: To determine the effectiveness of Lobelia inflata ointment at different concentrations (5% and 10%) in promoting wound contraction, tensile strength, and tissue remodeling, and to compare its efficacy with a standard wound-healing agent (1% Betadine). Background: Wound healing is a critical biological process involving a series of intricate steps, including hemostasis, inflammation, proliferation, and remodeling, to restore tissue integrity. Interest in natural wound-healing agents has surged due to their potential therapeutic benefits and fewer side effects. This study investigates the efficacy of Lobelia inflata, a plant known for its medicinal properties, in enhancing wound healing. Materials &amp; Methods: Thirty adult male Wistar rats with age group more than 9 weeks were randomly divided into five groups (n=6 per group): Group I served as the normal control (untreated), Group II received a simple ointment base (vehicle control), Group III was treated with 1% Betadine ointment (standard group), Group IV was treated with 5% Lobelia inflata ointment, and Group V with 10% Lobelia inflata ointment. Two wound models were employed: in the incision model, a linear full-thickness dorsal skin incision was created, and wound contraction and tensile strength were assessed over time. In the excision model, full-thickness circular wounds were developed on the back, with wound closure rate and epithelialization evaluated. Additionally, histological analysis of healed tissues was conducted to assess collagen deposition, angiogenesis, and re-epithelialization. Results: Treatment with Lobelia inflata ointment (5% and 10%) significantly improved wound healing, with the 10% ointment (Group V) showing the fastest wound closure and healing. Increased tensile strength was observed in the treated groups, with Group V outperforming Group IV. Histopathological analysis revealed enhanced collagen deposition, angiogenesis, and re-epithelialization, particularly in the 10% Lobelia inflata group, highlighting its superior wound-healing efficacy. Conclusions: Lobelia inflata extract, particularly at a 10% concentration, demonstrates significant potential as a wound-healing agent. It promotes faster wound contraction, improved tensile strength, and enhanced tissue remodeling, making it a promising natural alternative for wound care.

Comparative study of the refined mini-pterional approach with reduced skin incision versus the conventional mini-pterional approach for clipping unruptured middle cerebral artery aneurysms: a propensity score-matched analysis.

This study aimed to compare the safety and efficacy of the refined mini-pterional approach (rMP), utilizing a smaller skin incision, with the conventional mini-pterional approach (cMP) for microsurgical clipping of unruptured intracranial aneurysms (UIAs) in the middle cerebral artery (MCA). A retrospective cohort analysis was conducted, including 186 patients: 92 patients who underwent rMP between 2021 and 2022, and 94 patients treated with cMP between 2019 and 2020. Clinical outcomes included length of stay (LOS, days), operative time (minutes), intraoperative blood loss (ml), aneurysm obliteration rate, postoperative complication rates, and the severity of temporalis muscle atrophy (TMA). Propensity score matching (PSM) was employed to minimize selection bias and ensure comparability of baseline characteristics between the two cohorts. Following PSM, the rMP group demonstrated significantly reduced LOS (cMP, 4.76 ± 2.32 days vs. rMP, 3.25 ± 1.10 days; p < 0.001), shorter operative time (cMP, 166.86 ± 51.62min vs. rMP, 119.03 ± 33.71min; p < 0.001), and lower intraoperative blood loss (cMP, 396.36 ± 392.04ml vs. rMP, 225.75 ± 149.56ml; p = 0.001) compared to the cMP group. There were no statistically significant differences in aneurysm obliteration rates or postoperative complication rates between the two approaches. The degree of TMA showed a favorable trend in the rMP cohort. The rMP offers significant advantages over the cMP in MCA UIA clipping, including shorter LOS, reduced operative time, lower intraoperative blood loss, and less severe TMA, without compromising aneurysm obliteration or increasing complication rates. These findings suggest that the rMP is a safe and effective alternative to the cMP for MCA aneurysm clipping.