Surgery Intervention Research Articles

16. 5 Years of Lower Limb Osseointegrated Prostheses: Anticipating the “Who, What, and When” of Poor Outcomes

PURPOSE: Osseointegrated prostheses are a novel alternative to socket-suspended prostheses, especially when the latter are complicated by poor fit, soft tissue damage, or pain. However, osseointegrated prostheses can also lead to post-operative issues that rely on plastic surgery intervention. Little is known about the timeline of or risk factors for these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Fisher’s exact test and unpaired t-tests were performed (alpha=0.05). RESULTS: 70 patients met our study criteria: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Indications for amputation were trauma(56), prior surgical complication(7), cancer(4) and other(3). Postoperative complications included soft tissue infection(26), osteomyelitis(5), neuroma(6), limb fracture(4), soft tissue revision(7), and hardware failure(2). Statistically significant correlations existed between increased age at implantation and neuroma development, decreased time from amputation to implantation and limb fracture, obesity and soft tissue infection, and female gender and soft tissue infection. Decreased surgeon experience was significantly associated with increased risk of osteomyelitis and neuroma. Subgroup analysis by amputation indication or level did not affect outcomes. Hypertension(15) and tobacco use(27) did not correlate with any complications. CONCLUSION: Certain modifiable factors (BMI, timing of surgery) and unmodifiable factors (age, gender) correlate with increased risk of complications following lower limb osseointegration. These results can aid surgeons in better selecting appropriate candidates and anticipating post-operative outcomes.

32. When to Expect the Unexpected: A Timeline of Complications in Lower Limb Osseointegrated Protheses

PURPOSE: Osseointegrated prostheses are a novel alterative to socket-suspended prostheses that have been shown to improve mobility, nerve pain, and other issues associated with poorly tolerated sockets. However, osseointegrated prostheses themselves can lead to post-operative complications that rely on plastic surgery intervention. Little is known about the timeline of these complications as few centers currently perform the procedure. METHODS: A retrospective analysis was performed on all patients who received single-stage lower-limb osseointegration at our institution between 2017 and 2022. Demographics, medical history, and postoperative complications were reviewed. Time-to-event analyses were performed for identified complications. RESULTS: Our study included 70 patients: 48 males and 22 females with 41 transfemoral and 29 transtibial amputations. Patients were followed for 19.6 months on average. Hardware failures(2) occurred on postoperative days 7 and 245. Limb fractures(4) occurred on average at 135 days post-op. Neuromas(3) occurred on average at 306 days post-op. Cases of osteomyelitis(5) occurred on average at 332 days post-op. Revisions of soft tissue(7) occurred on average at 389 days post-op. Soft tissue infections(26) occurred on average at 129 days post-op. 50% of soft tissue infections occurred within one month post-operatively, and 81% within four months. CONCLUSION: Certain postoperative complications often occur shortly after implantation (Soft tissue infections, limb fractures), while others occur at later timepoints (neuromas, osteomyelitis, soft tissue excess). These results can help elucidate the etiologies of observed complications, and aid surgeons in anticipating when osseointegrated prostheses complications may occur in future patients.

Bariatric–metabolic surgery versus lifestyle intervention plus best medical care in non-alcoholic steatohepatitis (BRAVES): a multicentre, open-label, randomised trial

Observational studies suggest that bariatric-metabolic surgery might greatly improve non-alcoholic steatohepatitis (NASH). However, the efficacy of surgery on NASH has not yet been compared with the effects of lifestyle interventions and medical therapy in a randomised trial. We did a multicentre, open-label, randomised trial at three major hospitals in Rome, Italy. We included participants aged 25-70 years with obesity (BMI 30-55 kg/m2), with or without type 2 diabetes, with histologically confirmed NASH. We randomly assigned (1:1:1) participants to lifestyle modification plus best medical care, Roux-en-Y gastric bypass, or sleeve gastrectomy. The primary endpoint of the study was histological resolution of NASH without worsening of fibrosis at 1-year follow-up. This study is registered at ClinicalTrials.gov, NCT03524365. Between April 15, 2019, and June 21, 2021, we biopsy screened 431 participants; of these, 103 (24%) did not have histological NASH and 40 (9%) declined to participate. We randomly assigned 288 (67%) participants with biopsy-proven NASH to lifestyle modification plus best medical care (n=96 [33%]), Roux-en-Y gastric bypass (n=96 [33%]), or sleeve gastrectomy (n=96 [33%]). In the intention-to-treat analysis, the percentage of participants who met the primary endpoint was significantly higher in the Roux-en-Y gastric bypass group (54 [56%]) and sleeve gastrectomy group (55 [57%]) compared with lifestyle modification (15 [16%]; p<0·0001). The calculated probability of NASH resolution was 3·60 times greater (95% CI 2·19-5·92; p<0·0001) in the Roux-en-Y gastric bypass group and 3·67 times greater (2·23-6·02; p<0·0001) in the sleeve gastrectomy group compared with in the lifestyle modification group. In the per protocol analysis (236 [82%] participants who completed the trial), the primary endpoint was met in 54 (70%) of 77 participants in the Roux-en-Y gastric bypass group and 55 (70%) of 79 participants in the sleeve gastrectomy group, compared with 15 (19%) of 80 in the lifestyle modification group (p<0·0001). No deaths or life-threatening complications were reported in this study. Severe adverse events occurred in ten (6%) participants who had bariatric-metabolic surgery, but these participants did not require re-operations and severe adverse events were resolved with medical or endoscopic management. Bariatric-metabolic surgery is more effective than lifestyle interventions and optimised medical therapy in the treatment of NASH. Fondazione Policlinico Universitario A Gemelli, Policlinico Universitario Umberto I and S Camillo Hospital, Rome, Italy.

Bariatric–metabolic surgery versus lifestyle intervention in non-alcoholic steatohepatitis

Bariatric–metabolic surgery versus lifestyle intervention in non-alcoholic steatohepatitis

Editorial: Cardiac Rehabilitation; An Essential Component of Cardiovascular Disease Management

Cardiovascular disease (CVD) is a significant global health issue and remains a leading cause of mortality worldwide. According to the World Health Organization (WHO), CVD is responsible for approximately 17.9 million deaths annually, accounting for 31% of all global deaths (1). However, the good news is that many CVD risk factors are modifiable, and lifestyle interventions can significantly reduce the incidence and progression of CVD. Cardiac rehabilitation (CR) is a comprehensive program that includes exercise, education, and behavioral interventions to help individuals with CVD recover and improve their quality of life.&#x0D; CR has been shown to improve functional capacity, reduce symptoms, decrease hospitalizations, and increase survival rates in patients with CVD (2-3). Exercise training is a key component of CR and has been shown to improve cardiovascular fitness, decrease blood pressure, and reduce insulin resistance (4). In addition, education and counseling regarding medication adherence, smoking cessation, and nutrition can help patients better manage their disease and improve their overall health (5).&#x0D; Despite the proven benefits of CR, participation rates remain low. Many patients are not referred to CR by their healthcare providers, and those who are referred may face barriers such as lack of transportation, cost, or lack of social support (6). In addition, there is a shortage of trained professionals to deliver CR programs, particularly in rural or underserved areas (7).&#x0D; To address these issues, healthcare providers should prioritize CR as an essential component of CVD management and ensure that all eligible patients are referred to CR programs. Public health campaigns and education initiatives can also help increase awareness of the benefits of CR among patients and healthcare providers (8). Finally, policymakers should allocate resources to improve access to CR, particularly in underserved areas, and promote reimbursement for CR services (9).&#x0D; One of the challenges in promoting CR is the perception that it is primarily for older individuals who have already had a cardiac event. However, CR is beneficial for a much wider range of patients, including those with heart failure, peripheral arterial disease, and those who have undergone cardiac surgery or percutaneous coronary intervention (10). Additionally, CR can help prevent future cardiac events in individuals who are at high risk due to their family history, lifestyle choices, or other factors.&#x0D; Another challenge is ensuring that CR programs are tailored to the needs of individual patients. CR programs should take into account a patient's medical history, age, fitness level, and personal preferences. In addition, CR programs should be culturally sensitive and tailored to meet the needs of diverse populations. This can include providing materials in multiple languages, incorporating cultural preferences into dietary recommendations, and ensuring that CR programs are accessible to individuals with disabilities or other special needs.&#x0D; Finally, technology can play a critical role in expanding access to CR. Telemedicine and mobile health applications can allow patients to participate in CR programs from home or remote locations. These technologies can also facilitate communication between patients and healthcare providers, improve medication adherence, and provide patients with real-time feedback on their progress (11).&#x0D; In conclusion, CR is an essential component of CVD management and can significantly improve outcomes for patients with CVD. Healthcare providers, policymakers, and patients should work together to ensure that CR is widely available and accessible to all those who need it. By doing so, we can reduce the burden of CVD and improve the overall health and well-being of our communities.&#x0D; &#x0D; Keywords: Cardiac rehabilitation, cardiovascular disease, lifestyle modification

Effects of bariatric surgery and dietary intervention on insulin resistance and appetite hormones over a 3 year period

To examine an impact of three types of bariatric surgery compared with dietary intervention (DIET), on concurrent changes in Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and appetite hormones over 3 years. Fifty-five adults were studied during phase of weight loss (0–12 months) and during weight stability (12–36 months) post intervention. Measurements of HOMA-IR, fasting and postprandial PYY and GLP1, adiponectin, CRP, RBP4, FGF21 hormones and dual-Xray absorptiometry were performed throughout the study. All surgical groups achieved significant reductions in HOMA-IR with greatest difference between Roux-en-Y gastric bypass and DIET (− 3.7; 95% CI − 5.4, − 2.1; p = 0.001) at 12–36 months. Initial (0–12 months) HOMA-IR values were no different to DIET after adjustment for the lost weight. During 12–36 months, after controlling for treatment procedure and weight, for every twofold increase in postprandial PYY and adiponectin, HOMA-IR decreased by 0.91 (95% CI − 1.71, − 0.11; p = 0.030) and by 0.59 (95% CI − 1.10, − 0.10; p = 0.023) respectively. Initial, non-sustained changes in RBP4 and FGF21 were not associated with HOMA-IR values. While initial rapid weight loss reduces insulin resistance, the enhanced secretions of PYY and adiponectin may contribute to weight-independent improvements in HOMA-IR during weight stability.Clinical trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000188730.

Gastric Myoelectric Activity and Body Composition Changes during Weight Loss via Sleeve Gastrectomy and Lifestyle Modification: Prospective Cohort Study.

The capability of bariatric surgery (BS) and lifestyle intervention (LSI) in ameliorating obesity-associated altered gastric myoelectric activity (GMA) in relation to body composition is underinvestigated. This work studied GMA during weight loss via sleeve gastrectomy and multimodal lifestyle intervention. Seventy-nine participants with morbid obesity were assigned into three groups: bariatric surgery (BS group, n = 27), in which laparoscopic sleeve gastrectomy was performed; lifestyle intervention (LS group, n = 22), in which a calorie-deficit balanced diet with gradual physical activity and personalized behavioral modification were carried out; and waitlist control (C group, n = 30). For all participants, multichannel electrogastrography (EGG) with water-load testing and bioelectric impedance body composition analysis were done at baseline, after three months, and at six months. In the BS group, the water-load volume was decreased but without improvement in the bradygastria. In the LS group, preprandial bradygastria were reduced and some postprandial normogastria were increased throughout the study period. Except for fat-free mass and total body water, the parameters of body composition changes were superior in the BS group. In the LS group, the amount of fat-mass loss was negatively correlated with bradygastria times and positively correlated with preprandial and the early postprandial average dominant frequency (ADF). In addition, in the BS group, fat-mass loss was positively correlated with the ADF at late postprandial times. In conclusion, compared to BS, LS produced moderate normalization of GMA with the preservation of fat-free mass. The GMA changes were significantly associated with the amount of fat loss, regardless of the method of obesity management.

Inflammatory Cytokines, Redox Status, and Cardiovascular Diseases Risk after Weight Loss via Bariatric Surgery and Lifestyle Intervention.

Background and Objectives: Obesity is a chronic inflammatory condition and is considered a major risk factor for cardiovascular disease (CVD). The effects of obesity management via sleeve gastrectomy (SG) and lifestyle intervention (LS) on inflammatory cytokines, redox status, and CVD risk were studied in this work. Materials and Methods: A total of 92 participants (18 to 60 years old) with obesity (BMI ≥ 35 kg/m2 were divided into two groups: the bariatric surgery (BS) group (n = 30), and the LS group (n = 62). According to the achievement of 7% weight loss after 6 months, the participants were allocated to either the BS group, the weight loss (WL) group, or the weight resistance (WR) group. Assessments were performed for body composition (by bioelectric impedance), inflammatory markers (by ELISA kits), oxidative stress (OS), antioxidants (by spectrophotometry), and CVD risk (by the Framingham risk score (FRS) and lifetime atherosclerotic cardiovascular disease risk (ASCVD)). Measurements were taken before and after six months of either SG or LS (500 kcal deficit balanced diet, physical activity, and behavioral modification). Results: At the final assessment, only 18 participants in the BS group, 14 participants in the WL group, and 24 participants in the WR group remained. The loss in fat mass (FM) and weight loss were greatest in the BS group (p < 0.0001). Levels of IL-6, TNF-a, MCP-1, CRP, and OS indicators were significantly reduced in the BS and WL groups. The WR group had significant change only in MCP-1 and CRP. Significant reductions in the CVD risk in the WL and BS groups were detected only when using FRS rather than ASCVD. The FM loss correlated inversely with FRS-BMI and ASCVD in the BS group, whereas in the WL group, FM loss correlated only with ASCVD. Conclusions: BS produced superior weight and fat mass loss. However, both BS and LS produced a similar reduction in the inflammatory cytokines, relief of OS indicators, and enhancement of antioxidant capacity, and consequently reduced the CVD risk.

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery.

In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.

Immunohistochemical Findings in Retrocorneal Membranes of Eyes with Corneal Decompensation after Complicated Intraocular Surgery.

Retrocorneal membranes (RCMs) may result from epithelial ingrowth, stromal keratocytic downgrowth, fibrous metaplasia of the corneal endothelium, or a combination of these processes. In an institutional case series, the clinical history, ocular findings, and immunohistochemical staining results of RCMs were analysed in patients with unilateral corneal decompensation after complicated intraocular surgery. Between January 2021 and September 2022, six retrocorneal membranes were excised during Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) procedures and classified after screening with haematoxylin and eosin, periodic acid-Schiff, elastic van Gieson staining, and immunohistochemical screening with cytokeratin 7 (CK7), anti-cytokeratin (CAM5.2 and AE1/3), cell surface glycoprotein CD34, smooth muscle actin (α-SMA), and vimentin. On the basis of the immunohistochemical screening, the majority of excised RCMs (5 of 6) could histopathologically be classified as membranes originating from fibrous metaplasia of the corneal endothelium. All these RCMs were positive for CK7, α-SMA, and vimentin and negative for CAM5.2 and CD34. In one patient, an RCM had developed after 18 days of corneal contact to a free-floating dexamethasone implant in the anterior chamber and was classified as originating from stromal keratocyte downgrowth (α-SMA- and vimentin-positive, all others negative). All eyes in this series had a previous history of complicated cataract surgery, partially with subsequent intraocular lens exchange. No eyes after previous penetrating keratoplasty were in this series. In this series of eyes with previous complicated intraocular interventions (in most cases cataract surgery and revisions), the dominating RCM belonged to the type originating from fibrous metaplasia of the corneal endothelium.

SUBXIPHOID VIDEO ASSISTED THORACOSCOPIC SURGERY (VATS) FOR CHEST TRAUMA AND COMPLICATIONS

Introduction: Subxiphoid approach Video Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgical technique which can applied to variety of thoracic procedures with unanimous results even in emergency conditions such as chest trauma. This paper presents uniport-subxiphoid approach Video Assisted Thora Aim: coscopic Surgery (VATS) used in chest trauma and its detailed analysis. In this study, a total of 30 patients from November Material and Methods: 2022 to March 2023 underwent Subxiphoid approach Video Assisted Thoracoscopic Surgery (VATS) for the management of haemothorax and complications post chest trauma. In a Result: total of 30 patients from November 2022 to March 2023, Single port subxiphoid approach Video Assisted Thoracoscopic Surgery (VATS) was used to successfully conclude the surgery essential in all these patients presenting to Teerthanker Mahaveer Medical College and Hospital, post chest trauma. Additionally, 3 patients who developed bronchopleural stula post chest trauma also underwent correction using uniport subxiphoid Video Assisted Thoracoscopic Surgery (VATS). No postoperative wound infection was noted. Complete Haemothorax removal was achieved in all these patients. There was no case noted of post operative wound infection. All the patients were discharged early. Conclusion: Classical Median Sternotomy is the standard approach for haemothorax evacuation as indicated in previous studies. However, access through classical median sternotomy is associated with a higher risk of local infection and sternal instability. Additionally, it may sometimes be burdened with a high perioperative risk due to massive mediastinal adhesions in the late postoperative period. The uniport subxiphoid approach Video Assisted Thoracoscopic Surgery (VATS) is an effective procedure for evacuating haemothorax and correcting chest complications post trauma. Subxiphoid Video Assisted Thoracoscopic Surgery (VATS) intervention is also associated with decreased rates of chest infections and superior cosmesis. Moreover, it signicantly reduced the duration of ventilator dependency. The clinical outcomes were signicantly better for patients undergoing uniport Subxiphoid Video Assisted Thoracoscopic Surgery (VATS).

An in-depth look at zone III and IV anatomy of the finger extensor mechanism and some clinical implications for use of the relative motion flexion orthosis

BackgroundFor hand therapists and hand surgeons acute and chronic injuries of the extensor mechanism (EM) in zones III-IV are challenging to treat with satisfying results. IntroductionEarly active motion combined with relative motion flexion (RMF) orthoses to manage EM zone III injuries and boutonnière deformity has renewed interest in the complex anatomy and biomechanics of the EM. PurposeTo provide an in-depth discussion of EM zones III-IV anatomy with emphasis on inter-tendinous structures, often omitted in simplified, model-wise illustrations which focus mostly on the tendinous structures. MethodIn collaboration the authors combined on the one hand extensive clinical experience and knowledge of the EM literature and on the other hand decades of anatomical, biomechanical and kinesiology research of the EM with special interest for the spiral fibers, through gross anatomy and microdissection anatomy laboratory work, MRI and ultrasonography studies. ResultsThe inter-tendinous tissues (i.e., spiral fibers) in zone III are of imminent importance for proper functioning of the EM and to prevent boutonnière deformity to develop after EM surgery or injury. DiscussionInter-tendinous links between the tendinous structures of the EM are necessary for balanced finger motion. The spiral fibers are described in more detail because of their role in controlling volar migration of the conjoined lateral bands and because their disruption makes development of boutonnière deformity more likely. Understanding the anatomy and biomechanics of the EM may assist in progress toward ‘proof of concept’ for use of RMF orthoses and controlled early active motion after EM injury or surgery. ConclusionHand surgery and hand therapy practice interventions, including use of RMF orthoses for management of non-surgical and surgical EM injuries may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics.

The economic impacts of cataract surgery on sustainable vision and quality of life in Katsina state

AbstractBackgroundThis study investigates the economic impacts of eye care interventions on the quality of life in Katsina state. Eye care intervention is a requirement for equitable and inclusive development in the state.MethodsThe study used a survey method and 5‐point Likert scale questionnaire to collect data. A multistage sampling strategy was employed to select 300 beneficiaries from the existing beneficiaries of Noor Dubai Foundation (NDF) eye care interventions.ResultsThe findings show that cataract surgery interventions improve economic benefits and quality of life of beneficiaries in Katsina state. The results show that productivity, income, employability, dignity and skills of beneficiaries have improved significantly after the cataract surgery. Precisely, 96.2% of the beneficiaries agree that their productivity has improved; 99.6% of the beneficiaries revealed that their income has improved; 99% of respondents evidence that their employability has improved; 90% of beneficiaries have experienced an improvement in their dignity; while 97% agreed that their skills have improved.ConclusionThe implication of these findings is that poor eye health is negatively related to economic benefits and quality of life while good eye health is a vital determinant of standard of living. Without good eye health, it is hard to participate in the labour force, produce goods and earn income. Thus, the Katsina state government should further improve awareness of good eye health to mitigate preventable cases of blindness for equitable and inclusive development.

In which context and for whom can interventions improve leadership of surgical trainees, surgeons and surgical teams and why: a realist review protocol.

Improving effective leadership of individuals, groups, and healthcare organisations is essential for improving surgical performance and indirectly improving health outcomes for patients. Numerous systematic reviews have been conducted which seek to determine the effectiveness of specific leadership interventions across a range of disciplines and healthcare outcomes. The purpose of this realist review is to systematically synthesise the literature which examines in which context and for whom leadership interventions improve leadership of surgeons, surgical teams, and trainees. Several approaches will be used to iteratively search the scientific and grey literature to identify relevant evidence. Selected articles will inform the development of a programme theory that seeks to explain in which context and for whom interventions can improve leadership of surgical trainees, surgeons, and surgical teams. Next, empirical studies will be searched systematically in order to test and, where necessary, refine the theory. Once theoretical saturation has been achieved, recommendations for advancing leadership in surgery will be developed. Stakeholder and patient and public consultations will contribute to the development of the programme theory. The review will be written up according to the Realist And Meta-narrative Evidence Synthesis: Evolving Standards publication standards. No ethical review will be required for the conduct of this realist review. The knowledge gained from this review will provide evidence-based guidance for those planning or designing leadership interventions in surgery. The recommendations will help policymakers, educationalists, healthcare providers, and those delivering or planning leadership development programmes across the surgical disciplines to design interventions that are acceptable to the surgical community and successful in improving surgical leadership.PROSPERO registration: CRD42021230709.

The effect of nursing interventions with therapeutic play and video animations prepared with psychodrama technique in reducing fear, anxiety, and pain of children at male circumcision: A randomized controlled study.

This research was carried out to reduce the fear, anxiety and pain of 4-6 age circumcised children with therapeutic play and video animation interventions. This research was conducted as a randomized controlled study between November 2019 and April 2021. Using block randomization, 30 (n = 30) children were assigned to the control group, 30 (n = 30) to the therapeutic puppet group and 30 (n = 30) to the video animation group. Before the circumcision surgery, therapeutic puppet and video animation interventions were applied to children with scenario prepared with psychodrama technique. Fear, anxiety, and pain findings of children before and after surgery were determined. The fear and anxiety scores of the children were similar before the nursing intervention in all groups, and that the fear and anxiety scores of therapeutic puppet play and video animation intervention groups had statistically lower than the control group after nursing intervention. The pain scores of the children from the therapeutic puppet play and video animation groups had lower pain scores than the control group after surgery (F = 5.24, p = 0.007). Therapeutic play and video animation intervention can be effective in reducing fear and anxiety of children aged 4-6 before and after circumcision surgery.

Hydrogel-Based Strategies for the Management of Osteomyelitis.

Osteomyelitis is a type of bone infection caused by bacteria, with Staphylococcus sepsis being responsible for most cases. Osteomyelitis treatment generally requires a multifaceted approach that may include intervention of surgery and administration of antibacterial agents, where several materials have been utilized as delivery vehicles for antibiotics and other antibacterial materials. Hydrogel has become a popular candidate for osteomyelitis treatment due to its biocompatibility, water-containing porous structure, and adaptable physicochemical properties. In this review, we discuss several hydrogel-based strategies for osteomyelitis treatment and categorized them based on the encapsulated cargos (i.e., antibiotics, silver nanoparticles, protein and bacteriophage, and reactive oxygen species (ROS) generator). Several representative examples of osteomyelitis treatment using hydrogels are described here, focusing on their design, preparation, properties, and outcomes. We also provide our perspectives on the remaining concerns regarding fabricating advanced hydrogels for osteomyelitis treatment. This review will be valuable to the hydrogel community and inspire researchers to develop next-generation hydrogels for specific and practical clinical applications in osteomyelitis.

Evaluation of the wound-healing potential of the kiwifruit extract by assessing its effects on human gingival fibroblasts and angiogenesis.

Oral surgery and surgical interventions in the field of periodontology require the uneventful wound healing of soft tissues to be successful. However, since the oral cavity is exposed to saliva and is a niche for oral microorganisms, wound healing can be delayed, causing pain and discomfort to the patient. Hence, a great deal of interest has shifted to the study of agents that can enhance wound-healing processes. The aim of the present study was to evaluate the oral wound-healing potential of the Actinidia deliciosa (kiwifruit) extract by assessing its effects on the viability, proliferation and migration of human gingival fibroblasts, and its ability to enhance angiogenesis in the chicken chorioallantoic membrane (CAM). The collection of the A. deliciosa extract and experimentation were carried out in the Maratha Mandal Dental College, Belgavi, India. Human gingival fibroblasts were cultured in a suitable medium and treated with 6.25 μg, 12.5 μg or 25 μg of the ethanolic kiwifruit extract. The MTT cell viability and scratch assays were then carried out in vitro. To determine the angiogenic potential of the extract, solutions of concentrations of 10 μg/mL, 50 μg/mL and 100 μg/mL were transferred to sterile Whatman™ filter paper disks, which were placed on the CAM of 5-day-old Leghorn chicken eggs. The ethanolic extract of A. deliciosa was not cytotoxic to gingival fibroblasts at a dosage of 6.25 μg/mL. In addition, the scratch assay demonstrated the migration of the fibroblasts and the closure of an artificially created wound within 24 h, which is similar to in vivo wound closure. The CAM assay showed that the kiwifruit extract concentrations of 10 μg/mL and 50 μg/mL showed a moderate proangiogenic effect, and a concentration of 100 μg/mL exerted a strong pro-angiogenic effect. The results demonstrate that the kiwifruit extract is safe to use, can enhance the proliferation and migration of human gingival fibroblasts, and promotes angiogenesis, making it a suitable oral wound-healing agent.

The matrix revolutions: How databases and database linkages will transform epidemiologic research.

The matrix revolutions: How databases and database linkages will transform epidemiologic research.

The involvement of Lymphocyte activation gene 3 and the inhibitor in non-small cell lung cancer

Non-small cell lung cancer, or NSCLC, is the most typical malignant tumor in lung carcinoma. NSCLC causes a relatively high fatality and prevalence rate compared to other cancers worldwide. A combination of surgery, chemotherapy, and chemoradiotherapy interventions are commonly used as standard or front-line therapy for patients with NSCLC. However, a relatively novel treatment, immunotherapy, has become a popular target for many cancer-related clinical researches in recent years, including melanoma, urothelial cancer, and NSCLC. The general purpose of immunotherapy is to target the host’s immune system and increase the immune response opposing the tumor. Within immunotherapy, immune checkpoint inhibitor (ICI) was gaining increasing attention as a therapeutic method for many cancers through recent studies. Immune checkpoints (ICs) regulate the immune response and suppress the activity of immune cells when expressed. This mechanism of action prevents immune cells from developing autoimmunity, which, if it happens, immune cells will start attacking healthy cells in the host. However, one disadvantage of IC is that they indirectly enhance tumor survival by deactivating immune cells. Thus, many ICIs are developed to directly inhibit the activity of the targeted IC. Among all types of immune checkpoints, lymphocyte activation gene 3 (LAG-3) acts as an essential IC in the host’s cell. The primary objective of this article is not only to elucidate the association between LAG-3 and NSCLC but also to explain the effect of anti-LAG-3 drugs in patients with NSCLC, its synergistic effect with other checkpoint inhibitors, and the limitations of immune checkpoint inhibitors for future investigation.

Validation of a modified South African triage scale in a high-resource setting: a retrospective cohort study

BackgroundTriage systems are widely used in emergency departments, but are not always validated. The South African Triage Scale (SATS) has mainly been studied in resource-limited settings. The aim of this study was to determine the validity of a modified version of the SATS for the general population of patients admitted to an ED at a tertiary hospital in a high-income country. The secondary objective was to study the triage performance according to age and patient categories.MethodsWe conducted a retrospective cohort study of patients presenting to the Emergency Department of Haukeland University Hospital in Norway during a four-year period. We used short-term mortality, ICU admission, and the need for immediate surgery and other interventions as the primary endpoints.ResultsA total of 162,034 emergency department visits were included in the analysis. The negative predictive value of a low triage level to exclude severe illness was 99.1% (95% confidence interval: 99.0–99.2%). The level of overtriage, defined as the proportion of patients assigned to a high triage level who were not admitted to the hospital, was 4.1% (3.9–4.2%). Receiver operating characteristic (ROC) curves showed an area under the ROC for the detection of severe illness of 0.874 (95% confidence interval: 0.870–0.879) for all patients and 0.856 (0.837–0.875), 0.884 (0.878–0.890) and 0.869 (0.862–0.876) for children, adults and elderly individuals respectively.ConclusionWe found that the modified SATS had a good sensitivity to identify short-term mortality, ICU admission, and the need for rapid surgery and other interventions. The sensitivity was higher in adults than in children and higher in medical patients than in surgical patients. The over- and undertriage rates were acceptable.