Surgical Treatment Research Articles

Long-term prognosis and related factors of neonatal and small infants meningitis caused by streptococcus agalactiae

Objective: To explore the long-term prognosis and related factors of neonates and infants meningitis caused by Streptococcus agalactiae. Methods: The Clinical data of neonates and small infants with Streptococcus agalactiae meningitis admitted to the Children's Hospital of Zhengzhou University from January 2015 to May 2022 were retrospectively collected, and long-term follow-up of neurological development was conducted for the patients, with a follow-up period of ≥18 months. According to long-term neurological prognosis indicators, the patients were divided into good prognosis group and poor prognosis group, and the multivariate logistic regression model was used to analyze the factors affecting the long-term prognosis of the patients. Results: A total of 86 children were included, with 50 males and 36 females, and their age ranged from 3 to 85 (29.7±18.5) days. The follow-up duration was 20 to 78(47.2±17.0) months, and the age at the end of follow-up was 1.8 to 6.6(4.2±1.3) years. Among them, there were 54 cases in good long-term prognosis group and 32 cases in poor prognosis guoup. Infectious shock [56.3%(18/32) vs 13.0%(7/54), P<0.001], hypoproteinemia [46.9%(15/32) vs 22.2%(12/54), P=0.017], surgical intervention for neurological complications [31.0%(13/32) vs 7.4%(4/54), P=0.003], abnormal neurological examination at discharge [37.5%(12/32) vs 7.4%(4/54), P<0.001], and abnormal cranial imaging at discharge [53.1%(13/32) vs 7.4%(4/54), P<0.001] were higher in the poor prognosis group than those in the good prognosis group. The peripheral blood WBC count [M(Q1, Q3)] [4.7(3.4, 7.6)]×109/L at the onset of the disease was lower in the poor prognosis group than that in the good prognosis group [10.1(3.8, 14.1)]×109/L, and the cerebrospinal fluid protein concentration [3.0(2.1, 3.8)] g/L was higher in the poor prognosis group than that in the good prognosis group [2.5(1.9, 2.8)] g/L (both P<0.05). The multivariate logistic regression model found that peripheral blood WBC<4.0×109/L (OR=5.501,95%CI:1.430-21.170,P=0.013), infectious shock (OR=4.600,95%CI:1.008-21.004,P=0.047), neurological complications undergoing surgical intervention (OR=8.961,95%CI:1.792-44.812,P=0.008), and abnormal head imaging at discharge (OR=12.636,95%CI:2.502-63.829,P=0.002) were related factors for poor long-term prognosis in neonatal and infants meningitis caused by Streptococcus agalactiae. Conclusions: Neonates and infants meningitis caused by Streptococcus agalactiae have a high incidence of long-term adverse prognosis. Peripheral blood WBC<4.0×109/L, infectious shock, neurological complications undergoing surgical intervention, and abnormal cranial imaging at discharge are related factors for poor long-term prognosis.

Long-term Outcomes of Surgical Treatment for Pancreatic Neuroendocrine Neoplasm with Synchronous Hepatic Metastasis: A Multicenter Retrospective Cohort Study

Abstract Objectives: To evaluate surgical impact on the overall survival (OS) of pancreatic neuroendocrine neoplasm (pNEN) with synchronous hepatic metastases (sHM). Methods: A total of 163 pNEN-sHM patients were recruited from 3 institutions in China, who were categorized into 3 groups: no resection (NR), resection of the primary lesion (PR) and resection of both primary and hepatic lesions (PHR). Cox regression was employed to evaluate surgical impact on the OS. Results: In the overall cohort analysis, PHR demonstrated a significant protective effect on OS (HR 0.302, 95% CI: 0.127–0.721, p = 0.007). Nevertheless, subgroup analysis revealed PHR conferred a survival advantage in patients with pancreatic neuroendocrine tumor (pNET) located on the pancreatic body/tail (bt-pNET-sHM) (HR 0.287, 95% CI: 0.087–0.946, p = 0.040), whereas surgical treatment did not significantly impact survival in the subgroups of pancreatic neuroendocrine carcinoma (pNEC)-sHM or pancreatic head/neck pNET-sHM (hn-pNET-sHM). Conclusions: In this study, the survival benefit of surgery was only observed in the bt-pNET-sHM subgroup. Considering the multifactorial nature of decision-making, surgical intervention for pNEN-sHM management should be approached with a careful and comprehensive assessment, to prevent excessive surgery strategies.

Correlation linking illness perception, negative emotions, and the post-operative recovery effect in patients with perianal disease

BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease. Although surgical treatments are effective, the outcomes of post-operative recovery (POR) are influenced by various factors, including individual differences among patients, the characteristics of the disease itself, and the psychological state of the patient. Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease. AIM To investigate the effect of illness perception (IP) and negative emotions on POR outcomes in patients with perianal disease. METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited. We employed a general information questionnaire, the Brief Illness Perception Questionnaire (B-IPQ), and the Hospital Anxiety and Depression Scale (HADS). We used the 15-item Quality of Recovery Score (QoR-15) to measure patients’ recovery effects. Finally, we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality. RESULTS Fifty-three (36.3%) had poor knowledge of their disease. Thirty (20.5%) were suspected of having anxiety and 99 (67.8%) exhibited symptoms. Forty (27.4%) were suspected of having depression and 102 (69.9%) displayed symptoms. The B-IPQ, HADS-A, HADS-D, and QoR-15 scores were 46.82 ± 9.97, 12.99 ± 3.60, 12.58 ± 3.36, and 96.77 ± 9.85, respectively. There was a negative correlation between pre-operative IP, anxiety, and depression with POR quality. The influence of age and disease course on post-operative rehabilitation effect are both negative. The impact of B-IPQ, HADS-A, and HADS-D on POR was negative. Collectively, these variables accounted for 72.6% of the variance in POR. CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age, disease course, IP, anxiety, and depression.

Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study

Abstract Objective Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS). Methods All pediatric patients (&lt; 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded. Results Seventy-one pediatric patients with a median age of 9 years were included. Most patients (58%) were females. Chiari 1 was associated with syringomyelia (51%), scoliosis (37%), and hydrocephalus (7%). Perioperative complications occurred in 13 patients (18%) of which two required additional procedures under general anesthesia. On multivariable proportional odds logistic regression, motor deficits (OR: 0.09; CI95%: [0.01–0.62]; p = 0.015), and surgical complications (OR: 0.16; CI95%: [0.41–0.66]; p = 0.011) were significant predictors of worse outcomes. The presence of syringomyelia was identified as a predictor of better outcomes (OR: 4.42 CI95% [1.02–19.35]; p = 0.048). A persistent hydrocephalus during the early postoperative period after posterior fossa decompression was a strong predictor of worse long-term CCOS (OR: 0.026; CI95%: [0.002–0.328]; p = 0.005). Conclusion Results from this study indicate that the existence of motor deficits and syringomyelia prior to surgery, and surgical complications and persistent hydrocephalus despite posterior fossa decompression, were useful predictors of long-term outcome.

Determination of the Surgical Landmarks for the Anterior and Middle Cranial Fossa in Dry Skulls With the Photography System, Cadavers and 3-Dimensional Computed Tomography

The present paper was designed to analyze the dimensions of such important bony structures and surgical landmarks, which are used by many clinicians in many surgical interventions, in dry skull, cadaver, and healthy subjects on computed tomography (CT) images, and to determine whether there is a significant difference between these methods, and to obtain reference values from 3 different methods. Eight cadavers and 16 dry skulls and 100 three-dimensional (3D) CT images were studied. Necessary permissions for the study were obtained from Ethics Comittee. The 16 parameters were measured with an electronic digital caliper accurate 0.01 mm (LCD Digital Vernier Dial Microcaliper (INCA, DCLA-0605, 0.6–150 mm, USA). Also, the images obtained were transferred to the 3D Slicer (version 5.6.2) software program. Eight cadavers and 16 dry skulls of Turkish adults were unknown age and sex, whereas the mean age of females and males on CT images were 31.63±11.23 and 33.70±13.34 years, respectively. All values of the surgical landmarks for the anterior and middle cranial fossa obtained from cadavers, dry skulls, and 3D CT subjects (except length of lesser wing, anterior clinoid lengths for 2 sides, and width for right side) were statistically significant between 3 groups (P&lt;0.05). This paper was conducted for the morphometric analysis of the specific regions of the anterior cranial fossa (ACF), and middle cranial fossa (MCF), which are used in neurosurgical procedures This detailed anatomic and radiologic reference values will be an extremely important source in the planning of both clinical and surgical approaches for neurosurgeon, anatomist, and radiologists.

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial

Abstract Background Following successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications. Methods Study design: A prospective multicenter randomized controlled trial. Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18–67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included. Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB. Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot &amp; Ankle Society Score (AOFAS)). Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks. Discussion This study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic. Trial registration ClinicalTrials.gov NCT05721378, accepted on February 7, 2023.

Malignant Transformation of Recurrent Benign Phyllodes Tumor: A Case Report and comprehensive review of literature

Introduction: Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, accounting for less than 1% of all breast tumors. The World Health Organization (WHO) classifies PTs into benign, borderline, or malignant categories based on histological features. While benign PTs generally have a favorable prognosis, they carry a risk of transformation into malignant variants, particularly in cases of recurrence. Case Presentation: A 33-year-old female presented with a recurrent benign PT, previously treated with lumpectomy on two occasions. Recent imaging suggested possible malignant transformation, and histopathological examination confirmed a malignant PT. Discussion: This case highlights the crucial role of imaging in the early detection of malignant transformation in PTs. Surgical management strategies are discussed, with an emphasis on the potential for recurrent benign tumors to progress to malignancy. Conclusion: Regular imaging and close follow-up are essential for early detection of malignant transformation in recurrent PTs, guiding timely and appropriate surgical intervention.

Solitary fibrous tumor of the gallbladder: a case report

Abstract Background Primary solitary fibrous tumors (SFTs) of the gallbladder are rare. Here, we report the case of a patient who underwent surgical treatment for a primary SFT originating in the gallbladder. Case presentation A 48-mm gallbladder tumor was detected in a 70-year-old man using abdominal ultrasonography at a primary hospital, and he was subsequently referred to our department. A 50-mm enhanced tumor in the gallbladder was identified using computed tomography. Magnetic resonance imaging revealed a smooth-marginated tumor with hyperintensity on T2-weighted imaging. 18F-Fluorodeoxyglucose positron emission tomography confirmed high-level fluorodeoxyglucose uptake in the gallbladder tumor in the early phase without increasing uptake in the later phase. Surgical resection was planned to evaluate the tumor diagnosis. Initially, we performed open cholecystectomy with wedge resection of the gallbladder bed. Intraoperative pathological examination suggested gallbladder cancer; therefore, we performed radical surgery, including resection of the common bile duct, extended radical lymphadenectomy, and choledochojejunostomy. Ultimately, the final pathological examination revealed an SFT originating from the gallbladder with a negative surgical margin. Postoperatively, the patient developed bile leakage that was treated with tube drainage. The patient recovered satisfactorily and was discharged on postoperative day 20. At 24 months postoperatively, the patient was in good general condition without recurrence. Conclusions We report a rare case of a primary SFT originating in the gallbladder. Clinicians should be aware that SFT can be found in the gallbladder, and when it is difficult to make a preoperative diagnosis, surgical treatment should be considered.

Intracerebral hemorrhage

Background: Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and more severe disability. Asian such as Chinese and Japanese and Mexican Americans, Latin Americans, African Americans, Native Americans have higher incidences than do white Americans. So, ICH is an important cerebrovascular disease in Asia. Summary: ICH accounts for approximately 10-20% of all strokes. The incidence of ICH is higher in low- and middle-income than high-income countries and is estimated 8-15% in western countries like USA, UK and Australia, and 18-24% in Japan, Taiwan and Korea. The ICH incidence increases exponentially with age, and old age especially over 80 years is a major predictor of mortality independent of ICH severity. Females are older at the onset of ICH and have higher clinical severity than males. Modifiable risk factors include blood pressure, smoking, alcohol consumption, lipid profiles, use of anticoagulants, antiplatelet agents and sympathomimetic drugs. Non-modifiable risk factors constitute old age, male gender, Asian ethnicity, cerebral amyloid angiopathy, cerebral microbleed, and chronic kidney disease. Blood pressure is the most important risk factor of ICH. Imaging markers may help predict ICH outcome, which include black hole sign, blend sign, iodine sign, island sign, leakage sign, satellite sign, spot sign, spot-tail sign, swirl sign, and hypodensities. ICH prognostic scoring system such as ICH scoring system and ICH grading scale scoring system in Chinese and Osaka prognostic score and Naples prognostic score has been used to predict ICH outcome. Early minimally invasive removal of ICH can be recommended for lobar ICH of 30–80 mL within 24 hours after onset. Decompressive craniectomy without clot evacuation might benefit ICH patients aged 18–75 years with 30–100 mL at basal ganglia or thalamus. However, clinical studies are needed to investigate the effect of surgery on patients with smaller or larger ICH, ICH in non-lobar locations, and for older patients or patients with preexisting disability. Surgical treatment is usually associated with neurological sequels if survived. For medical treatment, blood pressure lowering should be careful titrated to secure continuous smooth and sustained control and avoid peaks and large variability in systolic blood pressure. Stroke and cancer are the most common causes of death in Asian ICH patients, compared to stroke and cardiac disease in non-Asian patients. Key Messages: The incidence and outcome are different between Asian and non-Asian patients, and more clinical studies are needed to investigate the best management for Asian ICH patients.

Features of hematological indices in cataract in the dynamics of surgical treatment

BACKGROUND: Cataract is one of the most common ophthalmologic diseases leading to blindness. AIM: To study the features of hematological indices in men over 40 years old with different types of cataract before and after surgical treatment. MATERIAL AND METHODS: The examination groups included 25 patients (25 eyes) with opacities localized in the cortical substance of the lens, 19 (19 eyes) with total opacities, 26 (26 eyes) with nuclear opacities, 30 (30 eyes) with subcapsular opacities; of these, 43 patients (43 eyes) had initial cataract, 39 (39 eyes) — immature, 18 (18 eyes) — mature cataract. The control group consisted of 30 people. All study participants underwent a complete ophthalmologic examination and assessment of hematological indices. The following integral hematological indices were calculated using generally accepted formulas: lymphocyte index (lymphocytes/neutrophils); leukocyte intoxication index; neutrophil/lymphocyte ratio index; neutrophil/monocyte ratio index; lymphocyte/monocyte ratio index; lymphocyte/eosinophil ratio index; leukocyte ratio and erythrocyte sedimentation rate index. Statistical analysis was performed using the Statistica 10 package. The Kruskal–Wallis and Mann–Whitney nonparametric tests were used to assess differences in the groups. The critical level of statistical significance when testing scientific hypotheses was p 0.05. RESULTS: At all stages of cataract maturity, before and after surgery, unidirectional changes in the hematological indices were revealed: the lymphocyte and eosinophil ratio decreased (1.4–2.0; p=0.01), the neutrophils and monocytes (1.3–2.1; p=0.04), lymphocytes and monocytes (1.4–2.5; p=0.02) ratios, leukocytes and erythrocyte sedimentation rate (2.9–6.8; p=0.01) increased. In immature cataract, the intoxication index according to the hematological indices increased by 2 times in the dynamics of surgical treatment. At the same time, multidirectional changes in the hematological indices were revealed in cortical and subcapsular opacities of the lens, unidirectional changes — in nuclear and total opacities. CONCLUSION: Patients with nuclear and total cataracts have the greatest number of disturbances in the ratio of cell populations according to hematological indices, therefore they constitute a risk group for the development of complications.

Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?

Objective: There are no studies that evaluate the effects that insurance or socioeconomic status may have on treatment and outcomes of scaphoid nonunions in children. We evaluated whether there is an association between insurance status and (1) time from injury to hand surgeon evaluation, (2) time from specialist evaluation to surgery, and (3) postoperative outcomes of scaphoid fracture nonunions in children. Methods: A chart review was performed for patients who underwent surgical treatment of scaphoid fracture nonunion from January 2015 and April 2021 at a large tertiary care pediatric hospital. Underinsured patients were defined as those with no medical insurance or Medicaid/state-funded insurance. Results: There were 21 privately insured patients and 17 patients who were underinsured. There was no difference in age, race, or fracture characteristics between the two groups. The mean time between injury and hand surgeon evaluation was 192 SD 195 days for the privately insured group compared with 155 SD 205 days for the underinsured group (P = 0.57). The mean time between specialist evaluation and surgical treatment was 35 SD 54 days for the privately insured group and 31 SD 31 days for the underinsured group (P = 0.82). Union was achieved in 80% of patients with private insurance compared with 88% of underinsured patients after primary surgery (P = 0.67). There was no difference detected in the proportion of patients who had residual pain (15% vs 19%), range of motion deficits (38% vs 40%), strength deficit (6% vs 7%), and return to activity (94% vs 93%) between privately insured and underinsured patients, respectively (P = 1.00). Conclusions: There was no difference in time from injury to specialist evaluation, time from evaluation to surgery, or postoperative outcomes based on insurance status for pediatric patients with scaphoid fracture nonunions. Although insurance status was not associated with access to care for pediatric scaphoid fracture nonunions at our institution, this information may not be generalizable to other populations, including patients who sustain primary scaphoid fractures and who have not yet developed nonunions. Level of Evidence: Level III—retrospective cohort study.

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

Abstract Introduction Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

Comparative Analysis of Full Endoscopic Interlaminar Lumbar Discectomy and Lumbar Microdiscectomy

Study Design: Retrospective clinical study. Objectives: The aim is to assess and contrast the results of full endoscopic lumbar discectomy (FELD) and lumbar microdiscectomy (LMD) for L5–S1 disc herniation, with a specific emphasis on postoperative pain reduction and surgical effectiveness. Background: Although minimally invasive spine operations are becoming more popular, there is still little research on the comparative effectiveness of FELD and LMD. Materials and Methods: The research had a total of 50 patients who received surgical intervention for L5–S1 disc herniation, with 25 patients getting full endoscopic interlaminar discectomy and the other 25 patients undergoing LMD. Clinical outcomes were assessed using the Visual Analog Scale for low back and leg pain, collected preoperatively and at the end of 1 week, 3 months, and 6 months postsurgery. Patient satisfaction was evaluated using Odoms criteria at the same intervals. Results: The study included 50 patients (26 men, 24 women), with a mean age of 51.11 ± 13.76 years. The groups had no significant differences in demographic data. Back and leg pain Visual Analog Scale scores decreased more significantly in the FELD group after 1 week of surgery (P &lt; 0.001), although the declines at 3 months and 6 months were not significantly different between the two groups. According to Odoms criteria, patient satisfaction was favorable in both groups and significantly better in the FELD group than in the LMD group at 1 week postoperatively [excellent in 20 patients (80%) in the FELD group vs 9 patients (36%) in the LMD group (P = 0.025)]. However, patient satisfaction at 3 months and 6 months did not differ between the groups. Conclusion: This study demonstrates that FELD offers significant early postoperative advantages over LMD at the L5–S1 level when compared with pain and satisfaction scales. Level of Evidence Level III.

The Impact of Mindfulness-Based Meditation and Yoga on Stress, Body Image, Self-esteem, and Sexual Adjustment in Breast Cancer Patients Undergoing Modified Radical Mastectomy

Background Surgical interventions are commonly utilized in the treatment of breast cancer; however, they can elicit adverse effects on women’s perceptions of femininity, leading to stress, negative body image, diminished self-esteem, and challenges in sexual adjustment. Objective This study investigates the efficacy of mindfulness-based meditation and yoga in alleviating stress, enhancing self-esteem, improving body image, and facilitating sexual adjustment among women undergoing modified radical mastectomy. Methods Using a prospective (pretest, posttest, and second-month follow-up), 2-arm (1:1), randomized controlled experimental design, the study involved 39 women (intervention group = 19, control group = 20) undergoing modified radical mastectomy. The intervention group participated in face-to-face mindfulness-based meditation and yoga sessions lasting approximately 90 minutes each over an 8-week period. Results Following the intervention, significant reductions in perceived stress and the significance attributed to breasts in sexuality were observed (P &lt; .05), accompanied by increases in self-esteem and body perception (P &lt; .05). However, no significant differences were observed in sexual adjustment (P &gt; .05). Conclusions Mindfulness-based meditation and yoga interventions demonstrated efficacy in mitigating perceived stress, enhancing self-esteem, and improving body perception among women undergoing modified radical mastectomy. The findings advocate for the integration of mindfulness-based stress reduction programs, particularly during the preoperative phase, to support oncological patients, particularly those with breast cancer. Implications for Practice Psychosocial aspects such as body image, self-esteem, and sexual adjustment following radical mastectomy are frequently overlooked in clinical care. This research highlights the potential benefits of incorporating mindfulness-based yoga and meditation techniques into nursing interventions to alleviate stress and enhance body confidence among women undergoing mastectomy.

Surgery and the first 8000 days of life: a review

Abstract The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2–21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children's surgery through initiatives like the Optimal Resources for Children's Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.

Results of a Phase 2 Multicenter Study to Evaluate the Efficacy of VP-315, an Investigational Therapy for Basal Cell Carcinoma

Introduction: VP-315 is an intratumorally injected, chemotherapeutic oncolytic peptide in development as a non-surgical immunotherapeutic agent to be utilized as first line therapy in a primary or neoadjuvant setting for patients with basal cell carcinoma (BCC). Objective: In Part 2 of this study, the secondary objective was to evaluate the effect of various dosing regimens on the antitumor efficacy of VP-315 in a larger population of adult subjects with biopsy proven BCC. Methods: Eighty-two (82) subjects with up to 2 target BCC tumors (total 91 tumors) were treated intratumorally with VP-315 for up to 2 weeks. Cohort 3 was not enrolled based on results from Cohorts 1-2. Each 7-day treatment week was comprised of 2 or 3 consecutive treatment days followed by a no-treatment period of at least 4 days. Dosing scheme: Cohort 1: (n=6) Tumor injected 3 days consecutively (3X/week 4 mg loading dose Day 1 followed by 8 mg dose). Cohort 2: (n=3) Tumor injected 3 days consecutively (3X/week 8 mg dose). Cohort 4: (n=36) Each tumor was injected 2 days consecutively (2X/week 8 mg split dose*). Cohort 5: (n=37) Each tumor was injected 3 days consecutively (3X/week 8 mg split dose*). * Dose split into 2 injections, 30% injected initially; 70% injected 15-30 minutes later. Efficacy endpoints included histological clearance of target tumor(s) and estimate of remaining tumor volume (tumor size reduction) at excision (Week 12-13). Results: Eighty-two (82) subjects (n=92 lesions) completed treatment for BCC with VP-315 in Part 2. Approximately 51% of tumors achieved complete histologic clearance. All tumors treated had a reduction in tumor size. Overall tumor size reduction was 86%. Tumor size reduction in subjects who still had any residual tumor was 71%. Conclusion: Complete histological clearance in a majority of VP-315 treated tumors could eliminate the need for surgical intervention in those patients in clinical practice. In subjects with residual tumor burden, the substantial reduction in tumor size after VP-315 treatment would markedly reduce the surgical incision area and the amount of potential post-surgical scarring. Based on the favorable results, further research using VP-315 as a potential non-surgical immunotherapy for BCC as a first line therapy in a primary or neoadjuvant setting is warranted.

Guardian Knowledge in Primary Congenital Glaucoma: A Cross-Sectional Study

Précis: Guardian education level and frequency of surgical interventions are key determinants of knowledge in primary congenital glaucoma, highlighting the need for targeted educational strategies. Background: Management of congenital glaucoma poses unique challenges, particularly concerning the patient guardians’ understanding of the condition, which is crucial for treatment adherence and follow-up compliance. This study aimed to assess guardians’ knowledge levels and identify the influencing factors. Methods: This cross-sectional study included 103 guardians of pediatric patients with PCG. Participants with missing data were excluded from the study. The participants were assessed using a 20-question survey covering various aspects of glaucoma. Descriptive and inferential statistics were used for analysis. Results: The sample included 96 guardians, primarily females (80.2%). The children’s ages varied significantly, averaging approximately 44 months (SD = 39.8). The guardians predominantly had secondary education (34.4%) and most were housewives (77.1%). There was a positive correlation between higher education levels and the overall knowledge score of guardians (P = 0.006). Similarly, the guardian’s locality showed a positive correlation with knowledge scores, with urban guardians having higher scores than rural guardians. Additionally, there was a positive correlation between the number of surgical operations performed on the child and the guardians’ knowledge. For the subtotals, variables such as the child order among siblings and age of the child showed significant positive correlations, emphasizing the multifaceted influences on guardians’ understanding. In the multivariate analysis, the guardian’s education level showed a significant positive correlation for the Overall Score, as did the number of operations performed on the patient. Conclusions: The study revealed gaps in guardian knowledge, irrespective of educational level or other demographic factors. Guardians’ education level and the number of operations performed on the child are critical determinants of guardians’ understanding of congenital glaucoma. Traditional approaches to educational interventions may require re-evaluation, and there is a pressing need for targeted educational interventions.

The use of adjuvant chemotherapy in cats with mammary carcinomas undergoing surgical removal.

PICO Question In cats with mammary carcinomas undergoing surgical removal, does the addition of adjuvant chemotherapy compared with surgical removal alone result in increased survival time? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Five retrospective cohort studies were critically reviewed. Strength of evidence Weak. Outcomes reported In cats with mammary carcinomas undergoing surgical removal, the addition of adjuvant chemotherapy compared with surgical removal alone was significantly associated with an increase in disease-specific survival time in one of the studies. This statistical significance was not found in the other four papers. Conclusion All five studies reviewed presented weak evidence for the clinical question due to their retrospective nature and weak study design. It is, therefore, concluded that there is not enough evidence to suggest that cats with mammary carcinomas that have undergone surgical treatment will have a longer survival time if treated with adjuvant chemotherapy. More prospective, placebo-controlled, double-blinded studies are needed to understand the clinical significance of adjuvant chemotherapy in cats with mammary carcinomas.

Surgical treatment of fallopian tubal pregnancy and interstitial pregnancy has no differential effect on intrauterine pregnancy after in vitro fertilization-embryo transfer

Surgical treatment of fallopian tubal pregnancy and interstitial pregnancy has no differential effect on intrauterine pregnancy after in vitro fertilization-embryo transfer

The Initial Exploration of Polidocanol Sclerotherapy for the Treatment of Axillary Osmidrosis: A Retrospective Study

BACKGROUND Axillary osmidrosis (AO) is a strong, unpleasant odor that originates from the apocrine axillary glands. Treatments of AO include surgical treatment and nonsurgical treatment. The surgical procedure yields effective results with a low recurrence rate but requires a longer recovery time and has more postoperative complications. Nonsurgical treatments are minimally invasive and safe, but short-term recurrence may occur in some cases. OBJECTIVE Polidocanol sclerotherapy was first described for management of AO. This retrospective study explored the clinical efficacy in relieving symptom of AO assessed by AO severity using the axillary osmidrosis grading system and safety of polidocanol sclerotherapy in treating AO. PATIENTS AND METHODS This retrospective study included 25 patients with AO single-site study, with 12 patients receiving polidocanol (1%) sclerotherapy (the polidocanol group) and 13 receiving botulinum toxin A (BTX-A) injection (the BTX-A group). The short-term efficacy (7 days after injection), the long-term efficacy (6 months after injection), the recurrence rate, and complications were compared between the 2 groups. A p-value of &lt;0.05 was considered statistically significant. RESULTS The short-term efficacies of polidocanol sclerotherapy and BTX-A injection were 100% and 69.2%, which was not clinically significant (p &gt; .05), whereas their long-term efficacies were 100% and 46.2%, respectively (p &lt; .05). The recurrence rates in the polidocanol and BTX-A groups were 25.0% and 84.6%, respectively (p &lt; .05). The complications did not differ significantly between the 2 groups (p &gt; .05). Although the short-term efficacy and complications were comparable between the 2 groups, the long-term efficacy of polidocanol sclerotherapy was superior to BTX-A injection. The polidocanol group has a lower recurrence rate than the BTX-A group. CONCLUSION Polidocanol sclerotherapy may provide an effective and safe treatment with longer efficacy compared to toxin, which is an effective and safe option for AO treatment.