Surgical Success Rate Research Articles

Analysis of the effectiveness and safety of 7.5 Fr ultra-thin flexible ureteroscope combined with a tip-flexible suctioning ureteral access sheath for the treatment of kidney stones.

To compare the efficacy and safety of using a 7.5 Fr flexible ureteroscope (f-URS) with tip-flexible suctioning ureteral access sheath (TFS-UAS) versus a 9.2 Fr f-URS with traditional ureteral access sheath (T-UAS) in the treatment of kidney stones. A retrospective analysis was conducted on 205 patients with kidney stones measuring 1.0-2.0cm treated with 7.5 Fr and 9.2 Fr f-URS in the Urology Department of The Affiliated Dazu Hospital of Chongqing Medical University from November 2022 to November 2023. The patients were randomly divided into two groups. Among them, 78 patients were selected to use the 7.5 Fr f-URS, which was designated as the GroupA. The remaining 127 patients were selected to use the 9.2 Fr f-URS, which served as the GroupB. The study compared the operation duration, lithotripsy duration, surgical success rate, immediate postoperative stone-free rate (SFR), 1-month postoperative SFR, and the incidence rate of postoperative complications between the two patient groups. In terms of demographic characteristics, the size of calculi, surgical success rate, and 1-month postoperative SFR, there was no statistically significant difference between GroupA and GroupB. However, GroupA demonstrated superior performance compared to GroupB in operation duration (48 (40.55) min vs 74 (56.94) min), lithotripsy duration (35 (27.43) min vs 59 (42.78) min), and immediate postoperative SFR (53.52% (38/71) vs 29.41% (35/119)), with statistically significant differences observed (P < 0.05). In terms of complication occurrence, GroupA reported 10 cases of minor (Grade 1) complications, whereas GroupB had 32 cases of minor (Grade 1) complications and 7 cases of severe complications (including 2 cases of Grade 3 and 5 cases of Grade 4). The difference between the two groups was statistically significant (P < 0.05). The GroupA reported significantly fewer cases of postoperative fever (4) and analgesic treatment (3) compared to GroupB, which had 18 fever cases and 19 analgesic cases (P < 0.05).The GroupA did not experience any cases of septicemia or steinstrasse. Conversely, the GroupB had 5 cases of septicemia and 3 cases of steinstrasse, including 2 patients who underwent reoperation. Both groups also reported cases of ureteral mucosal rupture (5 in GroupA, 10 in GroupB), but these differences were not statistically significant (P > 0.05). Compared with 9.2 Fr f-URS combined with T-UAS, the use of 7.5 Fr f-URS with TFS-UAS in the treatment of kidney stones has higher lithotripsy efficiency and lower complication rate. This combination is safe and effective in the treatment of kidney stones.

A generalizable procedure for Brown's class Ⅱ and Ⅲ defects reconstruction with deep circumflex iliac artery flap using computer-assisted technique

ObjectiveThis study summarizes and analyzes the characteristics of deep circumflex iliac artery (DCIA) flap reconstruction for maxillary defects and proposes a generalized protocol under the guidance of computer-assisted technique to enhance surgical efficiency and success rate. Materials and methodsWe retrospectively reviewed 10 cases of maxillary defects reconstructed using DCIA flaps under the application of computer-assisted technique, collecting clinical data for statistical analysis. ResultsThese cases included 2 cystic lesions, 2 mucinous tumors, 2 ameloblastomas, 1 mucoepidermoid carcinoma, 1 odontogenic fibroma, 1 bone defect following squamous cell carcinoma (SCC) surgery, and 1 ossifying fibroma. According to Brown's classification system, there were 7 Type IIb defects, 1 Type IId defect, 1 Type IIIb defect, and 1 Type IIId defect. The length of the iliac bone harvested ranged from 42 mm to 100 mm, and the width from 20 mm to 51 mm. In 7 patients, chimeric iliac myofascial flaps were used; in 2 patients, deep circumflex iliac artery perforator (DCIAP) flaps were utilized; and in 1 patient, a vascularized iliac crest was employed. The recipient vessels were the facial artery and vein in all cases. Intraoral anastomoses were performed in 4 cases, and submandibular anastomoses in 6 cases. The donor site was chosen from the ipsilateral ilium in 8 patients and from the contralateral ilium in 2 patients. The mean operative time was 8.74 hours. Postoperatively, 9 patients recovered well without any complications, while 1 patient experienced necrosis of the bone flap on the first day after surgery and underwent secondary reconstruction using a vascularized fibula flap. The average postoperative hospital stay was 8.6 days. ConclusionThe combination of DCIA flaps with computer-assisted technique provides a reliable method for the reconstruction of maxillary defects and functional restoration. Establishing generalized procedures could facilitate its broader application.

Long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults

Background Tonsillectomy is an effective treatment option for obstructive sleep apnoea in selected adult patients, but there has been a lack of long-term follow-up data. Objectives To analyse the long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults, with the longest follow-up periods to date. Materials and methods We recruited adults who had undergone extracapsular tonsillectomy because of obstructive sleep apnoea between 2004 and 2018 in the Hospital District of Southwest Finland. A new home sleep study, questionnaires, and a structured phone interview were conducted on these patients 4–17 years after surgical treatment. The primary outcome was the change in the apnoea-hypopnoea index. Results The mean apnoea-hypopnoea index was reduced from 27.1 preoperatively to 14.1 after the long-term follow-up (mean 12 years), and the mean Epworth Sleepiness Scale score decreased from 9.2 to 4.6. The long-term surgical success rate was 38.5%. Four out of five patients would choose the surgery again according to the phone interview. Conclusions and significance This study supports the notion that extracapsular tonsillectomy alone can be considered as a surgical treatment option for selected adults with obstructive sleep apnoea and tonsillar hypertrophy. For most of the patients, the obstructive sleep apnoea is alleviated.

Application of disposable digital hysteroscope for outpatient hysteroscopy in women undergoing artificial assisted reproductive procedures: a clinical research

BackgroundHysteroscopy is the preferred method for the diagnosis and treatment of uterine diseases. With the increasing demand for outpatient hysteroscopy, disposable digital hysteroscopy has emerged, which can meet the requirements of diagnosis and treatment integration, and greatly reduce the labour and storage costs.MethodsA total of 108 outpatients who underwent hysteroscopy using disposable digital hysteroscope were divided into two groups: the non-porous group (group A, n=49) and the married with child group (group B, n=59). The patients’ general information and clinical data were recorded and statistical analysis was performed.ResultsNo differences were found between the age, weight, body mass index, menopausal status and indication for hysteroscopy of the two groups. The most common indication was embryo transfer failure. The surgical success rate of 108 patients was 100%, the concordance rate between hysteroscopic diagnosis of chronic endometritis and pathological diagnosis was 94.44% (68/72), while the false positive rate stood at 38.89% (14/36). Additionally, incidental findings rate for endometrial polyps was 92.00% (23/25) with a low false positive rate of only 6% (5/83). The mean visual analogue scale score of group A was 2.285±0.180, which was not significantly different from group B (p=0.483, 95% CI(−0.60-0.44)). The pregnancy rate among patients who received assisted reproductive technology and were followed up for 1 year after surgery was 66.67% (40/60), while the abortion rate stood at 5.00% (3/60).ConclusionsThe disposable digital hysteroscope is a valuable and effective tool for outpatient hysteroscopy.

Clinical Outcomes Following Profunda Artery Perforator Flap Breast Reconstruction: A Systematic Review and Meta-Analysis.

There is a lack of reliable evidence on the surgical outcomes of profunda artery perforator (PAP) flap breast reconstruction. We conducted a meta-analysis to evaluate its safety and compare it with deep inferior epigastric perforator (DIEP) flap, aiming to offer more information on whether the PAP flap was an ideal alternative for autologous breast reconstruction. PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The postoperative complication rates following PAP reconstruction were pooled. Mean differences of patients' age, BMI, mastectomy weight and flap weight between PAP and DIEP group were calculated, and relative risk was estimated to compare their incidence of complications. Twenty-four articles reporting 1612 PAP flap breast reconstructions were included. The surgical success rate was 99.6%; the incidence of total and partial flap loss was 0.4% and 0.0%; the incidence of infection, hematoma, seroma, fat necrosis and wound dehiscence in recipient sites was 0.3%, 1.4%, 1.0%, 3.3% and 0.3%, respectively; the incidence of infection, hematoma, seroma, wound dehiscence and sensory disturbance in donor sites was 2.0%, 0.9%, 3.5%, 9.2% and 0.6%, respectively. Compared to the DIEP group, the average age, BMI, mastectomy weight and final flap weight were significantly lower in the PAP group. No significant difference was observed in terms of flap failure, breast fat necrosis and donor site wound dehiscence. This systematic review demonstrates similar levels of postoperative morbidities for the PAP and DIEP flaps with some subtle differences and verifies the PAP flap as a second-line treatment for patients when the DIEP is unavailable or undesirable. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Comparison of postoperative cyclosporine 2.0% versus betamethasone 0.1% eye drops following trabeculectomy: A randomized clinical trial.

To investigate the effect of cyclosporine A 2% eye drop following trabeculectomy on intraocular pressure (IOP) and surgical success compared to postoperative steroid drop. Prospective, randomized clinical trial in an institutional setting. Forty patients with primary open-angle glaucoma and candidates for trabeculectomy were included in this study. Standard fornix-based trabeculectomy augmented with mitomycin C was performed for all patients. None of the included subjects had a history of prior laser or intraocular surgery in that eye. All included subjects were randomly assigned to either postoperative cyclosporine A 2% or betamethasone 0.1% eye drops. IOP measured by applanation tonometer and surgical success rate. Seventy-five potentially eligible POAG patients were seen during the study period, and 40 met the study criteria and were randomly assigned to one of the study groups. Patients in the cyclosporine A 2% group had consistently lower IOP, fewer glaucoma medications, and higher success rates for at least 24 months after surgery (P < 0.0001). Complete success was more frequent in the cyclosporine group. Moreover, the cyclosporine A group had more diffuse and elevated bleb with less vascularity in the first 3 months after surgery (P ≤ 0.01). This was paralleled with fewer dry eye signs and symptoms in the cyclosporine group in the first 3 months (P < 0.03). Postoperative cyclosporine A 2% eye drop can be used instead of steroid drops and is associated with improved surgical success and decreased dry eye manifestations.

Evaluating the 1-year success and safety of ab interno canaloplasty in combination with cataract surgery in glaucoma patients

PurposeTo evaluate the treatment success and safety of ab interno canaloplasty (AbiC) combined with cataract surgery in glaucoma patients.MethodsThe prospective case study included 43 eyes that received an AbiC combined with cataract surgery (age 73.3 ± 8.2 years). The 360° microcatheterization and viscodilatation of the Schlemm’s canal was conducted using VISCO 360 (Sight Sciences, CA, USA). The observation period was 12 months with visits at 2 and 6 as well as 12 months, 7 eyes were lost to follow up.ResultsThe preoperative IOP was 19.8 ± 4.9 mmHg and was reduced to 14.5 ± 2.8 mmHg 12 months after AbiC (p < 0.0001). The relative IOP reduction was 23.6 ± 23.1% after 12 months. Topical glaucoma medication was also reduced from 2.4 ± 1.1 drugs to 1.1 ± 1.4 (p < 0.001) after 12 months. The complete surgical success rate (defined as IOP < 18 mmHg without topical therapy) was 31.6% whereas the qualified surgical success was 89.5% (IOP < 18 mmHg, with local therapy) There were no relevant intra- or postoperative complications.ConclusionAbiC in combination with cataract surgery is a safe and effective procedure to achieve a significant reduction of IOP and local glaucoma medication 12 months after surgery.

One-year results of trabeculectomy with emphasis on the effect of patients' age.

This study investigated the association between one-year surgical outcomes following trabeculectomy and age, accounting for confounding factors. Retrospective observational study. Analyzing data from 305 patients undergoing initial trabeculectomy from 2019 onward, we employed three approaches to adjust variables: stratified analysis, regression analysis, and propensity score matching. Surgical success at 1-year post-surgery was defined by two criteria: achieving intraocular pressure of between 5 and 15 mmHg with a ≥ 20% reduction compared to pre-surgery levels and no additional glaucoma surgery (Criterion A); achieving intraocular pressure of between 5 and 12 mmHg with a ≥ 30% reduction compared to pre-surgery levels and no additional glaucoma surgery (Criterion B). Stratified analysis by age unveiled a significant increase in exfoliation glaucoma (XFG) and a trend towards shorter axial lengths with advancing age (both p < 0.0001). Older age groups were more likely to experience surgical failure in both Criterion A and B (p = 0.21, < 0.01). Univariate analysis showed age as a significant factor in surgical failure for Criterion A (p < 0.05) and a nearly significant factor for Criterion B (p = 0.12). However, this trend was not evident in multivariate analysis (p = 0.23/0.88), where XFG became a significant factor for surgical failure (both p < 0.001) in Criteria A and B. Propensity score matching revealed no significant differences in surgical success rates for Criteria A and B between younger and older patients (p = 1.00 and 0.88). Age is not a primary determinant of failure in trabeculectomy; however, the increasing incidence of XFG with aging suggests a potential for poorer outcomes.

The Controlling Nutritional Status (CONUT) Score as a Predictor of Local Recurrence in Patients Underwent Partial Nephrectomy Alongside the R.E.N.A.L. Nephrometry Score.

This study aims to assess the utility of the CONUT (Controlling Nutritional Status) Score and R.E.N.A.L. (Renal Nephrometry Score) Score in predicting tumor recurrence in patients with kidney cancer. Additionally, we investigated which parameters contributed to these scores. In total, 115 patients who underwent partial nephrectomy between January 2015 and August 2023 at a single tertiary center were enrolled. After the exclusion criteria, data from 88 patients were analyzed. Age, gender, body mass index (BMI), comorbidities (hypertension, diabetes), smoking status, tumor characteristics, CONUT Scores, and R.E.N.A.L. scores were retrospectively recorded. Statistical analyses were performed, and significant p was p < 0.05. The presence of diabetes and hypertension showed a statistically significant association with tumor recurrence (p = 0.033 and p = 0.003, respectively). A high BMI significantly increased the risk of recurrence (p < 0.05). There was a strong positive relationship between the high tumor stage and positive surgical margins with recurrence (p < 0.001). Patients with high R.E.N.A.L. Scores and high CONUT Scores had a higher risk of recurrence (42.1% and 8.7%, respectively), and this difference was statistically significant (p < 0.001). CONUT and R.E.N.A.L. scores may be used to predict tumor recurrence after partial nephrectomy. Additionally, diabetes, hypertension, high BMI, and positive surgical margin rate might affect surgical success rate for recurrences. Clinicians should consider all these parameters and coring systems to gather more successful results after partial nephrectomy.

Three-year results of XEN gel stent implantation in the treatment of glaucoma

Objective: To evaluate the long-term efficacy and safety of XEN gel stent implantation in patients with refractory glaucoma. Methods: A retrospective case series study was conducted. Clinical data were collected from patients who received medical treatment at the First Affiliated Hospital of Fujian Medical University between January 2020 and September 2020 and underwent XEN gel stent implantation by the same surgeon. Preoperative and postoperative clinical parameters, including the intraocular pressure (IOP), number of ocular hypotensive medications, best-corrected visual acuity, surgical success rates, status of filtering blebs, and complications, were recorded at 1 day, 1 week, 1, 2, 3, 6, 12, 18, 24, and 36 months after surgery. Statistical analyses were performed using the analysis of variance (ANOVA), the least significant difference (LSD) method, and the Fisher's precision probability test. Results: A total of 8 patients (8 eyes) with glaucoma meeting the criteria were included, consisting of 6 males (6 eyes) and 2 females (2 eyes). The preoperative IOP reached (30.88±12.17) mmHg (1 mmHg=0.133 kPa), and the IOP at all postoperative follow-up time points was significantly lower than the preoperative value (P<0.05). At 3 years after surgery, the IOP was (14.38±1.60) mmHg, with a reduction of 53.43% [(16.50±12.07) mmHg]. Only 2 patients required monotherapy for IOP control, and there was no significant decline in best-corrected visual acuity in 7 patients. The surgical outcome at 3 years postoperatively was a complete success in 6 patients, a qualified success in 1 patient, and a failure in 1 patient. The filtering blebs were generally flat and diffuse, with only mild to moderate vascularization. One patient presented elevated IOP at 3 months, and after a subsequent revision of the XEN gel stent, the IOP became stable with the administration of travoprost eye drops. Conclusion: The XEN gel stent implantation proved to effectively reduce the IOP in glaucoma patients, with a high degree of safety demonstrated up to 3-year long-term follow-up.

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

Safety and efficacy assessment of the Inno-Xmart venous stent system in managing symptomatic iliofemoral venous obstruction: a 12-month outcome analysis.

This study aims to evaluate the safety and efficacy of the dedicated Inno-Xmart braided venous stent system (Suzhou Innomed Medical Device Co., Ltd., Jiangsu, China) in treating symptomatic iliofemoral venous obstruction. This clinical study followed a prospective, multicentre, single-arm design with the application of an objective performance goal. Patients diagnosed with symptomatic iliofemoral venous obstruction who met the eligibility criteria of this study were enrolled and treated with the Inno-Xmart venous stent system. The safety endpoints included the assessment of stent fracture, satisfaction of delivery system and 12-month incidence rate of major adverse events (MAEs). The primary efficacy endpoint focused on evaluating the 12-month primary patency rate through venography as determined by core laboratory. Secondary efficacy endpoints included surgical success rate, 6-month primary patency rate and the changes in quality of life from baseline to 6- and 12-month follow-up intervals. Between September 18, 2019, and April 26, 2021, 193 patients were successfully enrolled across 18 research institutions. The surgical success rate was 95.3% (184/193), the 12-month MAE rate was 5.1% (9/178) with no stent fractures or migrations. The 12-month primary patency rate for the participants was 96.1%, significantly surpassing the literature-derived objective performance of 80% (95% confidence interval [CI], 92.1-98.4; P < 0.0001). In addition, the mean venous clinical severity score (VCSS) and Chronic Venous Disease Quality of Life Questionnaire (CIVIQ) scores at the 6- and 12-month follow-ups were significantly lower than the preoperative scores (P < 0.001). The innovative, dedicated braided venous stent designed to address symptomatic iliofemoral venous obstruction demonstrates a high technical success rate, low complication rates, and impressive mid-term (12-month) patency. It effectively enhanced the quality of life for patients and holds promising prospects for a wide range of applications. The clinical study was officially registered in the "Chinese Clinical Trial Registry" (Registration number: ChiCTR2000040216, date of registration: November 25th, 2020).

Outcomes of Trabeculectomy and Predictors of Success in Patients of African Ancestry with Primary Open Angle Glaucoma.

To investigate outcomes of trabeculectomy ab externo in African ancestry primary open-angle glaucoma (POAG) patients, and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates. A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within one year) were collected. Analysis included linear/logistic regression models adjusting for inter-eye correlation. Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within one year. Subjects experienced reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P<0.001). However, there was a postoperative decline of 56% in visual acuity (VA) (P<0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation (P=0.02) and a 19% decrease in visual field index (P=0.004). Top of FormBottom of Form59% of patient eyes experienced complications within one year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery (P=0.01) and family history of glaucoma (P=0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR 0.79 per 0.1 LogMAR increases, P=0.02) was associated with lower likelihood of surgical success. This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success. Trabeculectomy in African ancestry individuals with primary open-angle glaucoma shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.

Efficacy of Expansion Pharyngoplasty without Drug-induced Sleep Endoscopy Screening in Obstructive Sleep Apnea.

Introduction Expansion sphincter pharyngoplasty has been shown to be a good alternative to continuous pressure devices in patients with moderate to severe obstructive sleep apnea. On the other hand, drug-induced sleep endoscopy provides information on the pattern of collapse in obstructive sleep apnea, although it is unclear whether this information improves the surgical outcomes. Objective To evaluate the success rate obtained when performing expansion sphincter pharyngoplasty on a group of patients diagnosed with moderate to severe obstructive sleep apnea who were not previously selected by drug-induced sleep endoscopy. Methods We present a series of patients with moderate to severe obstructive sleep apnea who underwent surgery. Pre- and postoperative home sleep apnea tests were performed. The success rate was calculated, and we assessed whether there were statistically significant pre- and postoperative differences in the apnea-hypopnea index and oximetry values. Results In total, 20 patients were included, and the surgical success rate was of 80%. Statistically significant improvements were demonstrated in the mean apnea-hypopnea index (from 40.25 ± 15.18 events/hour to 13.14 ± 13.82 events/hour; p < 0. 0001), the mean oximetric data (from 26.3 ± 12.97 desaturations/hour to 13.57 ± 15.02 desaturations/hour; p = 0.034), and in the mean percentage of total sleep time in which the patient had less than 90% of saturation (from 8.64 ± 9.25% to 4.4 ± 7.76%; p = 0.028). Conclusion The results showed significant improvements in the apnea-hypopnea index and in the oximetric data, with a surgical success rate of 80%, despite the lack of prior drug-induced sleep endoscopy screening.

Clinical effects of hybrid debranching technique for acute Stanford type A aortic dissection

BackgroundTo investigate the clinical effects and safety of the hybrid debranching technique for patients with acute Stanford type A aortic dissection (AD).MethodsOne hundred nine patients with acute Stanford type a AD were selected and divided into observation group and control group according to the different surgical methods. Fifty-five patients in the observation group were treated with hybrid debranching, and 54 patients in the control group were treated with Sun’s operation. The operation duration, clamp time, cardiopulmonary bypass duration, volume of blood transfusion, ventilator application duration, duration of stay in the intensive care unit, aortic rupture, second thoracotomy due to hemorrhage, gastrointestinal hemorrhage, stroke, paraplegia, renal failure, and all-cause mortality were recorded. Postoperative follow-up was conducted. The number of cases that underwent follow-up and the number of cases with complete thrombosis of the false aneurysm cavity detected by computed tomography angiography (CTA) was recorded.ResultsThe surgical success rate was 100% in both groups, and there were no cases with unplanned secondary surgery. Compared with the control group, only the difference in the volume of blood transfusion was not significantly significant between the two groups (P = 0.052), while the rest of the observation indicators were significantly lower in the observation group than in the control group (P < 0.001 for all). The proportion of cases with complete thrombosis of the false aneurysm cavity was significantly higher in the observation group than in the control group at 3 and 6 months after surgery (P < 0.05).ConclusionIn patients with acute Stanford type A AD involving the arch, the hybrid debranching technique was safe and effective. It was recommended for patients with advanced age and a high risk of intolerance to deep hypothermic circulatory arrest.

Myringoplasty: A comparison of inlay and underlay techniques

PurposeMyringoplasty aims to improve hearing and prevent otorrhea, making graft uptake rates and hearing crucial considerations. This study analyzed the factors associated with unsuccessful graft uptake and hearing improvement to guide the selection of optimal surgical approaches for myringoplasty. MethodsWe retrospectively reviewed 56 ears with chronic otitis media. All patients were followed up for >6 months after tympanic membrane closure surgery. We compared the underlay method using the transcanal approach with the inlay method using the retroauricular approach for myringoplasty in patients with chronic otitis media. The underlay and inlay methods were used for 23 and 33 ears, respectively. The primary outcomes were graft uptake rate and hearing improvement. Additionally, factors such as the location of tympanic membrane perforation, patient age, and the degree of mastoid development were evaluated. ResultsThe perforation rate was high when the transcanal underlay method was employed to repair perforations in the anterior inferior quadrant. Both the underlay and inlay methods significantly improved hearing. However, the success rate of the inlay method was lower. Within the cases performed using the inlay method, outcomes tended to be poorer in older age groups. There were no significant differences in surgical success rates related to mastoid development. ConclusionThe inlay method using the retroauricular approach is a favorable option for repairing perforations involving the anterior inferior quadrant. However, older patients presented lower rates of hearing improvement when the inlay method was used.

Comparison of the Novel Ankura Plus Stent and Castor Stent for the Treatment of Stanford Type B Aortic Dissection with an Insufficient Proximal Anchoring Area

To compare the efficacy and safety of the Ankura Plus and Castor stents in Stanford type B aortic dissection (TBAD) with an insufficient proximal anchoring area. Between January 2020 and October 2022, 54 patients with TBAD were enrolled, including 16 patients with Ankura Plus stents and 38 patients with Castor stents. Data from the 2 stents were retrospectively analyzed. The surgical success rate for both stents was 100%, and no endoleaks or deaths occurred during hospitalization. The Ankura Plus stent group had a longer surgery time than the Castor stent group (122.6±5.1 vs. 103.7±10.0, P < 0.001). After an average follow-up of 12months, the patency rates of the main and branch stents were 100% in both groups. The diameter of the true lumen (TL) was significantly increased, the diameter of the false lumen (FL) was reduced, and there was no statistically significant difference in the probability of complete thrombosis of the FL (68.8% vs. 67.6%, P=0.993). There were no significant differences in the incidences of renal failure (6.3% vs. 8.1%, P=0.814), stroke (6.3% vs. 2.7%, P=0.520), or endoleaks (6.3% vs. 10.5%, P=0.621) between the Ankura Plus and Castor stent groups. One patient in the Castor stent group underwent reintervention because of a type I endoleak 3months after surgery. One patient in the Ankura Plus stent group had an additional covered stent placed after 1month due to distal TL stenosis of the main stent. One patient in the Castor stent group died of renal failure 4months after surgery. Both the Ankura Plus and Castor stents are feasible, safe, and effective in the treatment of TBAD with an insufficient proximal anchoring area. Additional long-term studies are required to evaluate the robustness and applicability of Ankura Plus stents.

Clinical effects of percutaneous elastic intramedullary nail assisted by arthrography for the treatment of radial neck fractures in children

To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children. A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation (arthrography with elastic nail group) from January 2019 to December 2022, including 12 males and 11 females, aged from 2 to 12 years old with an average of (7.36±1.89) years old;According to Judet fracture types, 14 children were type Ⅲ and 9 children were type Ⅳ. In addition, 23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation (elastic nail group), including 11 males and 12 females, aged from 2 to 14 years old with an average of (7.50±1.91) years old;Judet classification included 15 children were type Ⅲ and 8 children were type Ⅳ. Operative time and intraoperative fluoroscopy times were compared between two groups. Metaizeau evaluation criteria was used to evaluate fracture reduction, and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups. Both groups were followed up for 12 to 24 months with an average of (16.56±6.34) months. Operative time and intraoperative fluoroscopy times of elastic nail group were (56.64±19.27) min and (21.13±7.87) times, while those of joint angiography with elastic nail group were (40.33±11.50) min and (12.10±3.52) times;there were difference between two groups (P<0.05). According to Metaizeau evaluation, 11 patients got excellent result, 9 good and 3 fair in joint angiography with elastic nail group, while in elastic nail group, 5 excellent, 13 good, 4 acceptable, and 1 poor;the difference between two groups was statistically significant (P<0.05). According to Tibone-Stoltz criteria, 14 patients got excellent result, 8 good, and 1 fair in joint arthrography with elastic nail group;while in elastic nail group, 12 patients got excellent result, 9 good, 1 fair and 1 poor;there was no significant difference between two groups (P>0.05). Compared to percutaneous elastic intramedullary nail fixation, closed reduction assisted by arthrography has advantages of reduced operation time, decreased intraoperative fluoroscopy frequency, and improved fracture reduction. Arthrography enables clear visualization of the anatomical structures of radius, head, neck, bone, and cartilage in children, facilitating comprehensive display of fracture reduction and brachioradial joint alignment. This technique more precisely guides the depth of elastic intramedullary nail implantation in radius neck, thereby enhancing surgical efficiency and success rate.

3D Transesophageal Echocardiography in the Selection of Occluder Size for Left Atrial Appendage Occlusion: A Meta-Analysis

Background: Left atrial appendage occlusion (LAAO) can effectively reduce the risk of stroke in atrial fibrillation (AF) patients. However, the structure of left atrial appendage (LAA) varies greatly among individuals, and the size of the occluder influences the surgical success rate and prognosis. This study used a meta-analysis to investigate whether three dimensional-transesophageal echocardiography (3D-TEE) can prompt physicians to select the appropriate size of the occluder, thereby improving prognosis in patients with LAAO. Methods: Studies on 3D-TEE-assisted selection of occluder sizes in the treatment of LAAO were searched in pubmed, cochrane, Web of Science, CNKI, Wanfang, and Weipu public databases from the inception of each database to June 10, 2024. The QUADAS-2 tool was used to assess the quality of the studies. Results: 10 studies published between 2016 and 2024 were finally included, with a total sample size of 552 cases. The maximum opening of the LAA obtained by 3D-TEE, coronary angiography (CAG) and video-assisted thoracic surgery (VATS) significantly correlated with the size of the occluder (p &lt; 0.05). 3D-TEE was superior to 2D-TEE in measuring the maximum (p = 0.04) and minimum diameters (p = 0.01) of LAA openings, and to DSA in measuring depth (p = 0.01). Conclusion: 3D-TEE can be applied to obtain LAA opening data close to the size of the occluder with minimal side effects and to assist physicians in selecting the appropriate occluder.