Tomography Scan Research Articles

Assessment of Surgical Accuracy in Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea: A Preliminary Analysis.

This retrospective study aimed to: (1) investigate the surgical accuracy of maxillomandibular advancement (MMA) in obstructive sleep apnea (OSA) patients, with a specific focus on maxillary and mandibular advancement and counter-clockwise rotation and (2) investigate the correlation between the amount of achieved advancement and the reduction in the relative apnea hypopnea index (AHI). Sixteen patients, for whom a three-dimensional virtual surgical plan was generated preoperatively and a computed tomography scan (CT) or cone-beam computer tomography (CBCT) was acquired postoperatively, were included. The postoperative CT or CBCT was compared to the virtual surgical plan, and differences in the mandibular and maxillary advancement and counter-clockwise rotation were assessed. Maxillary and mandibular advancement (median 3.1 mm, p = 0.002 and 2.3 mm, p = 0.03, respectively) and counter-clockwise rotation (median 3.7°, p = 0.006 and 4.7°, p = 0.001, respectively) were notably less than intended. A significant correlation was found between the planned maxillary advancement and the difference between the planned and actual maxillary advancement (p = 0.048; adjusted R2 = 0.1979) and also between the planned counter-clockwise rotation and the difference between the planned and actual counter-clockwise rotation for the mandible (p = 0.012; adjusted R2 = 0.3261). Neither the maxilla-first nor the mandible-first surgical sequence proved to be superior in terms of the ability to achieve the intended movements (p > 0.45). Despite a significant reduction (p = 0.001) in the apnea hypopnea index (AHI) from a median of 62.6 events/h to 19.4 events/h following MMA, no relationship was found between the extent of maxillary or mandibular advancement and AHI improvement in this small cohort (p = 0.389 and p = 0.387, respectively). This study underlines the necessity for surgeons and future research projects to be aware of surgical inaccuracies in MMA procedures for OSA patients. Additionally, further research is required to investigate if sufficient advancement is an important factor associated with MMA treatment outcome.

Conservative Management of Large Vertex Extradural Hematoma: A Case Report

Vertex extradural hematomas may be missed when axial section brain computed tomographic scans are used alone for diagnosis. Conservative treatment may be preferred in such patients when actualized the essential conditions. A 24-year-old mentally retarded male patient was admitted to the emergency department with a history of falling from the same level and head trauma. Neurological examination and axial cross-sectional brain computed tomography performed in the emergency room were evaluated as normal, and the patient was discharged. Vertex extradural hematoma adjacent to the bone fracture was diagnosed with axial, coronal and sagittal reconstructed brain computerized tomography sections of the patient who came back with headache complaint 2 days later. Despite the difficulties in neurological examination due to mental retardation, surgical treatment was not planned with very close neurological examination. The patient was followed up in the neurosurgery intensive care unit for 2 days and in the neurosurgery service for 7 days. He was discharged because there was no abnormality in his neurological follow-ups and no increase in hematoma size. In the first outpatient follow-up, one month later, the hematoma was completely resorbed. The patient was treated conservatively with close conscious and neurological examination follow-up. In order not to miss vertex extradural hematomas in the brain computed tomography performed in patients presenting to the emergency department with head trauma, coronal and sagittal sections should be reconstructed in addition to axial sections. Conservative treatment can be preferred if vertex extradural hematomas are neurological examined closely, no motor deficits and there is no increase in hematoma size in control imaging.

Mandibular reconstruction with TMJ prosthesis: management of osteomyelitis after orthognathic surgery (Case Report).

This case report presents a mandible reconstruction with temporomandibular joint (TMJ) prothesis for treatment of osteomyelitis infection following a bimaxillary orthognathic and genioplasty surgeries. The patient, a 41-year-old female, presented with facial pain, difficulty in opening her mouth, and mandibular deviation four months after the initial orthognathic surgery. During the four months, the patient had experienced two more surgerys post-operative for treatment of the complications. Examination revealed mobility between osteotomy segments of the right mandibular osteotomomie between body and ramus, and Computer Tomographic scan analysis revealed osteomyelitis and non-union within the osteotomy side of the right mandible from the previous surgery. Due to the advanced state of the disease and significant bone resorption, treatment was planned in two stages, involving bone debridement and then reconstruction with a custom made extended temporomandibular joint prosthesis. The patient had no postoperative complications and achieved satisfactory functional and aesthetic outcomes. This case emphasizes the importance of careful monitoring and prompt management of postoperative complications following orthognathic surgery to prevent rare but serious complications such as osteomyelitis.

The Use of the Ascyrus Medical Dissection Stent in Acute Type A Aortic Dissection Repair Reduces Distal Anastomotic New Entry Tear

BackgroundA distal anastomotic new entry tear (DANE) can occur at the time of surgical repair for acute type A aortic dissection (ATAAD). This study aimed to compare the occurrence of DANE following a standard hemiarch repair with that following a hemiarch repair with an uncovered arch dissection stent. MethodsAll patients who received a hemiarch repair or a hemiarch repair with an Ascyrus Medical Dissection Stent (AMDS) for ATAAD from 2017 to 2021 were included. Baseline and intra- and postoperative characteristics were collected. All available pre- and postoperative computed tomographic scans were analysed. The primary outcome measures were the incidence of DANE, positive aortic remodelling, mortality, and aortic reintervention rates at last follow-up. ResultsA total of 114 patients underwent repair of Debakey I ATAAD during the study period with either an isolated hemiarch (n = 77) or a hemiarch with AMDS (n = 37). There was no significant difference in mortality (P = 0.768) or other in-hospital adverse events. During the follow-up period, DANE occurred in 43.3% (n = 26) of the isolated hemiarch group and in 11.8% (n = 4) of the hemiarch with AMDS group (P = 0.002). The incidence of false lumen thrombosis and obliteration favoured the AMDS group in the aortic arch (P = 0.029), the proximal descending thoracic aorta (P = 0.031), and level of pulmonary artery bifurcation (P = 0.044). ConclusionsThe incidence of DANE is significantly reduced with the addition of an AMDS at the time of hemiarch repair for ATAAD repair. Further follow-up is necessary to identify late aortic complications that may have been prevented by reducing the incidence of postoperative DANE.

Predictors of Postoperative Diplopia following Orbital Fracture Repair in Adults.

Postoperative diplopia is reported in up to 52% of orbital bone fracture (OBF) repair. Evidence on these risk factors is based on low-quality data, single-institution studies, and small sample sizes. Our study is the largest and first multicenter study to determine the predictors of postoperative diplopia following OBF repair. The authors conducted a retrospective review of patients who underwent OBF repair at 2 centers from 2015 to 2019. The authors' primary outcome was the incidence or persistence of postoperative diplopia at least 2 weeks after OBF repair. Descriptive statistics were calculated. Multivariable logistic regression was performed to determine significant predictors of postoperative diplopia. Of 254 patients, the median age was 36.1 years (interquartile range, 27.8 to 50.7 years), and the median follow-up was 79.5 days (interquartile range, 40.3 to 157.3 days). The most common postoperative ocular symptom was diplopia (51 of 254 [20.1%]). Patients who had preoperative limited ocular motility or enophthalmos had greater odds of developing postoperative diplopia, compared with patients who did not have these preoperative symptoms (adjusted ORs, 2.33 [95% CI, 1.03 to 5.24] and 2.35 [95% CI, 1.06 to 5.24], respectively). Patients who had combined orbital floor and medial wall and moderate OBF (>2-cm 2 defect or >3-mm displacement) on preoperative computed tomographic scan had greater odds (adjusted ORs, 2.16 [95% CI, 1.04 to 4.46] and 3.77 [95% CI, 1.44 to 9.83], respectively) of developing postoperative diplopia, compared with patients without these preoperative computed tomographic findings. During primary assessment of the patient with OBF, preoperative ocular signs and symptoms, fracture severity, and location of OBF are key predictors of postoperative diplopia. Risk, III.

Comparison of the effectiveness of three different rhinoplasty techniques to correct stenotic nostrils using silicone models: A case study.

To compare the effects of three different rhinoplasty techniques on the postoperative cross-sectional areas (CSAs) of the nares and nasal vestibuli. Experimental study. Ninety-nine 3D-printed, remolded silicone models of a single French bulldog's rostral nose. Models were fabricated based on a computed tomographic (CT) scan of the nose of a French bulldog with moderately stenotic nares. Each model underwent either vertical wedge resection (VW), modified horizontal wedge resection (MHW), or ala-vestibuloplasty (AVP) performed by a single surgeon (n = 33 per group). Preoperative and postoperative CT scans of the models were performed, and CSAs of the airway from the nares to the caudal end of the nasal vestibules were calculated. All three rhinoplasty techniques increased CSAs (adjusted p values <.001) but to different levels caudally within the nasal vestibule. Vertical wedge resection achieved this up to the start of the alar fold, MHW up to halfway between the nares and the alar fold and AVP up to the caudal nasal vestibule. Average percentage increases in CSA were 26%, 15% and 74%, respectively. Ala-vestibuloplasty led to larger CSAs than VW and MHW from the nares to the caudal nasal vestibule (adjusted p values <.05). The proportional difference within each technique was <7%. Ala-vestibuloplasty resulted in a larger increase in the airway CSA of silicone modeled nares and nasal vestibules of a single French bulldog in comparison with VW and MHW. Ala-vestibuloplasty can be considered for French bulldogs with moderately stenotic nares and evidence of nasal vestibular stenosis.

Finite Element Analysis of Fracture Resistance of Mandibular Molars with Different Access Cavity Designs

IntroductionThis study aimed to assess the fracture resistance of mandibular first molars after preparation with 3 different access cavity designs and 2 rotary systems using finite element analysis. MethodsSix 3-dimensionally printed mandibular first molars simulating natural teeth received traditional, conservative, and ultraconservative (truss) access cavity preparations. The root canals in each group were instrumented with either XP-Endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland) or TruNatomy (Dentsply Sirona, Ballaigues, Switzerland) rotary files. The models were individually digitized, and micro–computed tomographic scans were transferred to Mimics software (Materialise NV, Leuven, Belgium) to create a geometric model of the tooth. The designed model was exported to 3-matic software (Materialise NV), and STL files were transferred to Geomagic Design X (3D Systems, Rock Hill, SC). Point cloud data were used for surfacing and transferred to ANSYS software (Ansys, Canonsburg, PA). A 200-N superficial force was applied vertically to the buccal cusps and central fossa, and the maximum and minimum equivalent von Mises stress values were calculated and reported. ResultsThe traditional and ultraconservative access cavity designs yielded the highest and the lowest von Mises stress values, respectively. In the ultraconservative cavity design, the stress values in pericervical dentin were lower in canal preparation with TruNatomy compared with XP-Endo Shaper. In the traditional and conservative cavity designs, stress was lower in the first 2 mm from the cementoenamel junction in the XP-Endo Shaper group and in the next 3 mm in the TruNatomy group. ConclusionsStress was lower in the ultraconservative and conservative cavity designs compared with the traditional design. Also, root canal preparation with TruNatomy yielded lower stress values in general compared with XP-Endo Shaper.

Improving the Management of Adults With Mild Traumatic Brain Injury: An Initiative to Reduce Unnecessary Computed Tomographic Scans in the Emergency Department.

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients. The purpose of this project was to reduce radiation exposure and ED length of stay by using the CCHR to decrease unnecessary CT scans in adults with TBI. Cost of care was also estimated. The CCHR implementation strategy included an education program for ED staff. The use of the CCHR was promoted throughout the intervention period. The outcomes measured were the number of CT scans ordered, ED length of stay, and the cost of avoidable CT scans. Data were collected through medical record reviews completed by the project leader and were evaluated using the independent samples t test. A total of 600 medical records were reviewed. There was a significant difference between adherence to the CCHR before (M = 64.6%) and after provider education (M = 74.3%). The percentage of CT scans that could have been avoided significantly decreased from baseline (M = 0.63) after provider education (M = 0.46). Length of stay for mTBI patients who were managed based on the CCHR (M = 184.9) was significantly less than the length of stay for those who were not (M = 260.1). The cost of avoidable scans was decreased by 37% over the course of the project. There were no incidents of missed diagnosis found. By increasing awareness of the CCHR and promoting its use, the number of head CT scans ordered, cost of care, and ED length of stay for patients who present after mTBI were significantly improved.

Optical Diagnostics in Periodontology

In terms of clinical performance, the conventional methods for diagnosing periodontitis fall short of ideal. By adding optical techniques to ocular inspection and periodontal probing, these procedures can be made better. The minor changes in periodontal tissues that cannot be visually inspected can be identified and measured constantly over a period of time with the help of optical diagnostic techniques. The removal of subgingival microbial biofilms and dental calculus deposits during debridement of teeth and dental implants can be made more efficient by using magnifying loupes, operating microscopes, and cutting-edge methods based on how light interacts with bacterial deposits, such as differential reflectometry and light-induced fluorescence. The absence of ionizing radiation from optical devices, which enables frequent usage on the same patient in clinical practice, is one of the greatest reasons in favor of their use as diagnostic adjuncts. The periodontium’s soft tissues can be examined using three-dimensional scanning, fluorescence spectroscopy, and optical coherence tomography to see how they relate to natural teeth and dental implants. By limiting the under- and overuse of treatment alternatives, an accurate prognosis-determining system would enable a more targeted deployment of finances, enhancing the appropriateness and quality of dental care. The clinical management of people with periodontal disease may be enhanced by a novel approach to periodontal diagnostics.

Rosette‐scan tomographic single‐pixel imager

AbstractSpin‐scan tomographic scanning imagers utilise a reticle with a fixed number of thin slits and nutating optics, and have produced images and video at both infrared and optical wavelengths. However, the fixed nature of these systems reduces their versatility by restricting changes that can be made after manufacture. An alternative rosette‐scan tomographic scanning imager based on similar concepts is proposed to overcome this limitation. A single thin‐slit reticle is rotated to be perpendicular to the line scan angle of each rosette petal, thereby allowing tomographic reconstruction. The parameters of the proposed system can be dynamically changed to achieve different trade‐offs between resolution and frame rate. Initial results obtained from a proof‐of‐concept prototype demonstrate the feasibility of this approach.

Modified 3-Dimensional Alveolar Ridge Augmentation in the Anterior Maxilla: A Prospective Clinical Feasibility Study.

Vertical and horizontal reconstruction of the alveolar ridge, especially in the anterior maxilla, is considered a clinical challenge for dentists. There is still a lack of a standard technique to address the hurdles in 3-dimensional bone regeneration in the anterior maxilla. In this clinical feasibility study, we aimed to modify Khoury's technique by combining the conventional guided bone regeneration standards with the principles of this technique. The autogenous bone blocks were harvested from the retromolar area and grafted into the deficient anterior maxillae by mini-screws, and the gap was filled with xenogenic bone particles. The grafted site was covered with multilayered resorbable collagen membranes. Cone-beam computerized tomographic scans were obtained at the 6-month follow-ups, and the changes in ridge width and height were measured. Five subjects with multiple missing teeth at the anterior maxilla were included. The radiographic outcomes of the 6-month follow-ups revealed 1.2 mm of height and 3.5 mm of width gain. Between the 4- and 6-month visits, approximately 2 mm resorption in height and 0.3 mm in width occurred. No complications occurred. The proposed modification for Khoury's technique can serve as a feasible method in the 3-dimensional reconstruction of the anterior maxilla without additional autogenous bone particles.

Subpleural pulmonary cysts in children: Associations beyond Trisomy 21.

Small air-filled peripheral subpleural cysts are a well-described feature of pulmonary anatomy at computerized tomographic (CT) scan in children with Trisomy 21, yet only anecdotally described in association with other pathologies. The significance of these cysts is unknown. To investigate and explore the pathogenesis of these subpleural cysts in children. A retrospective review of 16 cases with subpleural cysts diagnosed on CT chest was performed. The distribution, location, and ancillary CT findings were recorded. Hospital charts were reviewed for clinical details, especially cardiac abnormalities, pulmonary artery hypertension (PAH) and genetic associations. Histopathological and clinical correlative data were recorded. Eleven of the 16 children (69%) were found to have an underlying chromosomal or genetic abnormality, six of whom had Trisomy 21. The remaining 5 of the 16 cases (21%) had miscellaneous disorders without an identifiable genetic basis. The most common co-morbidities were cardiac abnormalities (81%) and PAH (62.5%). Regardless of their underlying etiologies, the cysts were present bilaterally in most cases (14/16, 88%). We observed both the postnatal development and the progression of cysts in our cohort. On long-term follow-up, there were five deaths (31%) and six cases (38%) requiring maintenance oxygen therapy due to chronic hypoxia. Two cases (12.5%) became completely asymptomatic after correction of their underlying abnormalities. Subpleural cysts are not exclusive to Trisomy 21 and may be seen in other inherited or acquired causes, likely due to altered alveolar growth. We suspect these cysts are a sign of an underlying developmental disorder with variable clinical effect, especially in children with congenital cardiac disease.

Influence of the presence of dental implants on the accuracy and difficulty level of diagnosis of furcation involvement in molars: An in vitro CBCT study.

The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi-squared test and logistic regression analysis were used. There was no difference in the diagnostic accuracy of FI between the arches (p = .117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p > .05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p-value only for one and two ZI implants (p = .0061 and p = .0096, respectively). The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants.

Using a mobile computer tomography scanner in a field hospital setting to manage patients with COVID-19

The global outbreak of COVID-19 has posed unprecedented challenges to healthcare systems worldwide. Healthcare administrators had to make quick and effective decisions to ensure high quality of medical care standards in new conditions. The need to form a reserve bed fund during the pandemic was due to the high load on city hospitals in Moscow. Due to this fact, temporary reserved hospitals for COVID-19 patients were organized in non-core facilities, such as ice arenas, shopping malls, and exhibition pavilions. This urgency prompted a search for solutions that could provide the necessary level of diagnosis and treatment appropriate to specialized medical facility. Given the technical and time constraints associated with the installation of a fixed computer tomographic scanner, the deployment of mobile computer tomographic scanners emerged as a viable option.&#x0D; The study aims to share insights gained from using a mobile computer tomographic scanner within a temporary backup hospital setting to treating patients with COVID-19 coronavirus infection. The paper discusses the features, advantages, and disadvantages of mobile computer tomography. It also presents hardware and control room layouts, along with the placement options for the computer tomography device. The research includes the results of dosimetry studies and provides a clinical assessment of the applicability of this type of diagnostic devices.

In Vitro Comparison of the Accuracy of Cone-Beam Computed Tomography Scanning and Electronic Apex Locators in Detection of Simulated Root Perforations in Different Localizations

IntroductionThis study aimed to compare the accuracy of cone-beam computed tomographic (CBCT) scanning and 2 different electronic apex locators (EALs) in the detection of simulated root canal perforations in different localizations. MethodsEighty human mandibular premolars were prepared and divided into 2 groups according to the localization of the perforation area, having a 1-mm diameter. The distance between the occlusal edge and the beginning of the perforation was measured under a stereomicroscope (actual working length) using 2 EALs (Propex II [Dentsply Maillefer, Ballaigues, Switzerland] and Dentaport ZX [J. Morita, Tokyo, Japan]) (electronic working length) and CBCT images (CBCT working length). The calculations were made by subtracting the actual working length from the electronic working length and the CBCT working length to determine the differences. ResultsIn the apical third perforation group, there was a significant difference between Dentaport ZX and CBCT imaging. There was no significant difference between Dentaport ZX and Propex II and Propex II and CBCT measurements. In the middle third perforation group, Propex II was significantly more successful than CBCT imaging. In addition, there was no significance between the accuracy of Propex II in detecting the perforation area between the apical third perforation group and the middle third perforation group. CBCT imaging was more accurate in detecting the perforation area in the apical third perforation group than in the middle third perforation group. ConclusionsIn cases in which the root canal perforation was in the apical third of the root, both the EAL and CBCT imaging were successful in determining the perforation area, whereas the success rate of all devices used in this study decreased when the perforation area was in the middle third of the root.

Ontogenetic skull variation in a shovel-headed amphisbaenian species.

Leposternon microcephalum is a species belonging to the Amphisbaenia, a group of burrowing reptiles. Amphisbaenia present various morphological and physiological adaptations that allow them to penetrate the ground and live underground, through a system of galleries and permanent chambers that they build themselves. Among the morphological adaptations in this group, those of the skull stand out as it serves as the main excavation tool. Four basic skull shapes are recognized: rounded, keeled, shovel-shaped, and spade-shaped. The skull of L. microcephalum belongs to this last type, which is considered the most specialized. The species inhabits soils that are highly compacted and difficult to penetrate. Among the species of Leposternon present in South America, L. microcephalum has the widest distribution, being found in all Brazilian biomes and neighboring countries such as Bolivia, Argentina, Paraguay, and Uruguay. The analysis of the skull of this species was carried out using three-dimensional geometric morphometrics (3D-GMM), a technique that allows comparative analysis, through robust statistical methods, of shape and its variations, using Cartesian coordinate data from a configuration of homologous landmarks. The technique allows the size and shape components of a structure to be analyzed separately. From an ontogenetic point of view, this methodology had also been used to investigate variations in Cynisca leucura, a member of the Amphisbaenidae with a rounded head. Our hypothesis is that the patterns of morphological differentiation in the skull, mainly in the intermediate and occipital regions, are similar in different Amphisbaenia species. Therefore, the objective of this study was to analyze cranial morphological variations in an ontogenetic series of L. microcephalum using 3D-GMM. Computed Tomographic scans of 13 specimens were analyzed: juveniles (N = 8) and adults (N = 5), based on 20 landmarks that characterize the skull. Principal components and regression analyses between shape (dependent variable) and size (independent variable) showed a clear difference between the cranial morphological pattern of juvenile individuals and that of adults. For instance, young specimens tend to have a dorsoventrally tall neurocranium, with the tip of the snout more anteriorly oriented and its dorsal border subtly curved. Dorsally, the parietal region is thicker and smoothly dome-shaped in juveniles. As in C. leucura, the variation was strongly correlated with the size change from juvenile to adult, indicating a dominant role for ontogenetic allometry in determining skull shape.

Radioguided Occult Lesion Localization Technique for Biopsy of Nonpalpable Subcutaneous Lesions in Suspected Metastatic Melanoma.

In patients with a history of melanoma, the risk of recurrence depends on the stage at diagnosis. Patients who present with more advanced disease are more likely to experience recurrence; patients with less advanced disease at presentation have slower progression and lower likelihood of recurrence. The aim of this study was to evaluate the use of a minimally invasive and targeted technique as a diagnostic and therapeutic tool for the excision of nonpalpable lesions suspected to be melanoma metastases. The authors evaluated 21 patients with stage IIB, IIC, or III melanoma and subcutaneous nonpalpable lesions with a high risk of malignancy on positron emission tomography/computed tomography scan during oncologic follow-up. To guide biopsy, the authors used the radioguided occult lesion localization technique, using intralesional injection of technetium-99m albumin macroaggregates the day before surgery. During surgery, a handheld gamma probe was used to locate the lesions. Surgical localization of radiolabeled lesions was achieved in all cases. Relapsed melanoma was histologically confirmed in 13 patients. This technique proved to be a simple, safe, and effective method to detect and biopsy nonpalpable or difficult-to-locate lesions in suspected metastatic melanoma. The main advantage was disease restaging (eg, from stage II to III), allowing patients to access adjuvant therapies not approved as early-stage melanoma treatment. Therapeutic, IV.

A Comparative Study of Thoracoscopic Left Atrial Appendage Clipping vs Stapled Resection

BackgroundThe left atrial appendage (LAA) is the predominant site of thrombus formation in atrial fibrillation (AF), which is associated with ischemic stroke. This study comparatively evaluated the complete LAA closure rates between LAA clipping and stapled resections. MethodsThe study included 333 patients who underwent thoracoscopic operation with both preoperative and postoperative computed tomographic scans. Propensity score matching (4:1 ratio) was applied, matching 90 LAA clipping patients with 206 stapled resection patients. The primary end point was complete LAA closure, defined as a residual LAA depth of <1 cm on computed tomographic images obtained 1 year postoperatively. ResultsNo 30-day death was observed. Complete LAA closure was achieved in 85.9% (286 of 333) of patients. After propensity score matching, the clipping group demonstrated a significantly higher complete LAA closure rate than the stapled resection group (95.6% vs 83.0%, P = .003). The residual LAA stump depth was also shorter in the clipping group compared with the stapled resection group (2.9 vs 5.3 mm, P = .001). Two patients with a residual LAA stump exhibited an association with ischemic stroke during follow-up. ConclusionsThe clipping group demonstrated a higher rate of complete LAA closure compared with the stapled resection group. Close monitoring of patients with residual LAA stumps is essential. Further research with larger cohorts is needed to elucidate impact of the residual LAA stump on thromboembolic events.

Effects of sarcopenia and frailty on postoperative recovery in elderly patients: A prospective cohort study.

Sarcopenia and frailty are both age-related declines in functional reserve that are linked to adverse health outcomes. It is critical to know about the outcomes of a combination of these conditions. The study aimed to investigate the effects of sarcopenia and frailty on postoperative recovery in elderly patients and to explore risk factors. This prospective cohort study was conducted among 608 patients aged ≥60years, American Society of Anesthesiologists I-III, who were scheduled to undergo thoracic (non-cardiac) and abdominal surgery from 1 March 2022 to 31 October 2022 at the Affiliated Hospital of Xuzhou Medical University. Frailty was measured by the 28-item frailty index, and sarcopenia was assessed sarcopenia was assessed by skeletal muscle index in computed tomographic scan, handgrip strength and 6-m walk. Participants were classified as follows: Group A: both sarcopenia and frailty; Group B: sarcopenia only; Group C: frailty only; and Group D: neither frailty nor sarcopenia. The primary outcome was 90-day morbidity. Multivariable logistic regression model was used to estimate the association between sarcopenia, frailty and 90-day morbidity. The median (interquartile range) age of participants was 68 (64-72) years, and 62.7% were men. The prevalence rates of sarcopenia and frailty were 32.8% and 47.6%, respectively. The 90-day morbidity in Group A was 58.5%, in Group B was 46.2%, in Group C was 42.0% and in Group D was 28.8%, and the difference was significant (P<0.001). In the multivariable analysis, both sarcopenia and frailty [odds ratio (OR), 2.21; 95% confidence interval (CI), 1.26-3.89], sarcopenia only (OR, 1.84; 95% CI, 1.01-3.36), frailty only (OR, 1.77; 95% CI, 1.03-3.03), women (OR, 0.67; 95% CI, 0.45-0.99), body mass index (OR, 0.94; 95% CI, 0.88-0.99), pre-operative albumin (OR, 0.96; 95% CI, 0.91-1.00) and operative stress score (OSS) [OSS 3 (OR, 2.09; 95% CI, 1.21-3.67); OSS 4-5 (OR, 3.81; 95% CI, 2.31-6.42)] were independently associated with 90-day morbidity. In the multivariable analysis with inverse probability weighting adjusted cohort, sarcopenia and frailty were also significantly associated with 90-day morbidity. Sarcopenia and frailty were associated with higher risks of postoperative 90-day morbidity in elderly patients alone and in combination. Sex, body mass index, pre-operative albumin and operative stress were also independent factors for postoperative morbidity within 90days.

Expression and association of vascular endothelial growth factor, vascular endothelial growth factor receptor, and phosphorylated signal transducer and activator of transcription factor 3 in malignant gliomas.

Angiogenesis is one of the main characteristic features of malignant gliomas. Phosphorylated signal transducer and activator of transcription factor 3 (pSTAT3) is not only involved in glioma cell proliferation, anti-apoptosis, and immunosuppression but also plays a key role in cell migration and invasion. Constitutively, activated pSTAT3 induces expression of vascular endothelial growth factor (VEGF) and its receptor VEGFR, leading to endothelial cell proliferation and abnormal microvascular formation causing peritumoral edema (PTE). PTE is one of the significant contributors to mortality in malignant gliomas. Therefore, understanding the molecular mechanism involved in the evolution of gliomas is necessary. This study was to assess the level of expression of pSTAT3, VEGF, and VEGFR in malignant gliomas and analyze the extent of PTE and the extent of expression of one or more of these markers. This study included 84 patients categorized as per the World Health Organization classification of central nervous system tumors into grade IV, III, and II gliomas to investigate the expression of pSTAT3, VEGF, and VEGFR by immunohistochemistry. Furthermore, the presence or absence of PTE was determined using magnetic resonance imaging/computed tomography scans in these patients. The association between the markers (pSTAT3, VEGFR, and VEGF) and the extent of PTE in these patients was statistically significant (P < 0.05). The pSTAT3, VEGF-R, and VEGF signaling pathways could contribute to peritumoral edema and might be a regulatory mechanism during PTE formation during tumorigenesis and progression.