Type Of Surgery Research Articles

Supervised prehabilitation in patients scheduled for spinal surgery - a scoping review.

Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups. To evaluate the current state of research on preoperative interventions before spinal surgery, including the representation of subgroups, types of surgical procedures, and prehabilitation concepts. Additionally, it examines the outcomes analyzed and the methodologies employed in existing studies. Scoping review based on a systematic literature search. A comprehensive database search in MEDLINE/PubMed, EMBASE (Ovid), CINAHL (EBSCO), Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus was conducted. Exercise- and/or education-based prehabilitation concepts were identified, and findings were clustered and summarized according to PRISMA reporting standards. Thirty-six reports from 23 studies (50% RCTs), evaluating prehabilitation programs in terms of feasibility, experiences, and effects on physical performance, self-reported function, pain, psychological outcomes and health-economic factors were included. These studies encompassed 2,964 participants scheduled for spinal surgery and reported a wide range of preoperative interventions, settings, and adherence rates. Prehabilitation focused primarily on education (87%) and exercise (35%), either independently or in combination. Most authors have concluded that preoperative interventions benefit patients awaiting spinal surgery, particularly by improving self-reported function, disability, and pain in both the short and long term. However, the findings also highlight the variability in outcomes, strengths, limitations, and recommendations across studies. Notably, 76% of the authors advocated for preoperative preparation, emphasizing the importance of structured, personalized programs and the need for further large-scale clinical trials. Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.

Impact of choroid plexus coagulation on the success of endoscopic third ventriculostomy in children with hydrocephalus: a single-center retrospective observational cohort study.

Hydrocephalus is a common condition in childhood, often treated with ventriculoperitoneal shunts (VPS). Endoscopic third ventriculostomy (ETV) has emerged as an effective alternative, and the addition of choroid plexus coagulation (CPC) is believed to enhance its success, particularly in children under 6months. In this observational study, a retrospective analysis was conducted on 167 pediatric patients who underwent ETV, with and without CPC, at the Hospital da Restauração in Pernambuco. The primary outcome was to evaluate the success rates of ETV and ETV + CPC at immediate postoperative or outcome at discharge and 6-month follow-up. Statistical analyses, including chi-square, univariate, and multivariate logistic regression, were employed to assess correlations between dependent and independent variables. ETV + CPC showed a significantly higher success rate in the immediate postoperative period (91%) compared to ETV alone (75%) (p = 0.007). After 6months, success rates were similar for both groups (67% for ETV + CPC and 66% for ETV), with no significant difference (p = 0.855). Univariate and multivariate analyses revealed that the type of surgery (ETV + CPC vs. ETV) was a significant predictor of immediate postoperative success (OR 2.81, 95%CI 1.18-6.72, p = 0.020). Age and sex did not correlate significantly with surgical outcomes. The addition of CPC to ETV significantly enhances immediate postoperative success in young children with hydrocephalus. Although long-term outcomes equalized, these findings suggest that CPC can be a valuable adjunct in optimizing short-term results.

Incidence and risk factors of ocular complications among patients with homocystinuria in Saudi Arabia: a cross-sectional study

Background: Cysteine beta-synthase deficiency, often known as classic homocystinuria, is an uncommon inborn mistake in methionine metabolism. Developmental delay, intellectual incapacity, skeletal and vascular symptoms, and ocular abnormalities are possible main clinical characteristics. Objective: This study sought to describe the ocular anomalies that King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia, homocystinuria patients presented with between 2018 and 2022. Methods: This retrospective research included 6 homocystinuria patients. Demographic and clinical characteristics of patients as age, gender, comorbidities were collected. Relevant clinical and ophthalmic assessments, like visual acuity, fundus examination findings, complications and type of surgery were also reported. Results: Six patients with homocystinuria (12 eyes) were included. Associated diseases were mostly mental retardation (100%), epilepsy (66.7%), developmental delay (50.0%), scoliosis (33.3%), bronchiectasis (16.7%), thrombophilia (16.7%), metabolic disorders (16.7%) and deep venous thrombosis (16.7%). All patients had ectopia lentis (100%), while one patient (16.7%) had eye ectropion, one patient (16.7%) had anterior uveitis and one patient (16.7%) had scleromalacia. Surgery type was mostly Lensectomy and vitrectomy (83.3%) then scleral fixation (16.7%), and Grice green procedure (16.7%). There were insignificant differences between first and last Autoref readings in spherical, cylinder and axis errors of right and left eyes Conclusions: Late-diagnosed homocystinuria patients frequently have abnormalities of the eyes. Ectopia lentis should always raise the possibility that homocystinuria is the cause of the condition.

Imaging of the postoperative spine.

There has been a significant increase in the number of spinal surgical procedures performed over the last few decades, resulting in a proportionate increase in the number of postoperative imaging studies.An exhaustive literature search was performed along with consideration of various guidelines and expert opinions regarding postoperative spine imaging. Complications are divided into early (in the first few weeks) and delayed, depending on the time of onset. Some complications occurring in the early postoperative period are common for both the instrumented and non-instrumented spine. Delayed complications are specific to the type of surgery performed and have been described as such. This review discusses the normal postoperative appearance and the various early and delayed complications.An understanding of the normal postoperative appearance is pertinent to distinguish normal from abnormal. A plain radiograph is the primary imaging modality for immediate postoperative assessment and long-term follow-up after spinal instrumentation. MRI with or without contrast is the imaging modality of choice for the evaluation of the postoperative spine. CT is the best modality for the assessment of the instrumented spine and status of bony fusion. Imaging assessment of the postoperative spine is complex and requires knowledge of key factors for interpretation like indications for the initial surgical procedure, type and approach of the surgical procedure, instrumentation used, time elapsed since surgery, and clinical complaints. · For proper interpretation of the postoperative spine, it is very important to understand the indication and type of spinal procedure involved. · Baseline postoperative radiographs are important to detect any change in the position of metalwork and implant integration.. · Computed tomography is the modality of choice to evaluate bony fusion and metalwork-specific complications. · Postoperative fluid collection is the most common early complication and MRI is the imaging modality of choice for the identification of the same.. · Intravenous gadolinium is helpful to differentiate between scar/vascularized granulation tissue and recurrent or residual disc.. · Kaur S, Lalam R, Trivedi R. Imaging of the postoperative spine. Rofo 2025; DOI 10.1055/a-2507-8347.

Voiding dysfunctionafter surgery for colorectal deep infiltrating endometriosis: an updated systematic review and meta-analysis.

To define the risk factors of post-operative voiding dysfunction according to the type of surgical procedure performed. A systematic review through PubMed, the Cochrane Library, and Web of Science databases was performed. The Medical Subject Headings terms aimed for English articles about colorectal endometriosis surgery and voiding dysfunction published until December 26, 2022 were used. The primary outcome was the occurrence of post-operative voiding dysfunction. Secondary outcome was the presence of a persistent voiding dysfunction at 1month. MeSH terms included ''deep endometriosis'', ''surgery'', or ''voiding dysfunction''. Two reviewers (AM, PE) assessed the quality of each article independently. A Study Quality Assessment Tool was used to provide rating of the quality of the included studies. 22 studies were included in the final analysis. Rectal shaving was associated with less voiding dysfunction than segmental resection (OR 0.33; 95%CI [0.20: 0.54]; I2 = 0%; p < 10-3). No difference was found between rectal shaving and discoid excision (OR 0.44; 95%CI [0.07: 2.84]; I2 = 55%; p = 0.39), nor between discoid excision and segmental resection (OR 0.44; 95%CI [0.18: 1.09]; I2 = 49%; p = 0.08). Conservative surgery (i.e., shaving and discoid) was associated with less voiding dysfunction than radical surgery (i.e., segmental resection) (OR 0.37; 95%CI [0.25: 0.55]; I2 = 0%; p < 10-3). Regarding persistent voiding dysfunction, rectal shaving and discoid excision were less associated with voiding dysfunction than segmental resection (respectively, OR 0.30; 95%CI [0.14: 0.66]; I2 = 0%; p = 0.003 and OR 0.13; 95%CI [0.03: 0.57]; I2 = 0%; p = 0.007). Conservative bowel procedures are associated with lower rates of persistent post-operative voiding dysfunction and should be considered first when possible.Trial registration: Our meta-analysis was registered under the PROSPERO number: CRD42023395356.

Seizure after flumazenil reversal for total intravenous anaesthesia with remimazolam versus propofol: a matched retrospective cohort analysis of a large Japanese nationwide inpatient database.

Remimazolam is a novel anaesthetic and sedative agent that offers several advantages, including minimal adverse haemodynamic effects and availability of a specific antidote, flumazenil. Flumazenil can induce seizures as an adverse effect; however, the incidence of seizures after flumazenil reversal after total intravenous anaesthesia with remimazolam (remimazolam-flumazenil) remains unknown. We compared the risk of seizures between total i.v. anaesthesia with remimazolam-flumazenil or propofol. We retrospectively identified patients who underwent elective surgery (excluding brain surgery) with total i.v. anaesthesia in Japan between April 2020 and March 2022 using the Japanese Diagnosis Procedure Combination database. Patients were divided into remimazolam-flumazenil and propofol groups. Patients in the remimazolam-flumazenil group were matched to those in the propofol group at a variable ratio of 1:3 (maximum) based on age, sex, hospital, and type of surgery. We conducted conditional logistic regression analyses to assess the association between total i.v. anaesthesia with remimazolam-flumazenil and the incidence of perioperative seizures. We identified 12 033 patients who underwent total i.v. anaesthesia with remimazolam-flumazenil and 432 275 patients with propofol, creating a matched cohort of 19 105. The crude incidence of seizures was 0.66% (95% confidence interval, 0.63-0.68%). There was no significant difference in seizures between the two groups (adjusted odds ratio, 1.08; 95% confidence interval, 0.49-2.37). We observed no significant differences in perioperative seizures between remimazolam-flumazenil and propofol in patients undergoing non-neurological surgery. This suggests that remimazolam-flumazenil is a possible alternative to total i.v. anaesthesia with propofol.

Risk of Placenta Accreta Spectrum Disorder After Prior Non-Cesarean Delivery Uterine Surgery: A Systematic Review and Meta-analysis.

To evaluate the association between previous non-cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies. PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov, CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches. Studies included prospective, retrospective cohort, case-control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery. Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle-Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity (I2) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non-cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43-3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77-2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50-90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78-2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10-14.53), abortion (OR 1.65, 95% CI, 1.43-1.92), endometrial ablation (OR 20.26, 95% CI, 17.15-23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86-5.18). Prior non-cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery. PROSPERO: CRD42024552210.

Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan.

Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major-albeit rare-challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries. We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions. Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms. In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.

Investigating the impact of persistent HPV infection on recurrence of lesions post-surgery for early-stage cervical cancer and related influencing factors

ObjectiveTo explore the influencing factors of recurrence after surgical treatment for early-stage cervical cancer (stages IA1-IIA1) and to investigate the relationship between human papillomavirus (HPV) infection and postoperative recurrence of lesions.MethodsA retrospective analysis was conducted on the clinical data of 242 patients who underwent surgical treatment for early-stage cervical cancer (FIGO stages IA1-IIA1) at the Second Affiliated Hospital of Dalian Medical University between 2015 and 2022. Cox regression analysis was employed to evaluate the relationship between persistent postoperative HPV infection and lesion vaginal local recurrence while identifying the associated risk factors for persistent HPV infection following surgery.ResultsWithin 12 months postoperatively, the HPV clearance rate was 88.11%. HPV infection persisted beyond 12 months in 19 patients (7.9%), with 3 cases demonstrating the same HPV genotypes (types 52, 58) as those identified preoperatively. Multivariate analysis identified persistent postoperative HPV infection (odds ratio [OR] 1.72, 95% confidence interval [CI] -1.14 to 5, p=0.001*) as an independent risk factor for recurrence. Additionally, smoking (OR 7.49, 95% CI 1.19 to 47.13, p=0.032), abnormal vaginal microbiota (OR 0.663, 95% CI 0.403 to 1.088, p=0.001*), and the type of surgical procedure (OR 0.32, 95% CI 0.11 to 0.91, p=0.033) were significantly associated with a higher rate of persistent HPV infection.ConclusionPersistent HPV infection after surgery is an independent risk factor for postoperative recurrence in early-stage cervical cancer. Surgical approach, abnormal vaginal microbiota, and smoking are associated factors for persistent HPV infection after surgery.

Risk factors for the delayed discharge from anesthesia intensive care unit: a single-center retrospective study

BackgroundA single-center retrospective study was designed to investigate the risk factors associated with delayed discharge from the Anesthesia Intensive Care Unit (AICU).MethodsThis retrospective study involved patients admitted in the AICU from January 2017 to December 2022. Risk factors for the delayed discharge from the AICU were analyzed by the binary multivariate logistic regression analysis. Nomogram was constructed to predict the risk of delayed discharge from AICU. The performance of the nomogram was assessed using the receiver operating characteristic curve and calibration curve. A decision curve analysis was also performed to determine the net benefit threshold of prediction.ResultsA total of 14,338 patients admitted in the AICU were retrospectively recruited, involving 9,271 males and 5,067 females. The incidence of delayed discharge from the AICU in the cohort was 1.54% (221/14,338). Binary multivariate logistic regression analysis showed that younger than 18 years or older than 64 years, the American Society of Anesthesiologists physical status of class III-IV, body mass index of less than 18 kg/m2 or greater than 25 kg/m2, preoperative complications, emergency surgeries and intraoperative massive hemorrhage were risk factors for the delayed discharge from an AICU. We utilized nomograms to visually express data analysis results. Based on receiver operating characteristic analysis, calibration plots, and decision curve analysis, we concluded that the nomogram model exhibited excellent performance. Patients undergoing spine surgeries suffered from the highest proportion of delayed discharge from the AICU, followed by those receiving orthopedic and vascular surgeries. Postoperative hemorrhage was the major cause of delayed discharge from an AICU, followed by septic shock, hypoperfusion and pulmonary insufficiency.ConclusionThe incidence of delayed discharge from the AICU in a single-center tertiary hospital is 1.54%. It is influenced by various risk factors, including age, ASA physical status classification, BMI, preoperative complications, type of surgery and intraoperative blood loss. The nomogram model exhibits excellent performance.Trial registrationThe single-center retrospective study was approved by the Ethics Committee of Nanjing Drum Tower Hospital (No. 2021-563-01, Data: 22 November 2021) and registered on the Chinese Clinical Trial Registry (No. ChiCTR2300078251, Data: 01 December 2023).

Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: factors affecting mortality: a nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye

Abstract Purpose Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures. Methods We searched the Turkish Ministry of Health’s e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures. Results The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4–22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p &lt; 0.001 for all). Conclusions This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.

Effect of differences in vascular anatomy on surgical outcomes of left pancreatectomy: a retrospective study

BackgroundMinimally invasive left pancreatectomy (MILP) is increasingly performed worldwide, necessitating the need for improved understanding of vascular anatomy during surgery. However, the effect of differences in vascular anatomy on surgical outcomes remains unclear. In this study, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify factors that influence open and minimally invasive surgery (MIS) outcomes.MethodsThis was a single-center retrospective study involving 123 patients who underwent left pancreatectomy (LP). We analyzed the correlation between vascular anatomical variations, namely, (i) the root of the splenic artery (SpA; types 1 and 2), (ii) the parent artery of the dorsal pancreatic artery, (iii) confluence patterns of the left gastric vein, and (iv) the inferior mesenteric vein, and surgical outcomes. We also performed a risk analysis of prolonged operation time, considering surgery-related factors.ResultsSpA type 2 was only significantly associated with longer operation time (p < 0.01) in LP procedures. In all LP cases, the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69–11.18; p < 0.01), the SpA type (type 2; OR 2.77; 95% CI 1.16–6.94; p = 0.02), and surgery type (MIS; OR 5.24; 95% CI 2.17–14.00; p < 0.001) were independently associated with prolonged operation times. In open-LP cases, high body mass index (> 24 kg/m2; OR 7.24; 95% CI 1.89–36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79–33.79; p < 0.01), and the SpA type (type 2; OR 5.86; 95% CI 1.72–24.65; p < 0.01) showed significant association with prolonged operations. In MILP cases, sex (male; OR 9.07; 95% CI 2.61–38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18–17.08; p = 0.03) showed significant associations.ConclusionsSpA type 2 may negatively affect surgical outcomes. Therefore, it is important to recognize and approach vascular anatomy appropriately. MIS, especially robotic surgery, may be effective in mitigating the negative effects of variations in vascular anatomy.

Dynamic Augmented Reality Cues for Telementoring in Minimally Invasive Surgeries: Scoping Review.

Remote surgeons use telementoring technologies to provide real-time guidance during minimally invasive surgeries (MIS). Such technologies are continuously improving with the integration of dynamic augmented reality (AR) cues. This includes virtual overlays of hand gestures, pointers, and surgical tools onto the operating surgeon's view. The operating surgeon comprehends this augmented information to operate on the patient. Thus, understanding these dynamic AR cues (either during surgical training or live surgery) is crucial. In this paper, we aimed to review the existing telementoring technologies that use dynamic AR cues during MIS. This review describes the MIS (including surgery type, specialty, procedure, and clinical trial), the telementoring system, the dynamic AR cues generated by these systems, and evaluation of the technology in terms of technical aspects, user perceptions, skills gained, and patient outcomes. A scoping review was conducted using PubMed, Web of Science, Scopus, IEEE Xplore, and ACM Digital Library databases. The search terms included "telementoring," "minimally invasive surgery," and "augmented reality" without restrictions imposed on the publication year. Articles covering telementoring using dynamic AR cues during MIS, including laparoscopic and robot-assisted, were identified. A total of 21 articles were included and categorized based on type of surgery, the telementoring technology used, and evaluation of the technology. Most of the articles reported on laparoscopic suturing performed using synthetic phantoms. Hand gestures and surgical tools were the most frequently used dynamic AR cues (10 articles on each cue), while the mentors and mentees primarily consisted of experienced surgeons and medical students. The studies assessing the telementoring technologies were either descriptive (7 articles) or analytical (14 articles) where it was compared against no cue, prerecorded visual cue, in-person guidance, audio cue, or static AR cue. Outcomes were measured mostly using skills gained (13 articles) and user perception about the telementoring system. In general, telementoring using dynamic AR cues resulted in positive outcomes during MIS. In some cases, they were considered on par with conventional methods such as audio cues and in-person guidance. Further randomized controlled trials are required to objectively assess its clinical benefits.

The relationship between the atherogenic index of plasma and postoperative myocardial injury following non-cardiac surgery under general anaesthesia: a retrospective cohort study

BackgroundThe atherogenic index of plasma (AIP) is a reliable lipid marker associated with coronary artery stenosis (CAS) and cardiovascular events. However, the relationship between AIP and myocardial injury after non-cardiac surgery (MINS) remains insufficiently explored.MethodsThis retrospective study included adult patients who underwent non-cardiac surgery under general anaesthesia. The primary exposure was preoperative AIP, with MINS as the primary outcome. The predictive accuracy of AIP for MINS was assessed using the area under the curve (AUC). Restricted cubic splines (RCS) were used to explore the potential nonlinear relationship between AIP and MINS. Logistic regression analysis was conducted to examine the association of AIP with MINS. Subgroup and interaction analyses were carried out across multiple factors, including age, gender, body mass index, medical history, and the type of surgery (emergency or elective).ResultsThe cohort consisted of 1,160 adult patients, with a median preoperative AIP of -0.05. The incidence of MINS was 7.9%. The AUC for AIP in predicting MINS was 0.719, surpassing the AUCs of triglycerides and high-density lipoprotein cholesterol (0.644 and 0.683, respectively). RCS analysis demonstrated a linear relationship between AIP and MINS (P for nonlinear = 0.165). Patients in the highest quartile of AIP had significantly higher odds of developing MINS than those in the lowest quartile (adjusted OR, 8.05; 95% confidence interval [CI], 3.44 to 18.80; P < 0.001). The results across most subgroups were consistent with the primary analysis, showing no significant interaction effects.ConclusionsA significant and independent linear relationship exists between preoperative AIP and the risk of MINS. As an economical and easily accessible lipid marker, AIP holds potential for preoperative screening of patients at risk of postoperative cardiovascular events.

Gasless single-incision transaxillary endoscopic total thyroidectomy versus conventional open thyroidectomy in patients with papillary thyroid carcinoma based on propensity score matching: a case-control study.

In a previous study, we proposed a modified technique for gasless transaxillary endoscopic total thyroidectomy (ETT) for patients with bilateral papillary thyroid carcinoma (PTC) using a single incision. Whether this method shows non-inferiority to the conventional open approach (COT) remains unclear. This study aims to investigate the safety and feasibility of ETT compared to COT in patients with PTC. We retrospectively analyzed the medical records of cT1-2 PTC patients who underwent total thyroidectomy between April 2020 and December 2022. All patients were diagnosed with bilateral PTC and categorized into ETT and COT groups based on the type of surgery. Propensity score matching (PSM) using nine clinicopathological characteristics was employed to compare the technical safety and short-term oncologic outcomes of ETT and COT, generating 45 pairs of matched patients to reduce potential selection bias. This study was followed by STROBE guideline. After PSM, 90 patients who underwent ETT (n = 45) or COT (n = 45) were included. Age, sex, tumor size, BMI, Hashimoto's thyroiditis, multifocality, extrathyroidal extension, T-stage, and central compartment lymph node metastasis were not different between both groups. Both groups showed similar surgical outcomes, including lymph node yield, complications, and total medical costs. A few patients in each group experienced transient complications, all of which resolved within 6months. No patients had permanent complications. Compared to COT, ETT with a modified technique offers excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with bilateral papillary thyroid carcinoma. ETT is a safe and feasible alternative to COT.

Comparison of cold and tepid modified delnido cardioplegia on myocardial protection in open heart surgery patients

Objectives: Cardioplegia is a crucial component of myocardial protection during aortic cross-clamping and cardiopulmonary bypass. It has been reported to provide effective myocardial protection and improved clinical outcomes with enhanced surgical flow in adult cardiac procedures. This study investigates the efficacy and safety of cold-modified Del Nido cardioplegia versus tepid blood cardioplegia in adult cardiac surgery patients using Myotherm, a device mainly used in cardiac surgery to monitor and manage the myocardial temperature during surgery. Methods: After obtaining approval from the ethics committee and establishing entry criteria that included age, type of heart surgery, and absence of cardioplegic contraindications, the researchers defined exclusion criteria-such as previous heart surgery or significant comorbidities. Seventy patients were randomly divided into two groups: Group A received a cold solution at 4°C( n=35), while Group B received a tepid solution at 28°C (n=35).The amount of cardioplegia was 10 to 15 cc/kg and was injected with a pressure of 70 to 90 mm Hg in an anterograde manner. The temperature of cardioplegia was also adjusted with a Myotherm device. The day before the surgery, a written consent form was obtained from the patients, and the patients were informed about the study method. The sampling method is a double-blind clinical trial to achieve minimal bias, ensuring the reliability of the results and reducing influences on it. This study was conducted in Afshar Hospital in Yazd during 2023 and 2024. Results: There were no significant differences between the two groups in terms of the need for an intra-aortic balloon pump (p=1.0), intraoperative and postoperative inotropic support (p=0.26), and postoperative pacemaker (p=0.49). Also, there were no significant differences between the two groups in terms of troponin I level after surgery (p=0.50), left ventricular ejection fraction after discharge (p=0.34), time to return of spontaneous heart rhythm (P=0.25), cross-clamp time (P=0.30), cardiopulmonary bypass time (P=0.07), and length of stay in the ICU (P=0.21). Conclusions: The result showed that both techniques provide similar results. Although the time of cross-clamp and cardiopulmonary bypass was shorter in the group using tepid solution, these differences were not statistically significant. In other words, cold and tepid solutions are equally effective and safe to protect the myocardium, and doctors can use both types of solutions during open heart surgery.

Continuation Versus Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Undergoing Noncardiac Surgery.

There has been ongoing debate about whether to continue or withhold angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients undergoing noncardiac surgery. With over 200 million surgeries performed annually worldwide and millions of patients on ACE inhibitors and ARBs, it is crucial to elucidate the best management strategy for patients undergoing noncardiac surgery while on these medications. Several large randomized controlled trials, the Stop-or-Not and the Perioperative Ischemic Evaluation-3 trials, were conducted to investigate this important issue. Both clinical trials demonstrated no difference in cardiovascular adverse events, including vascular death, myocardial injury, stroke, and cardiac arrest, with continuation versus discontinuation of ACE inhibitors or ARBs in patients undergoing noncardiac surgery. However, these clinical trials showed a higher incidence of intraoperative hypotension in patients who continued taking their ACE inhibitor or ARB through the surgery. Based on this evidence, the American College of Cardiology 2024 Perioperative Guidelines recommend that patients undergoing elevated-risk surgery should have their ACE inhibitor or ARB withheld 24 hours before the surgery; however, patients with heart failure with reduced ejection fraction undergoing noncardiac surgery should continue their regimen. Currently, while the evidence indicates no difference in adverse outcomes between continuing and discontinuing ACE inhibitors and ARBs in patients undergoing noncardiac surgery, the decision to continue or withhold these medications remains individualized. Clinicians must consider various patient and clinical factors when making this decision, including the type of surgery, the risk for intraoperative blood loss and hypotension, and the specific indication of the ACE inhibitor or ARB.

Racing performance of Standardbred horses following surgical treatment of apical proximal sesamoid bone fractures (49 cases)

SummaryBackgroundApical proximal sesamoid bone (PSB) fractures are a common occurrence in Standardbred racehorses due to the high‐intensity nature of their work. Several studies have evaluated the racing performance after surgical removal of apical fracture fragments in Thoroughbred horses, however information pertaining to Standardbred racehorses is limited.ObjectivesTo (i) describe the distribution of apical PSB fractures in a population of Standardbred racehorses; and (ii) measure return to athletic ability in these horses following surgical removal of apical PSB fracture fragments.Study designRetrospective.MethodsMedical records of Standardbred racehorses presenting to the Atlantic Veterinary College (AVC) for surgical treatment of an apical PSB fracture were reviewed. Lifetime racing records were obtained, and the five race starts before injury and the five race starts following surgical treatment were analysed for total earnings and number of top‐3 placings for each horse.ResultsThirty‐three horses raced following surgery; 22 of which were racing prior to injury. No significant differences were found in top‐3 placings or monetary earnings for the 22 horses which had raced prior to and after surgery. There was no significant difference in limb or sesamoid affected and return to racing. No associations were found between type of surgery performed or degree of suspensory desmitis and whether the horse returned to racing.Main limitationsSmall sample size.Conclusions88% of horses that were racing prior to injury also raced following surgical treatment of an apical PSB fracture. Surgical removal of apical PSB fractures in Standardbred racehorses does not appear to affect their future athletic ability.

Trigeminal neuralgia - Overview

Trigeminal neuralgia is the most common cause of facial pain in individuals over 50 years old and can have a profoundly negative impact on quality of life. Epidemiological studies have measured the annual incidence of trigeminal neuralgia at around 4-5 cases per 100,000 inhabitants per year. In Iceland, this would amount to about 16-20 new cases annually. The incidence increases steadily with age, peaking between 50 and 70 years. The pain is sudden and often compared to an electric shock. The attacks usually occur in the second or third branches of the trigeminal nerve. The pain is often triggered by sensory stimulation. Chewing, brushing teeth, speaking, or exposure to cold wind on the face, can all trigger an attack. The most common cause of trigeminal neuralgia is believed to be pressure from a nearby blood vessel on the nerve at its origin in the brainstem. Other underlying causes include multiple sclerosis (MS), tumors and in some cases, no cause is found. Treatment for trigeminal neuralgia involves medication with drugs such as carbamazepine, oxcarbazepine, gabapentin, or various types of surgical procedures. This article will review the epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment of trigeminal neuralgia.

Distribution of lymph node metastasis and prognosis in duodenal bulb tumors: A multicenter retrospective study.

797 Background: Duodenal tumors, especially duodenal bulb tumors, is a relatively rare malignancy of the gastrointestinal tract. The optimal surgical procedure for primary duodenal tumors has not been established because of its low incidence. The purpose of this study was to examine the distribution of lymph node (LN) metastasis in duodenal bulb tumors. Specifically, in T1a and T1b tumors, we aimed to evaluate the feasibility of distal gastrectomy with duodenal bulb resection combined with lymphadenectomy of regional gastric LNs. Methods: Data from patients who underwent surgery for either adenocarcinoma or neuroendocrine tumor located in the duodenal bulb between 2000 and 2020 were retrospectively analyzed from five high-volume centers in Japan. Patient background, clinicopathological factors, type of surgery, distribution of LN metastasis, and long-term outcomes were evaluated. Results: Of the 128 patients evaluated, LN metastasis was observed in 36%. The frequency of LN metastasis in T1b was 18%. Metastatic LNs were identified in #3, #5, #6, #8a, #8p, #12a, and #13 in T1b. The distribution of LN metastasis in T1b was similar between adenocarcinoma and neuroendocrine tumors. The 3 years overall survival rate in T1a, T1b, and T2–4 was 100%, 93%, and 64%, respectively. ln T1b, while there were three patients with a recurrence, two cases were observed in distant organs without regional LNs, and one patient who underwent pancreaticoduodenectomy had metastasis in the gastric regional LNs. Conclusions: Based on the distribution of LN metastasis with pT1, distal gastrectomy with duodenal bulb resection and regional LN dissection is considered a curative treatment. Conversely, pancreaticoduodenectomy is recommended in tumors with T2 or deeper.