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Journal of Orthopaedic Surgery and... Jun 2024It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The... (Meta-Analysis)
Meta-Analysis Comparative Study
Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis.
BACKGROUND
It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT.
METHODS
PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables.
RESULTS
The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = - 0.60, 95% CI - 1.19 to - 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates.
CONCLUSION
Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified.
LEVEL OF EVIDENCE
Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials.
Topics: Humans; Arthroplasty, Replacement, Hip; Network Meta-Analysis; Traction; Treatment Outcome; Blood Loss, Surgical; Operating Tables; Randomized Controlled Trials as Topic; Postoperative Complications
PubMed: 38951886
DOI: 10.1186/s13018-024-04852-3 -
Data in Brief Jun 2024This dataset gathers the initial formation and the evolution of water content and distribution, as well as water evacuation, within a lung-inspired PEM (proton exchange...
This dataset gathers the initial formation and the evolution of water content and distribution, as well as water evacuation, within a lung-inspired PEM (proton exchange membrane) fuel cell with a 50 cm active area for various operating conditions such as cell pressure, relative humidity of the reactant (anode and cathode), temperature, and cell current density. Neutron imaging was used since it has been shown to be an effective technique for quantitative analysis of water distribution, obtaining the thickness of the water with the Lambert-Beer law, thus obtaining the numerical data that composes the tables and graphs in this dataset. A series of videos compiling the individual images obtained through neutron imaging, showing the water distribution evolution are presented. Numerical and graphical compilation of the amount of water in a cell through time in different regions of the cell and for a total of 10 experiments are provided. This dataset provides a deeper knowledge on the complex phenomena that liquid water is subjected to in fuel cells along time, as well as a basis for an experimental validation for Computational Fluid Dynamics (CFD) simulations.
PubMed: 38774241
DOI: 10.1016/j.dib.2024.110484 -
Diseases of the Colon and Rectum May 2024Splenic flexure mobilization is typically required in the management of left-sided colon and rectal resections to achieve tension-free anastomosis. Although the da Vinci...
BACKGROUND
Splenic flexure mobilization is typically required in the management of left-sided colon and rectal resections to achieve tension-free anastomosis. Although the da Vinci Xi® surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was designed for multi-quadrant operations, robotic mobilization of the splenic flexure continues to be challenging for some surgeons. Re-docking and patient repositioning may be required, which can be time-consuming, especially in centers without motion-activated operating tables. However, there are some tips and tricks to overcome these challenges. Here, we describe our single docking crossed-arm technique, which facilitates splenic flexure mobilization.
INTERVENTION
We demonstrate our technique in a 61-year-old woman with sigmoid colon cancer, and informed consent was obtained. The operation starts in the medial-to-lateral approach by ligating the inferior mesenteric artery and vein. After the left colon mobilization, robotic arm one (tip-up fenestrated grasper) is positioned on the patient's left, while arms two, three, and four are on the patient's right. A tip-up fenestrated grasper, inserted through port #1, retracts the descending colon medial and inferior towards the cecum. Then, we cross the arms from the lateral aspect of arm one and takedown the flexure without the collision of robotic arms. After the lateral side dissection is completed, we change the position of the instruments to mobilize the transverse colon. This time, the tip-up grasping instrument is used to retract the colon through the left lower quadrant, which enables us to work in the medial aspect of the grasping instrument. Dissection can be performed using bipolar forceps, monopolar scissors, or vessel-sealing devices.
OUTCOMES
We achieved complete mobilization of the splenic flexure. With this technique, dissection can be carried medially and cranially beyond the falciform ligament. After the splenic flexure takedown and freeing up the mesocolon above the pancreatic body, tension-free anastomosis can be performed. In this approach, re-docking is not necessary.
CONCLUSION
During robotic left-sided colorectal surgery, the crossed-arm technique with single docking avoids robotic arms collision and restricted mobility of the left upper quadrant instrument (port#1). This technique facilitates robotic splenic flexure mobilization and eliminates re-docking/repositioning, leading to shorter operative time and improved intraoperative flow. See Video Vignette.
PubMed: 38772012
DOI: 10.1097/DCR.0000000000003241 -
Anesthesiology Research and Practice 2024Prolonged fasting before surgery has negative effects on the physiology and psychology of patients. Preoperative liberal fasting proposes that patients can drink clear... (Review)
Review
BACKGROUND
Prolonged fasting before surgery has negative effects on the physiology and psychology of patients. Preoperative liberal fasting proposes that patients can drink clear liquids before entering the operating theater, challenging the guideline strategy of a two-hour preoperative liquid fast for adults. In recent years, there have been an increasing number of studies on liberal preoperative fasting in adults. However, currently there is no consensus on the safe amount of fluid consumed, adverse effects, or benefits of this new policy.
OBJECTIVE
This scoping review protocol will map the existing evidence of liberal preoperative fasting in adults undergoing elective surgery for clinical practice, to summarize more scientific evidence to healthcare professionals when providing perioperative care. The methodology will follow the six steps of the Arksey and O'Malley methodological framework and be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. A comprehensive search of six databases will be performed from their inception to 31 May 2023 to identify suitable English studies. Two trained investigators will independently screen and extract the data, and any disagreements will be judged by a third investigator. The results of the study will be presented as graphs or tables. . This scoping review only examines literature in the database, without reference to human or animal studies, and therefore does not require ethical approval. The findings of this scoping review will be published in peer-reviewed journals or presented at conferences. . This scoping review has been registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/PMW7C).
PubMed: 38751831
DOI: 10.1155/2024/1519359 -
Annals of Medicine and Surgery (2012) May 2024Multiple-choice questions (MCQs) offer a suitable means to assess the cognitive domain of learners with a high degree of objectivity. The study's objective is to...
INTRODUCTION AND IMPORTANCE
Multiple-choice questions (MCQs) offer a suitable means to assess the cognitive domain of learners with a high degree of objectivity. The study's objective is to formulate an equation for determining the ideal timing for MCQ examinations, thereby inspiring the development of a model to estimate the duration of these examinations.
METHODS
The authors generated a specific computer program that integrated with the operating system of the examination. Technical-specific features included the ability to calculate the speed of students taking examinations with images or videos in the questions or options. This bespoke computer program was designed specifically for assessing individual students' MCQ test-taking pace and generating a proctor report in a computer-readable format. Subsequently, data derived from this program underwent regression analysis to determine the speed at which students completed MCQ examinations.
OUTCOMES
The data were collected from a total of 1035 examinees, all of whom were non-native English speakers. The average reading rate was 62.38±20.4 words/min. It was found that the rate decreased significantly in difficult (50.65±6.9 words/min) items compared to easy (82.29±21.3 words/min) and intermediate (60.56±19.1 words/min) items (<0.001), respectively. The linear regression analysis predicted option selection (words/min) as; 33.92+1.93(%tables/figures)+0.14(%recall)-0.37(%application), r=0.45, <0.001.
CONCLUSION
It is not advisable to base the decision solely on reading time or time allocation. Examination administrators are advised to proactively plan ahead, with particular emphasis on establishing a well-defined taxonomy, as it constitutes a fundamental cornerstone in the utilization of the estimation equation.
PubMed: 38694350
DOI: 10.1097/MS9.0000000000002010 -
Scientific Reports Apr 2024This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy...
This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.
Topics: Humans; Laparoscopy; Female; Male; Aged; Middle Aged; Pressure Ulcer; Stress, Mechanical; Rotation; Pressure; Colorectal Surgery; Sacrum; Operating Tables
PubMed: 38679609
DOI: 10.1038/s41598-024-60424-9 -
Clinical Radiology Jun 2024Several studies have been published comparing deep learning (DL)/machine learning (ML) to radiologists in differentiating PCNSLs from GBMs with equivocal results. We... (Meta-Analysis)
Meta-Analysis Comparative Study
How does deep learning/machine learning perform in comparison to radiologists in distinguishing glioblastomas (or grade IV astrocytomas) from primary CNS lymphomas?: a meta-analysis and systematic review.
BACKGROUND
Several studies have been published comparing deep learning (DL)/machine learning (ML) to radiologists in differentiating PCNSLs from GBMs with equivocal results. We aimed to perform this meta-analysis to evaluate the diagnostic accuracy of ML/DL versus radiologists in classifying PCNSL versus GBM using MRI.
METHODOLOGY
The study was performed in accordance with PRISMA guidelines. Data was extracted and interpreted by two researchers with 12 and 23 years' experience, respectively, and QUADAS-2 tool was used for quality and risk-bias assessment. We constructed contingency tables to derive sensitivity, specificity accuracy, summary receiver operating characteristic (SROC) curve, and the area under the curve (AUC).
RESULTS
Our search identified 11 studies, of which 8 satisfied our inclusion criteria and restricted the analysis in each study to reporting the model showing highest accuracy, with a total sample size of 1159 patients. The random effects model showed a pooled sensitivity of 0.89 [95% CI:0.84-0.92] for ML and 0.82 [95% CI:0.76-0.87] for radiologists. Pooled specificity was 0.88 [95% CI: 0.84-0.91] for ML and 0.90 [95% CI: 0.81-0.95] for radiologists. Pooled accuracy was 0.88 [95% CI: 0.86-0.90] for ML and 0.86 [95% CI: 0.78-0.91] for radiologists. Pooled AUC of ML was 0.94 [95% CI:0.92-0.96]and for radiologists, it was 0.90 [95% CI: 0.84-0.93].
CONCLUSIONS
MRI-based ML/DL techniques can complement radiologists to improve the accuracy of classifying GBMs from PCNSL, possibly reduce the need for a biopsy, and avoid any unwanted neurosurgical resection of a PCNSL.
Topics: Humans; Deep Learning; Diagnosis, Differential; Machine Learning; Glioblastoma; Lymphoma; Magnetic Resonance Imaging; Brain Neoplasms; Sensitivity and Specificity; Radiologists; Central Nervous System Neoplasms; Astrocytoma
PubMed: 38614870
DOI: 10.1016/j.crad.2024.03.007 -
Alternative Therapies in Health and... Apr 2024Laparoscopic gastrectomy (LG) provides advantages such as rapid postoperative recovery and little trauma, but postoperative complications are still unavoidable....
CONTEXT
Laparoscopic gastrectomy (LG) provides advantages such as rapid postoperative recovery and little trauma, but postoperative complications are still unavoidable. Detecting serious complications after LG surgery is still a difficult problem for digestive surgeons.
OBJECTIVE
The study intended to evaluate the clinical significance of the C-reactive protein (CRP) ratio in predicting postoperative complications after LG.
DESIGN
The research team performed a retrospective analysis.
SETTING
The study took place at Department of General Surgery, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.
PARTICIPANTS
Participants were 128 patients with gastric cancer, confirmed through histopathology, who underwent an LG in the general surgery department of the hospital between January 2015 and January 2020.
GROUPS
Based on the optimal cut-off value of the CRP ratio, the research team divided participants into two groups, with 30 participants with a CRP ratio of >2.0 in the high CRP-value group and 98 with a CRP ratio of ≤2.0 in the low CRP-value group. Also, based on the incidence of complications, the team divided participants into a second set of groups, with 30 participants in a severe complications group and 98 in a nonsevere complications group.
OUTCOME MEASURES
The research team: (1) determined participants' CRP ratios and compared the clinicopathological characteristics of the high and low CRP-value groups, (2) identified the postoperative complications that participants experienced and compared the clinicopathological characteristics of the severe and nonsevere complications groups, (3) analyzed the predictive value of the CRP levels for early complications after LG using a receiver operating characteristic (ROC) curve, and (4) performed a multivariate regression analysis to determine the risk factors for serious complications.
RESULTS
No significant differences existed between the two complication groups in CRP value, white-blood-cell (WBC) count, and WBC count ratio on days 1 and 3 after surgery (P > .05), but the severe complications group had a significantly higher CRP ratio than the nonsevere complications group did (P < .001). The ROC curve showed that the sensitivity, specificity, positive predictive value, and negative predictive value of CRP in predicting severe complications after LG were 67.19%, 84.38%, 73.28%, and 83.27%, respectively. Thank you for your suggestion, we have added tables for these data. Compared to the low CRP-ratio group, the high CRP-value group had: (1) a significantly higher body mass index (BMI), with p=0.031; (2) was significantly more likely to have preoperative underlying diseases (P = .011); (3) was significantly more likely to have had a total gastrectomy (P = .006); (4) was significantly more likely to be in the T3+T4 stage (P = .034); (5) was significantly more likely to be in the tumor, node, metastasis (TNM) stage II or III (P = .010); and (6) was significantly more likely to have had postoperative severe complications (P < .001). The multivariate analysis found that the independent risk factors for severe complications after LG included: (1) preoperative underlying diseases-OR=3.624, 95% CI: (1.191, 11.206) and P = .023; (2) an advanced TNM stage [OR=9.037, 95% CI: (1.729, 47.226), P = .009; and (3) a CRP ratio >2.2 [OR=20.473, 95% CI: (7.948, 52.737), P < .001.
CONCLUSIONS
The CRP ratio after LG can effectively predict postoperative complications that need treatment, and when the ratio is more than 2.2, digestive surgeons should pay attention to the possibility of serious complications.
PubMed: 38607201
DOI: No ID Found -
BMC Cancer Apr 2024As comprehensive surgical management for gastric cancer becomes increasingly specialized and standardized, the precise differentiation between ≤T1 and ≥T2 gastric... (Meta-Analysis)
Meta-Analysis
BACKGROUND
As comprehensive surgical management for gastric cancer becomes increasingly specialized and standardized, the precise differentiation between ≤T1 and ≥T2 gastric cancer before endoscopic intervention holds paramount clinical significance.
OBJECTIVE
To evaluate the diagnostic efficacy of contrast-enhanced gastric ultrasonography in differentiating ≤T1 and ≥T2 gastric cancer.
METHODS
PubMed, Web of Science, and Medline were searched to collect studies published from January 1, 2000 to March 16, 2023 on the efficacy of either double contrast-enhanced gastric ultrasonography (D-CEGUS) or oral contrast-enhanced gastric ultrasonography (O-CEGUS) in determining T-stage in gastric cancer. The articles were selected according to specified inclusion and exclusion criteria, and the quality of the included literature was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale. Meta-analysis was performed using Stata 12 software with data from the 2 × 2 crosslinked tables in the included literature.
RESULTS
In total, 11 papers with 1124 patients were included in the O-CEGUS analysis, which revealed a combined sensitivity of 0.822 (95% confidence interval [CI] = 0.753-0.875), combined specificity of 0.964 (95% CI = 0.925-0.983), and area under the summary receiver operating characteristic (sROC) curve (AUC) of 0.92 (95% CI = 0.89-0.94). In addition, five studies involving 536 patients were included in the D-CEGUS analysis, which gave a combined sensitivity of 0.733 (95% CI = 0.550-0.860), combined specificity of 0.982 (95% CI = 0.936-0.995), and AUC of 0.93 (95% CI = 0.91-0.95). According to the I and P values of the forest plot, there was obvious heterogeneity in the combined specificities of the included papers. Therefore, the two studies with the lowest specificities were excluded from the O-CEGUS and D-CEGUS analyses, which eliminated the heterogeneity among the remaining literature. Consequently, the combined sensitivity and specificity of the remaining studies were 0.794 (95% CI = 0.710-0.859) and 0.976 (95% CI = 0.962-0.985), respectively, for the O-CEDUS studies and 0.765 (95% CI = 0.543-0.899) and 0.986 (95% CI = 0.967-0.994), respectively, for the D-CEGUS studies. The AUCs were 0.98 and 0.99 for O-CEGUS and D-CEGUS studies, respectively.
CONCLUSION
Both O-CEGUS and D-CEGUS can differentiate ≤T1 gastric cancer from ≥T2 gastric cancer, thus assisting the formulation of clinical treatment strategies for patients with very early gastric cancer. Given its simplicity and cost-effectiveness, O-CEGUS is often favored as a staging method for gastric cancer prior to endoscopic intervention.
Topics: Humans; Stomach Neoplasms; Ultrasonography; Sensitivity and Specificity; ROC Curve
PubMed: 38580944
DOI: 10.1186/s12885-024-12210-z -
Alternative Therapies in Health and... Mar 2024This study aims to investigate the impact of a novel and diversified teaching approach on training new nurses in the operating room.
OBJECTIVE
This study aims to investigate the impact of a novel and diversified teaching approach on training new nurses in the operating room.
METHODS
A comparative observational study with a quasi-experimental design was conducted. We selected 32 new nurses undergoing standardized training in the operating room at Panzhihua Central Hospital between March 2017 and March 2020, along with 29 nurses trained from January 2014 to December 2016, as research participants. These nurses were divided into a study group and a control group. The control group underwent traditional training, while the study group experienced an innovative and diversified training mode over a 3-year period. We conducted a comprehensive comparison of theoretical knowledge, professional competence, operation duration, and medical satisfaction between the two groups.
RESULTS
The study group, exposed to the innovative teaching approach, demonstrated significantly higher scores in both theoretical and practical examinations compared to the control group (P < .05). Moreover, the study group exhibited a notable reduction in the connection time between operating tables, fostering improved coordination. This group also reported enhanced tacit understanding between doctors and nurses. Notably, the study group expressed higher levels of satisfaction. These findings collectively suggest that the implementation of the new diversified teaching mode positively influences the theoretical knowledge, practical skills, and collaborative dynamics among nurses and medical professionals in the operating room.
CONCLUSIONS
The implementation of the new diversified teaching mode significantly enhances the standardized training of new nurses in the operating room. This approach contributes to their improved clinical performance, offering valuable insights for future training methodologies.
PubMed: 38551420
DOI: No ID Found