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Cureus May 2024Ensuring patients follow preoperative and postoperative instructions is vital for maximizing surgical success. This pilot study investigates the feasibility of using...
INTRODUCTION
Ensuring patients follow preoperative and postoperative instructions is vital for maximizing surgical success. This pilot study investigates the feasibility of using monetary incentives through a nudge engine application-based model of omnichannel communication to prompt adherence to preoperative and postoperative instructions.
METHODS
Over a six-month period, we conducted a longitudinal study employing the TheraPay Rewards app at Maimonides Medical Center in Brooklyn, United States. Our recruitment efforts targeted English and Spanish-speaking patients with smartphones through in-person visits and phone calls. Participants received a $15 credit on a gift card for each completed task. The tasks included preoperative validations such as obtaining primary care physician clearance, completing preoperative assessments, undergoing preoperative scans with accompanying compact disks (CDs), and discontinuing specific medications. Postoperative validations included attending postoperative visits, proper incision care, discontinuation of narcotics at three weeks, and initiation of the first physical therapy session.
RESULTS
We enrolled 16 patients with a mean age of 59.5 years (SD 11.68), the majority being male (n = 10, 62.5%). Preoperatively, task completion rates ranged from 83% to 100%. Postoperatively, rates varied from 20% to 100%. Preoperative task adherence averaged at 98.7% (SD 2.2%), while postoperative adherence averaged 60% (SD 21%).
CONCLUSION
Our study indicates that financial incentives delivered through a gamified approach effectively encourage patients to complete essential preoperative tasks, suggesting a promise for enhancing adherence. Nonetheless, the decrease in postoperative task adherence highlights the necessity for careful implementation. Future investigations should compare cancellation rates and outcome measures to gain deeper insights into the effectiveness of app-based incentives in improving surgical outcomes and patient adherence.
PubMed: 38910607
DOI: 10.7759/cureus.60950 -
The Journal of Arthroplasty Jun 2024With the decreasing age threshold for patients undergoing total hip arthroplasty (THA), there is an escalating demand for enhanced polyethylene durability. Although...
BACKGROUND
With the decreasing age threshold for patients undergoing total hip arthroplasty (THA), there is an escalating demand for enhanced polyethylene durability. Although reports assessing wear in remelted highly cross-inked polyethylene (HXLPE) through radiographic imaging exist, a consensus regarding its oxidation level is lacking. This study investigated the wear, oxidation levels, and degradation of remelted HXLPE that was retrieved at least 10 years after THA.
METHODS
Our analysis focused on seven cases of melted HXLPE liners retrieved ≥ 10 years after THA. All patients were women, who had an average age of 64 ± 6.5 years at the initial operation, and the mean postoperative period after THA was 12 years and 11 months ± 1 year and 5 months. The wear conditions were measured by matching the shape analysis data obtained from a coordinate-measuring machine with a spherical model. Fourier-transform infrared spectroscopy was used to study the oxidation of polyethylene, and the polyethylene structure was evaluated using scanning electron microscopy.
RESULTS
Osteolysis was not observed in any case on X-rays, computed tomography, or intraoperative findings during revision surgery. The average oxidation index of the sliding surface under load was 0.31 ± 0.22 in the six cases calculated after hexane treatment, and 0.69 for one case without hexane treatment. In the six cases calculated after hexane treatment, the average oxidation index of the non-load-bearing sliding surface was 0.11 ± 0.20. Average wear values were 0.33 ± 0.11 mm at 45 degrees from the equatorial direction and 0.04 ± 0.07 mm in the opposite direction. The initial structure of the polyethylene was preserved at all sites with low oxidation levels; however, in one case with stem subsidence, morphological changes and a high oxidation index were observed.
CONCLUSION
Long-term oxidation and wear of remelted HXLPE liners retrieved from THA patients were minimal.
PubMed: 38909854
DOI: 10.1016/j.arth.2024.06.034 -
International Journal of Surgery Case... Jun 2024Biliary atresia (BA) is characterized by the presence of persistent cholestatic jaundice during the neonatal period. This group of patients is at higher risk for liver...
INTRODUCTION AND IMPORTANCE
Biliary atresia (BA) is characterized by the presence of persistent cholestatic jaundice during the neonatal period. This group of patients is at higher risk for liver disease and/or portal hypertension compared with other chronic liver diseases.
CASE PRESENTATION
We present a newborn patient who had biliary stools early postnatally, but her gallbladder was not seen on radiological examination and was referred to our clinic. On examination, polysplenia was seen, and the inferior vena cava was not seen. The patient's stool color changed to a creamy stool without bile three weeks postnatally. The neonate was diagnosed with biliary atresia and splenic malformation (BASM) syndrome. The patient underwent a Kasai portoenterostomy in the 3rd week of age and was preoperatively diagnosed with malrotation and treated with a Ladd procedure at the same time. The patient had a postoperative stool with bile and decreased bilirubinemia with a normal defecation period.
CLINICAL DISCUSSION
BASM syndrome, clinically has different causes and a worse prognosis than isolated BA. The syndrome can lead to end-stage cirrhosis and liver failure if left untreated. Although timely Kasai surgery is the standard treatment for BA, the age of the patient at the time of the surgery is different depending on BA groups.
CONCLUSION
The most important prognostic factors for BASM syndrome are early diagnosis and treatment. Despite this, the patients need careful follow-up. Postoperative adjuvant steroid therapy may have a good impact on the outcomes.
PubMed: 38909387
DOI: 10.1016/j.ijscr.2024.109937 -
Diagnostic Pathology Jun 2024Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid...
BACKGROUND
Pulmonary hamartomas are benign lung lesions. Histopathologically, pulmonary hamartoma is composed of varying amounts of mesenchymal elements, including chondroid tissue, mature adipose tissue, fibrous stroma, smooth muscle, and entrapped respiratory epithelium. Most pulmonary hamartoma cases are asymptomatic and found incidentally during imaging. They usually appear as well-circumscribed lesions with the largest dimension of less than 4 cm. Asymptomatic giant pulmonary hamartomas that more than 8 cm are rare.
CASE PRESENTATION
In the current case report, a 12.0 × 9.5 × 7.5 cm lung mass was incidentally noticed in a 59-year-old female during a heart disease workup. Grossly, the lesion was lobulated with pearly white to tan-white solid cut surface and small cystic areas. Microscopically, representative tumor sections demonstrate a chondromyxoid appearance with relatively hypocellular stroma and entrapped respiratory epithelium at the periphery. No significant atypia is noted. No mitosis is noted, and the proliferative index is very low (< 1%) per Ki-67 immunohistochemistry. Mature adipose tissue is easily identifiable in many areas. Histomorphology is consistent with pulmonary hamartoma. A sarcoma-targeted gene fusion panel was further applied to this case. Combined evaluation of microscopic examination and sarcoma-targeted gene fusion panel results excluded malignant sarcomatous transformation in this case. The mediastinal and hilar lymph nodes are histologically benign. After surgery, the patient had an uneventful postoperative period.
CONCLUSIONS
Giant pulmonary hamartoma is rare; our case is an example of a huge hamartoma in an asymptomatic patient. The size of this tumor is concerning. Thus, careful and comprehensive examination of the lesion is required for the correct diagnosis and to rule out co-existent malignancy.
Topics: Humans; Hamartoma; Female; Middle Aged; Lung Diseases; Incidental Findings; Lung Neoplasms
PubMed: 38909245
DOI: 10.1186/s13000-024-01506-0 -
Scientific Reports Jun 2024Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral... (Comparative Study)
Comparative Study
Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral head(ONFH). Firstly, this study intends to compare the effectiveness of surgical hip dislocation combined with impacting bone grafts (SHD-IBG) and pedicled vascularised iliac bone graft transfer (PVIBGT) in treating ONFH. And the study investigates patients who suffered from hip preservation failures from both groups to better comprehend failure reasons. 30 patients (34 hips) with ARCO stage IIIA femoral head necrosis were selected between January 2012 and July 2022. They were divided into group A(SHD-IBG) and group B (PVIBGT) according to different surgical methods. Firstly, compared the 1-year effect between SHD-IBG and PVIBGT at 1 year postoperatively; Secondly, assessed the medium and long-term efficacy of SHD-IBG hip preservation treatment; Lastly, based on study of the femoral head removed from patients with hip preservation failure in the two groups, the reasons for the failure of hip preservation were comprehensively analyzed in the two groups. Group A: 11 males (13 hips), 4 females (4 hips);Group B: 9 males (11 hips), 6 females (6 hips).Firstly, the average Harris scores of the two groups at 1 year after surgery: preoperative: 70.7, 1 year after surgery: 78.9 in group A; preoperative: 69.5, 1 year after surgery: 81.5 in group B. The differences were statistically significant (P < 0.05).Compared to the preoperative period, quantitative analysis by DCE-MRI showed an increase in perfusion in the necroticarea and an improvement in hyperperfusion in the repair-responsive area one year after the surgery. Secondly, in group A, the hip preservation rate was 88.2% at 2.5-11 (average of 77 months) years of follow-up, and the mean Harris score at the last follow-up was 73.2.Semi-quantitative analysis of postoperative DCE-MRI showed that the perfusion curves of necrotic and repaired areas were similar to those of the normal area. This suggests the instability within the femoral head had been effectively improved, and the perfusion had partially recovered. Thirdly, according to Micro-CT and pathologica studies of patients with hip preservation failure in these two groups, all these patients' femoral head was significantly collapsed and deformed. Their trabeculae was thin and partially disorganized, with fractures in the subchondral bone and separation of the cartilage from the subchondral bone. The necrotic areas had sparse trabeculae, disorganized arrangement, loss of continuity, and disappearance of cells in the trabecular traps. The necrotic area was covered with fibrous tissue, and partial restoration was observed in the repair area. Mechanical finite element analysis showed that the maximum equivalent force was observed in the weight- bearing area and the cortical bone surrounding the shaft of femurand. The result of DCE-MRI showed that the repair reaction area exhibited abnormal hyperperfusion. In this study, the efficacy of SHD-IBG and PVIBGT was compared at 1 year after operation, and the long-term follow-up of SHD-IBG was 2.5-11 (mean 77 months) years, combined with DCE-MRI results, we found that the short-term effect of PVIBGT was more significant than that of SHD-IBG. SHD-IBG can achieve satisfactory hip preservation in the medium and long term follow-up.
Topics: Humans; Female; Male; Femur Head Necrosis; Adult; Middle Aged; Bone Transplantation; Treatment Outcome; Ilium; Femur Head; Hip Dislocation
PubMed: 38909104
DOI: 10.1038/s41598-024-65197-9 -
Medicina Oral, Patologia Oral Y Cirugia... Jun 2024This study aimed to investigate the effectiveness of combining sevoflurane with remifentanil, esmolol, or nitroglycerin for hypotensive anesthesia and determine the...
BACKGROUND
This study aimed to investigate the effectiveness of combining sevoflurane with remifentanil, esmolol, or nitroglycerin for hypotensive anesthesia and determine the suitable hypotensive anesthesia method for orthognathic surgery.
MATERIAL AND METHODS
This retrospective study included 60 patients who underwent orthognathic surgery for developmental malocclusion. They were divided into three groups based on the hypotensive agent preferences: Group 1 (n = 20), sevoflurane and remifentanil; Group 2 (n = 20), sevoflurane and esmolol; Group 3 (n = 20), sevoflurane and nitroglycerin. Bleeding volume, heart rate, systolic, diastolic, and mean arterial blood pressure were recorded at certain times during the perioperative period, including at stages with increased stress levels in the body, such as incision and osteotomy. The patients' blood pressure, analgesic consumption and pain level were recorded in the postoperative period.
RESULTS
Bleeding volume, surgery satisfaction related to bleeding, and total operation time did not differ significantly between groups. Intraoperatively, heart rates were significantly higher in Group 3 than in Groups 1 and 2 (p = 0.001). However, hemodynamic stability was similar in Groups 1 and 2. Postoperatively, analgesic consumption, pain levels, and blood pressure dynamics did not differ significantly between groups (p > 0.05).
CONCLUSIONS
Based on this study's results, it was concluded that infusing remifentanil, esmolol, or nitroglycerin with sevoflurane during orthognathic surgery successfully achieved the targeted hypotensive anesthesia and can be considered alternative methods. The decision on which method to use should consider the patient's overall health status and additional medical conditions.
PubMed: 38907646
DOI: 10.4317/medoral.26662 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2024Brain-derived neurotrophic factor (BDNF) is a factor that implicate in the pathophysiology and treatment of depression and anxiety. The aim of this study was to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Brain-derived neurotrophic factor (BDNF) is a factor that implicate in the pathophysiology and treatment of depression and anxiety. The aim of this study was to determine the relationship between dental anxiety and BDNF serum level through impacted third molar surgery.
MATERIAL AND METHODS
In this randomized, double-blind, cross-sectional study, the sample included patients who had been admitted for the impacted third molar extraction under local anesthesia between January to November 2020. The primary predictor variable was serum BDNF level and the second predictor variable was dental anxiety scores before and after operation in patients. The primary outcome variable was the correlation between anxiety scores (APAIS, MDAS, STAI, VAS) and serum BDNF level. The sample included 55 patients (22 Male, 33 Female) aged 18 to 42 (24,2+5,55).
RESULTS
Comparison of pre-operative scores (APAIS, MDAS, STAI, VAS and BDNF) and post-operative scores were statistically significant (P < .05). Post-operatively, MDAS and VAS scores decreased, while BDNF levels and STAI scores increased compared to the preoperative scores. BDNF was not correlated with APAIS, MDAS, STAI, and VAS preoperatively and postoperatively.
CONCLUSIONS
There may be a relationship between serum BDNF level and dental anxiety scale, but, no correlation was found between them.
Topics: Humans; Brain-Derived Neurotrophic Factor; Female; Male; Cross-Sectional Studies; Adult; Tooth, Impacted; Molar, Third; Young Adult; Dental Anxiety; Double-Blind Method; Adolescent; Tooth Extraction; Preoperative Period
PubMed: 38907644
DOI: 10.4317/medoral.26558 -
The Journal of International Medical... Jun 2024Malignant hyperthermia (MH), characterized by severe myoclonus, pyrexia, tachycardia, hypertension, elevated muscle enzymes, and hypercapnia, often occurs in patients...
Malignant hyperthermia (MH), characterized by severe myoclonus, pyrexia, tachycardia, hypertension, elevated muscle enzymes, and hypercapnia, often occurs in patients with congenital deformities or genetic disorders. Although the reported incidence rate is as low as 1:5000 to 1:100,000, patients with MH exhibit rapid aggravation and an elevated mortality rate. Thus, MH is associated with substantial perioperative risk. Successful treatment of patients with MH largely depends on early diagnosis and timely effective treatment. This clinical report provides a detailed description of a patient with newly diagnosed MH who developed a rapid rise in body temperature, end-tidal carbon dioxide, and heart rate during maxillary osteotomy. After successful rescue, the patient recovered smoothly during the postoperative period, indicating the importance of intraoperative monitoring, early diagnosis, effective treatment, and postoperative monitoring. This case is expected to serve as a reference for future interventions and healthcare practices in managing other patients with MH.
Topics: Humans; Malignant Hyperthermia; Anesthesia, General; Male; Female; Adult; Osteotomy
PubMed: 38907364
DOI: 10.1177/03000605241261962 -
BMC Geriatrics Jun 2024Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore...
BACKGROUND
Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore preoperative assessment tools of PMI in patients at increased cardiovascular (CV) risk who underwent noncardiac surgery under the surgical and medical co-management (SMC) model.
METHODS
A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated.
RESULTS
613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34-14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67-0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81-0.93).
CONCLUSIONS
The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.
Topics: Humans; Male; Female; Aged; Prospective Studies; Myocardial Infarction; Postoperative Complications; Risk Assessment; Risk Factors; Surgical Procedures, Operative; Middle Aged; Incidence; Aged, 80 and over; Frailty; China
PubMed: 38907213
DOI: 10.1186/s12877-024-05130-x -
Medicine Jun 2024To evaluate pre- and postoperative changes in the subjective awareness of exodeviation in patients with intermittent exotropia and compare pediatric and adult patients.... (Comparative Study)
Comparative Study Observational Study
To evaluate pre- and postoperative changes in the subjective awareness of exodeviation in patients with intermittent exotropia and compare pediatric and adult patients. This retrospective study included pediatric (6-17 years) and adult patients (≥18 years) with intermittent exotropia who underwent surgery. Patients with subjective awareness of exodeviation associated with exotropia were included. Postoperative improvement was defined as a decrease in the subjective awareness of exodeviation and alleviation of associated symptoms after surgery. Changes in subjective awareness of exodeviation after surgery were evaluated and compared between pediatric and adult patients. Clinical factors associated with postoperative improvement in subjective awareness of exodeviation were analyzed. A total of 195 patients (159 pediatric and 36 adult) were included. Among the included patients, 145 (74.4%, 145/195) reported postoperative improvements in their subjective awareness of exodeviation. A lower percentage of adult patients (15/36, 41.7%) showed postoperative improvement in subjective awareness of exodeviation than that of pediatric patients (130/159, 81.8%, P < .001). The level of distant control was significantly associated with postoperative improvement in subjective awareness of exodeviation in adult patients (odds ratio, 1.151; 95% confidence interval, 0.030-0.758; P = .022). There was a significant difference in the postoperative change in the subjective awareness of exodeviation between pediatric and adult patients with intermittent exotropia. Adult patients are less likely to exhibit postoperative improvement in subjective awareness of exodeviation than pediatric patients. Adult patients with a better level of distant control are more likely to show postoperative improvement in their subjective awareness of exodeviation.
Topics: Humans; Exotropia; Retrospective Studies; Male; Female; Adolescent; Child; Adult; Postoperative Period; Middle Aged; Ophthalmologic Surgical Procedures; Awareness; Age Factors; Young Adult; Treatment Outcome
PubMed: 38905363
DOI: 10.1097/MD.0000000000038696