Hasil untuk "Surgery"

J. Téllez-Zenteno, R. Dhar, S. Wiebe

R. Taylor, D. Stoianovici

R. Mckenna, W. Houck, C. Fuller

K. Robbins, G. Clayman, P. Levine et al.

Willem R Spanjersberg, J. Reurings, F. Keus et al.

B. Burmeister, B. Smithers, V. Gebski et al.

T. Adams, L. Davidson, S. Litwin et al.

CONTEXT Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain. OBJECTIVE To examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery. DESIGN, SETTING, AND PARTICIPANTS A prospective Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese (body mass index [BMI] ≥ 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) who sought and received RYGB surgery (n = 418), sought but did not have surgery (n = 417; control group 1), or who were randomly selected from a population-based sample not seeking weight loss surgery (n = 321; control group 2). MAIN OUTCOME MEASURES Weight loss, diabetes, hypertension, dyslipidemia, and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment. RESULTS Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P < .001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P < .001). The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively. CONCLUSION Among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years.

Steve Kwon, Rachel E. Thompson, P. Dellinger et al.

S. Brethauer, A. Aminian, Héctor Romero-Talamás et al.

S. Karmali, B. Brar, Xinzhe Shi et al.

A. Sepehri, Thomas Beggs, Ansar Hassan et al.

OBJECTIVE Current preoperative assessments for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II and the Society of Thoracic Surgeons risk score, are limited in their ability to predict postoperative outcomes. This is thought to be due to the reliance on chronological age as a predictor of health. In geriatrics, frailty assessments have been developed as a tool in determining physiologic functioning capacity. Whether or not frailty predicts postoperative outcomes independent of existing cardiac preoperative risk scores remains unknown. METHODS We performed a systematic review to determine the association of frailty with negative postoperative outcomes such as major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing cardiac surgery. We searched PubMed, EMBASE, the Cochrane library, and Ageline from inception until July 2013 and screened 5913 abstracts for potential inclusion. Of these, 6 studies examined the relationship between objective frailty assessments and postoperative outcomes. Our included studies evaluated 4756 patients undergoing cardiac surgery. RESULTS Frailty, defined using multiple criteria, had a strong positive relationship with the risk of MACCE (odds ratio, 4.89; 95% confidence interval, 1.64-14.60). Relationships were stronger in older patients undergoing transcatheter aortic valve replacement (TAVR) than younger patients undergoing coronary artery bypass grafting and valvular surgery (hazard ratio for frailty in TAVR, 3.31-4.89 vs hazard ratio for non-TAVR, 1.10-3.16). CONCLUSIONS Patients deemed frail, determined using an objective assessment tool, have a higher likelihood of experiencing mortality, morbidity, functional decline, and MACCE following cardiac surgery, regardless of definition. Further study is needed to determine which components of frailty are most predictive of negative postoperative outcomes before integration in risk prediction scores.

Marc Kegel, Monika Yadav

We classify all contact projective spaces with contact surgery number one. In particular, this implies that there exist infinitely many non-isotopic contact structures on the real projective 3-space which cannot be obtained by a single rational contact surgery from the standard tight contact 3-sphere. Large parts of our proofs deal with a detailed analysis of Gompf's $Γ$-invariant of tangential 2-plane fields on 3-manifolds. From our main result we also deduce that the $Γ$-invariant of a tangential 2-plane field on the real projective 3-space only depends on its $d_3$-invariant.

Alexander Cowtan, Zhiyang He, Dominic J. Williamson et al.

Quantum code surgery is a flexible and low overhead technique for performing logical measurements on quantum error-correcting codes, which generalises lattice surgery. In this work, we present a code surgery scheme, applicable to any qubit stabiliser low-density parity check (LDPC) code, that fault-tolerantly measures many logical Pauli operators in parallel. For a collection of logically disjoint Pauli product measurements supported on $t$ logical qubits, our scheme uses $O\big(t ω(\log t + \log^3ω)\big)$ ancilla qubits, where $ω\geq d$ is the maximum weight of the single logical Pauli representatives involved in the measurements, and $d$ is the code distance. This is all done in time $O(d)$ independent of $t$. Our proposed scheme preserves both the LDPC property and the fault-distance of the original code, without requiring ancillary logical codeblocks which may be costly to prepare. This addresses a shortcoming of several recently introduced surgery schemes which can only be applied to measure a limited number of logical operators in parallel if they overlap on data qubits.

John Hughes

This paper shows for the first time the existence of a Ricci flow with surgery with local topology change \mathbb{CP}^2\setminus\{ \mathrm{pt}\} \rightarrow \mathbb{R}^4. The post surgery flow converges to the Taub-NUT metric on \mathbb{R}^4 in infinite time.

Thomas Tienkamp, Fleur van Ast, Roos van der Veen et al.

Surgical treatment for tongue cancer can negatively affect the mobility and musculature of the tongue, which can influence articulatory clarity and variability. In this study, we investigated articulatory clarity through the vowel articulation index (VAI) and variability through vowel formant dispersion (VFD). Using a sentence reading task, we assessed 11 individuals pre and six months post tongue cancer surgery, alongside 11 sex- and age matched typical speakers. Our results show that while the VAI was significantly smaller post-surgery compared to pre-surgery, there was no significant difference between patients and typical speakers at either time point. Post-surgery, speakers had higher VFD values for /i/ compared to pre-surgery and typical speakers, signalling higher variability. Taken together, our results suggest that while articulatory clarity remained within typical ranges following surgery for tongue cancer for the speakers in our study, articulatory variability increased.

Jana K. Dickter, Yuqi Zhao, Vishwas Parekh et al.

ABSTRACT We investigated the presence of viral DNA and RNA in cutaneous squamous cell carcinoma (cSCC) tumor and normal tissues from nine individuals with a history of hematopoietic stem cell transplantation (HCT). Microbiome quantification through DNA and RNA sequencing (RNA-seq) revealed the presence of 18 viruses in both tumor and normal tissues. DNA sequencing (DNA-seq) identified Torque teno virus, Saimiriine herpesvirus 1, Merkel cell polyomavirus, Human parvovirus B19, Human gammaherpesvirus-4, Human herpesvirus-6, and others. RNA-seq revealed additional viruses such as Tobamovirus, Pinus nigra virus, Orthohepadnavirus, Human papillomavirus-5, Human herpesvirus-7, Human gammaherpesvirus-4, Gammaretrovirus, and others. Notably, DNA-seq indicated that tumor samples exhibited low levels of Escherichia virus in three out of nine subjects and elevated levels of Human gammaherpesvirus-4 in one subject, while normal samples frequently contained Gammaretrovirus and occasionally Escherichia virus. A comparative analysis using both DNA- and RNA-seq captured three common viruses: Abelson murine leukemia virus, Murine type C retrovirus, and Human gammaherpesvirus-4. These findings were corroborated by an independent data set, supporting the reliability of the viral detection methods utilized. The study provides insights into the viral landscape in post-HCT patients, emphasizing the need for comprehensive viral monitoring in this vulnerable population.IMPORTANCEThis study is important because it explores the potential role of viruses in the development of cSCC in individuals who have undergone allogeneic HCT. cSCC is common in this population, particularly in those with chronic graft-versus-host disease on long-term immunosuppression. By using advanced metagenomic and metatranscriptomic next-generation sequencing, we aimed to identify viral pathogens present in tumor and adjacent normal tissue. The results could lead to targeted preventive or therapeutic interventions for these high-risk people, potentially improving their outcomes and management of cSCC.

D.Alan Herbst, MD, Banafsheh Shakibajahromi, MD, Michael V. Genuardi, MD et al.

Advanced heart failure is associated with accelerated brain atrophy, largely related to chronic cerebral malperfusion. Both heart transplantation (HT) and left ventricular assist device (LVAD) implantation improve vital organ perfusion, but the comparative effect on brain atrophy remains unclear. Given the MR incompatibility of LVADs, we leveraged serial CT imaging in patients who underwent either HT or LVAD implantation. 58 patients were included in this single-center retrospective cohort (23 LVAD; 35 HT). LVAD patients experienced greater brain atrophy (median: 7.1 mL/year; IQR: 0.9–15.7) than transplant patients (median: 0.4 mL/year; IQR: −6.7–13.9), but this difference was non-significant (p=0.09). Temporal atrophy (expansion of the Sylvian fissure) was greater in LVAD patients (median: 0.91 mm/year; IQR: 0.14–2.27) than HT patients (median: 0.10 mm/year; IQR: 0.02–0.55), p=0.005. These observations reveal a need for future work to prospectively quantify brain atrophy after LVAD implantation and HT, while comparing with that of advanced heart failure.

Yanling Xiao, Lixia Liu, Xiaoying Peng et al.

Abstract Background Gastrointestinal bleeding (GIB) is associated with high mortality rates among critically ill patients. The hemoglobin-to-red blood cell distribution width ratio (HRR) has recently emerged as a potential prognostic marker in various clinical settings. However, the association between HRR and prognosis in critically ill patients with GIB is unclear. Methods We conducted a retrospective cohort study using the MIMIC-IV database (version 2.2). Patients diagnosed with GIB were included based on predefined criteria. The HRR was calculated as the ratio of hemoglobin to red blood cell distribution width. Kaplan-Meier curves and multivariate Cox regression models assessed the association between HRR and 180-day mortality. Restricted cubic spline curves were employed to evaluate the nonlinear relationship between HRR and mortality. Additionally, a segmented regression model was constructed to determine the threshold effect in nonlinearity. Subgroup analyses were performed to assess the consistency of the relationship between HRR and 180-day mortality across different patient populations. Results A total of 2,346 patients met the inclusion criteria. Higher HRR was independently associated with reduced 180-day all-cause mortality (adjusted HR, 0.15; 95% CI, 0.07–0.31; P < 0.001). Non-linear associations were observed using restricted cubic splines (P for overall < 0.001, P for non-linearity = 0.002). When HRR was less than 0.81, each unit increase in HRR was associated with a 90% reduction in 180-day mortality among patients with GIB (HR, 0.10; 95% CI, 0.04–0.24; P < 0.001). Subgroup analyses demonstrated that the association between HRR and 180-day mortality was consistent across all subgroups. Conclusion HRR exhibits a significant nonlinear negative association with 180-day mortality in critically ill patients with GIB. This association was consistent across multiple subgroups, suggesting that HRR may serve as a simple and effective prognostic biomarker in patients with GIB.

Lalisa Saeaeh, Pornprom Sitthivethayanont, Theerawat Chalacheewa et al.

Abstract Background The 15-item Quality of Recovery scale (QoR-15), a short form of the QoR-40, is a widely used self-reported tool for measuring the postoperative quality of recovery. It has been translated into many languages. In this study, we aimed to validate a translated Thai version of the QoR-15 in patients undergoing elective abdominal surgery under general anesthesia. Methods This was a single-center observational cohort study. The QoR-15 was translated into Thai and culturally adapted, which led to the items on severe and moderate pain being merged, yielding a 14-item scale: the QoR-14-Thai. Next, the QoR-14-Thai, a checklist measuring the patients’ activities of daily living (ADL), and a 100-mm visual analog scale for assessing their global health (VAS-GH) were administered to the study patients before and 24 h after their abdominal surgery. The validity, reliability, responsiveness, and feasibility of the QoR-14-Thai were assessed. Results Among 166 patients, 140 completed the questionnaires, achieving a questionnaire completion rate of 100%. We observed moderate convergent validity between the postoperative QoR-14-Thai and the VAS-GH (r = 0.54, p < 0.001) and ADL checklist (r = 0.50, p < 0.001). The QoR-14-Thai was negatively correlated with the length of hospital stay (r = − 0.23, p < 0.006) and postoperative admission to the intensive care unit (r = − 0.85, p = 0.001). The QoR-14-Thai had excellent internal consistency (Cronbach’s alpha = 0.869), split-half reliability (0.913), test–retest reliability (0.94), and high responsiveness (Cohen’s effect size: 1.01, standardized response mean: 0.73). The median time to complete the questionnaire was 2 min (interquartile range: 1–2). Conclusions The QoR-14-Thai was deemed a valid, reliable, and convenient tool for evaluating the quality of recovery after elective abdominal surgery. Trial registration This study was registered prospectively on the Thai Clinical Trials Registry, identifier TCTR20210326009, on March 26, 2021.

Zahra Nafisi, Adele Pouyafard, Amene Hosseini Yekani et al.

Introduction: Dental injuries are very common and negatively affect an individual's life. The effective management of emergencies in such situations depends on the knowledge of non-experts, such as healthcare providers, who are on-site during the event. This study aimed to investigate the knowledge extent and self-perceived practice of healthcare providers in elementary schools in Abarkuh City regarding the emergency management of traumatic dental injuries. Methods: This descriptive cross-sectional study utilized an online, anonymous questionnaire designed to gather demographic information, assess the background of previous exposure to dental traumatic injuries, and evaluate caregivers' performance in managing such injuries. The questionnaire was distributed to virtual groups of healthcare providers, who had one week to complete it. The collected data were analyzed using descriptive statistics and linear regression tests. Results: A total of 189 questionnaires were filled out, resulting in a response rate of 80.77%. The average knowledge score of the respondents was 5.63 ± 1.98 out of a possible 10 points, whereas their respondents’ average performance score was 4.48 ± 1.86 on the scale of 7 points. Linear regression analysis indicated that the caregivers' previous knowledge significantly influenced their knowledge level (p < 0.001). After adjusting for demographic variables, the study revealed that caregivers' work experience positively impacted their knowledge score (p = 0.009). However, the self-reported performance ratings of healthcare providers did not show any significant correlation with demographic variables. Conclusion: The results of this study show that primary school healthcare workers have inadequate knowledge and self-reported performance concerning dental injuries resulting from trauma.