Hasil untuk "Surgery"

M. Kocher, R. Soffietti, U. Abacioglu et al.

S. Kurtz, E. Lau, K. Ong et al.

Albert J. Pedroza, MD, Alex R. Dalal, MD, Jennifer Kim, MD et al.

Objectives: Loeys-Dietz syndrome comprises genetically discrete subtypes of varying clinical severity. This study integrates longitudinal Loeys-Dietz syndrome clinical outcomes after aortic root replacement with transcriptomic analysis of aortic smooth muscle cell dysregulation to investigate mechanisms governing this subtype-specific aortic vulnerability. Methods: Single institutional experience with aortic root replacement for nondissected aneurysm in patients with Loeys-Dietz syndrome was reviewed for midterm survival and distal aortic events (subsequent aortic intervention, aneurysm, or dissection). Single-cell RNA sequencing was performed using fresh aortic aneurysm tissue to compare smooth muscle cell phenotypes between patients with TGFBR1/2 and SMAD3 variants. Results: A total of 62 patients with Loeys-Dietz syndrome were identified, including 59 genetically confirmed (n = 36 TGFBR1/2, n = 16 SMAD3, and n = 7 TGFB2/TGFB3). Valve-sparing operations were performed in 54 patients, 8 patients underwent composite root replacement operations, and 19 patients underwent concomitant arch replacement. Median follow-up was 6.16 years (interquartile range, 2.88-10.82). Estimated 5- and 10-year survivals for TGFBR1/2 patients were 97% (99%-82%) and 86% (96%-61%), respectively, and estimated incidence of aortic events at 5- and 10-year follow-up was 17% (7%-36%) and 28% (14%-51%), respectively. For SMAD3 patients, estimated survival was 94% (99%-63%) at both 5 and 10 years, and estimated incidence of aortic events at both 5- and 10-year follow-ups was 0%. Single-cell RNA sequencing analysis (n = 3 TGFBR1/2, n = 5 SMAD3) demonstrated altered smooth muscle cell phenotype modulation patterns, with greater retention of contractile gene expression, enriched collagen, and integrin receptor expression in TGFBR1/2 smooth muscle cells, whereas SMAD3 patients showed activation of osteochondrogenic matrix components (TNFRSF11B, CYTL1) and inflammatory pathways. Conclusions: Loeys-Dietz syndrome subtypes may demonstrate variable clinical outcomes after aortic root replacement. Distinct gene dysregulation patterns suggest varying smooth muscle cell–extracellular matrix interactions may participate in clinical variation.

Ruben Sanchez Eligio, Christopher J. Salgado

John T. Paige, Laura Bonanno

Igor Mokryk, Irina Akhmedova, Fatemeh Ghasabeh Hassanzadeh et al.

Hatab Nur, Jezdić Zoran, Ivanjac Filip et al.

Introduction/Objective Quality of life before and after mono and bimaxillary surgery may vary from patient to patient depending on psychological assessment score. The aim of this study was to compare the quality of life before and six months after orthognathic surgery in correlation with a presurgical psychological assessment of patients with class III skeletal deformity. Assuming that patients with low psychological assessment results might have a lower quality of life after surgery despite successful treatment results. Methods For this prospective study 30 patients (19 female,11 male) were included. Psychological assessment was obtained before, and quality of life before and after surgery in skeletal deformity class III patients. Statistical analysis was done with a statistical package for social science - SPSS. Results Overall quality of life after surgery significantly improved in all patients. Surgical correction of class III deformities provided a significant improvement independent of the type of surgery and the severity of the deformity, as well as gender and age. There were significant differences in post-surgical quality of life scores between patients with good and poor psychological assessment scores, related to social disability (p < 0.05). Conclusion Patients with lower preoperative psychological scores experienced a lesser improvement in quality of life, particularly in the domain of social disability. This suggests that additional psychological treatment of these patients could further improve the beneficial effects of orthognathic surgery on postoperative quality of life.

Tong Tan, Peijian Wei, Yanjun Liu et al.

Abstract Background Pure aortic valve disease is common and has been treated with sternotomy aortic valve replacement for decades. Minimally invasive cardiac surgery has been widely used in atrioventricular valve lesions, but totally thoracoscopic aortic valve replacement has rarely been reported. Method The profiles of 9 patients who were diagnosed with severe aortic valve diseases and treated with two-port thoracoscopic aortic valve replacement between February 2021 and February 2022 were retrospectively reviewed. The clinical data, including baseline characteristics, operative data, postoperative complications, and short-term outcomes, were reported. Results All nine patients successfully underwent two-port thoracoscopic aortic valve replacement, with a cardiopulmonary bypass time of 137.56 ± 27.99 min and an aortic cross-clamp time of 95.33 ± 17.96 min. Seven (77.78%) patients underwent mechanical valve replacement, and two (22.22%) patients underwent bioprosthetic valve replacement. Two (22.22%) patients underwent a concomitant aortic root enlargement procedure. There were no intraoperative or postoperative deaths. The incidence of procedural complications was 0%, while the results of ventilation time, intensive care unit stay length, blood transfusion, chest tube drainage, and kidney function were satisfactory. Conclusion Two-port thoracoscopic aortic valve replacement is a safe and effective surgical treatment option for carefully selected patients with pure aortic valve diseases.

Natalia Smith-Cortinez, Natalia Smith-Cortinez, Ferry G. J. Hendriksen et al.

IntroductionThe leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5) is a tissue resident stem cell marker, which it is expressed in supporting cells (SCs) in the organ of Corti in the mammalian inner ear. These LGR5+ SCs can be used as an endogenous source of progenitor cells for regeneration of hair cells (HCs) to treat hearing loss and deafness. We have recently reported that LGR5+ SCs survive 1 week after ototoxic trauma. Here, we evaluated Lgr5 expression in the adult cochlea and long-term survival of LGR5+ SCs following severe hearing loss.MethodsLgr5GFP transgenic mice and wild type mice aged postnatal day 30 (P30) and P200 were used. P30 animals were deafened with a single dose of furosemide and kanamycin. Seven and 28 days after deafening, auditory brainstem responses (ABRs) were recorded. Cochleas were harvested to characterize mature HCs and LGR5+ SCs by immunofluorescence microscopy and quantitative reverse transcription PCR (q-RT-PCR).ResultsThere were no significant age-related changes in Lgr5 expression when comparing normal-hearing (NH) mice aged P200 with P30. Seven and 28 days after ototoxic trauma, there was severe outer HC loss and LGR5 was expressed in the third row of Deiters’ cells and in inner pillar cells. Seven days after induction of ototoxic trauma there was an up-regulation of the mRNA expression of Lgr5 compared to the NH condition; 28 days after ototoxic trauma Lgr5 expression was similar to NH levels.DiscussionThe presence of LGR5+ SCs in the adult mouse cochlea, which persists after severe HC loss, suggests potential regenerative capacity of endogenous cochlear progenitor cells in adulthood. To our knowledge, this is the first study showing not only long-term survival of LGR5+ SCs in the normal and ototoxically damaged cochlea, but also increased Lgr5 expression in the adult mouse cochlea after deafening, suggesting long-term availability of potential target cells for future regenerative therapies.

Giulia Marchionne, Emili Alcoverro, Simone Spinillo et al.

Case summary A 15-year-old female spayed domestic shorthair cat underwent an emergency craniotomy to remove an intracranial meningioma causing marked midline shift, caudal transtentorial and foramen magnum herniation. Because intracranial structures are enclosed in the cranium, any volume-occupying lesions might raise intracranial pressure (ICP), compromising cerebral perfusion. Relevance and novel information This case report discusses the anaesthetic management of a cat that presented with marked bradycardia and concomitant hypotension. Cushing’s reflex (CR) is a well-recognised cardiovascular reflex following sudden ICP increase, and it features an irregular breathing pattern and increased arterial blood pressure with reflex bradycardia. However, CR is reported to have a low sensitivity for the detection of raised ICP in humans with traumatic brain injury. In a previous study reporting seven cats undergoing surgical removal of intracranial meningioma, ICP was measured in four cases and, in these patients, CR was not observed during surgery. Because bradycardia was not secondary to hypertension, in this case, it might have been the result of direct compression of the nucleus of the vagus nerve. Based on the literature search, there is paucity of reports of cardiovascular changes in cats with increased ICP and their perianaesthetic management.

Juliana Tessari Dias Rohr, Juliana Tessari Dias Rohr, Cassiano Rodrigues Isaac et al.

Despite the various perceptual-motor deficits documented in strabismus, there is a paucity of studies evaluating visual illusions in patients with strabismus. The aim of this study was to examine how the illusionary perception occurs in children/adolescents (10–15 years old) with strabismus with referral for surgery to correct ocular deviations. A controlled cross-sectional study was carried out in which 45 participants with strabismus and 62 healthy volunteers aged 10–15 years were evaluated. The behavioral response to three geometric illusions [Vertical-Horizontal illusion, Müller-Lyer illusion (Bretano version) and Ponzo illusion] and respective neutral stimuli (non-illusory images) regarding the estimation of image size and response time were measured using the Method of Adjustment. To analyze the influence of secondary factors: type of ocular deviation (convergent, divergent or associated with vertical deviation); amount of eye deviation; presence of amblyopia and stereopsis, a one-way ANOVA was performed. Among the tested illusions, children with strabismus showed greater susceptibility (p = 0.006) and response time (p = 0.004) to Ponzo’s illusory images. Children with strabismus and preserved stereopsis, on the other hand, showed similar susceptibility and response time to control group patients to the Ponzo illusion (p &lt; 0.005). Patients with amblyopia showed overcorrection in the estimate of non-illusory Ponzo images (p = 0.046). Children with horizontal ocular deviation (esotropia or exotropia) associated with vertical deviation (hypertropia, DVD and/or alphabetical anisotropy) showed higher susceptibility to vertical adjustment images for the Müller-Lyer illusion (Brentano version) (p = 0.017). Individuals with strabismus tended to overcorrect the length of the straight-line segment adjusted for non-illusory images when testing non-illusory images in the Müller-Lyer test (Brentano version) (p = 0.009), as well as for the neutral images in the Vertical-Horizontal test (p = 0.000). The findings indicated impairment in the perception of geometric illusions and neutral figures, especially for the Ponzo illusion test by children with strabismus. As the behavioral response to illusory images may indirectly reflect the visual and morphofunctional alterations present in these individuals, we suggest that the investigation of visual illusory perception can be used as a new research strategy in the field of investigating the visual function in strabismus.

Yoshihiro Nagao, Katsuya Toshida, Akinari Morinaga et al.

Abstract Background Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. Case presentation The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. Conclusions A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered.

Keisuke Okuno, Keisuke Okuno, Rachana Garg et al.

Pak-Cheong Ho, Josephine M-W Wong, Wai-Wang Chau et al.

Introduction: Children with physical disabilities are less likely to access music and arts due to their extremity anomalies. “Budding Well” is a non-conventional rehabilitation program providing music and arts courses for the targeted participants. The program has run through the third year and a review of the service outcomes has been sorted. Materials and methods: Aged 6–18 years with different kinds and degrees of limb dysfunctions were invited to join the program. The course consisted of 10 learning classes on playing harmonica (music) or painting (arts). Functional assessments [Bruininks-Oseretsky-Test-of-Motor- Proficiency second edition (BOT-2) and Grip-and-pinch strength] and psychosocial centric questionnaires [Lyubomirsky and Lepper’s Subjective Happiness Scale (SHS), Well-being Index (WHO-5), and Culture-free Self-esteem Inventory-2 (CFESI-2) Form A] were performed and completed at the first and last (10th) class. Program evaluation questionnaire was filled at the last class. Results: Thirty-five participants (male = 20, female = 15) of mean age 8.65 joined the program. Functional assessments and psychosocial centric questionnaire outcomes except CFESI-2 did not show any statistical difference. Age sensitivity testing in CFESI-2 Social domain score showed the best result when cut-off age was at 10.5 (<italic>p</italic> = 0.04) and this cut-off value was further proved by receiver operating characteristic (ROC) analysis (<italic>p</italic> < 0.01). On subjective evaluation, parents noticed a significant improvement in the hand function of their children (<italic>p</italic>= 0.01). Conclusion: Hand functions and psychosocial skills of children and teenagers with different levels of physical disabilities or disfigurement proved to benefit from our program through music and arts. Participants of age at 10.5 best responded to the program, particularly on the significant improvement in self-esteem.

John L. Cameron

E. V. Davydova, M. V. Osikov, K. S. Abramov

Isolated fractures of femur account for more than 10% of all road traffic injuries. Traumatic injury of femoral bone triggers a cascade of interrelated neuroendocrine reactions at systemic level, primarily at the hypothalamic-pituitary-adrenal axis, systemic response of immune system, initiated by release of tissue degradation products, cytokines and other mediators of damage into systemic blood circulation. Specific cellular reactions in response to traumatic injury to bone tissue include both innate and adaptive immune responses. In this regard, there is still scarce information on changes in blood lymphocyte subpopulations observed after closed isolated fracture of the femoral diaphysis at the middle third, before and after surgery. The aim of the present study was to evaluate the subpopulations of peripheral blood lymphocytes following closed isolated fracture of the femoral diaphysis with bone displacement in thecourse dynamics of surgical treatment, thus being required for studies in pathogenesis, development of diagnostic criteria and creating innovative treatment approaches. The study included 20 apparently healthy men and 36 men with closed isolated fracture of the femoral diaphysis of the middle third (32A and 32B, by AO/ASIF clinical classification, coded according to ICD-10 S72.3). The exclusion criteria were as follows: exacerbation of chronic comorbidities, diseases of lymphatic system and haematopoietic organs, oncological diseases, and evidence of osteoporosis. The spectrum of blood lymphocyte subsets was assessed on days 5, 7 (immediately after surgery) and on day 18 after closed isolated fracture of femoral diaphysis. We have found that, on the day 5 after IPBC along with leukocytosis in peripheral blood, the number of T-regulatory cells, cells with markers of early (CD25+) and late activation (HLA-DR+) proved to be increased, whereas representation of NK cells was decreased. On the day 7 after IPBC and immediately after surgery, leukocytosis persisted in blood, along with increased number of T-regulatory cells, CD3+ cells with early and late activation markers. On the day 18 after closed isolated fracture of the femoral diaphysis, the total numbers of leukocytes, T-lymphocytes, T-helpers, T-regulatory cells, T cells with an early activation marker are restored in peripheral blood, whereas the number of T-lymphocytes expressing HLA-DR+ molecules showed a significant increase.

Eberhard Grambow, Heiko Sorg, Christian G. G. Sorg et al.

A large number of models are now available for the investigation of skin wound healing. These can be used to study the processes that take place in a phase-specific manner under both physiological and pathological conditions. Most models focus on wound closure, which is a crucial parameter for wound healing. However, vascular supply plays an equally important role and corresponding models for selective or parallel investigation of microcirculation regeneration and angiogenesis are also described. In this review article, we therefore focus on the different levels of investigation of skin wound healing (in vivo to in virtuo) and the investigation of angiogenesis and its parameters.

Daisuke Takeda, Kazunobu Hashikawa, Manabu Shigeoka et al.

Advanced mandibular osteoradionecrosis (ORN) sometimes requires extended resection (e.g., hemimandibulectomy). Bacterial infection contributes to ORN pathogenesis. To control infection and determine the extent of debridement required, an understanding of bacterial spread within sites of mandibular ORN is important. The current study used a histopathological approach to assess bacterial colonization in the mandibular condyle and elucidate possible paths of bacterial spread towards the mandibular condyle. Four hemimandibulectomy specimens were selected. Areas of bone destruction were macroscopically assessed and confirmed using hematoxylin and eosin staining. Bacterial presence within mandibular condyle was confirmed with Gram staining. Bone exposure was observed in the molar area in all specimens. Macroscopic bone destruction was apparent especially near the medial side of the cortical wall. Gram staining revealed bacterial colonization of the mandibular condyle in three of the four specimens. In conclusion, bacteria tended to spread posteriorly and through the medial side of the mandibular cortical wall. In patients with advanced ORN, the potential for bacterial colonization of the mandibular condyle should be considered during treatment.

Tsuguo Iwatani, Shinichi Noto, Koichiro Tsugawa

We aimed to determine the dynamic trends in health state utility values (HSUVs) in patients with end-stage breast cancer. We selected 181 patients comprising 137 with primary breast cancer (PBC) and 44 with metastatic breast cancer (MBC) (28 survivors and 16 patients with MBC death). HSUVs were 0.90 and 0.89 in patients with PBC and 0.83 and 0.80 in those with MBC (survivors) at 6 and 3 months, respectively, before the end of the observation period; these values were 0.73 and 0.66, respectively, in those with MBC (deceased) during the aforementioned period. The root-mean-squared error (RMSE) for the decrease in HSUVs over 3 months was 0.10, 0.096, and 0.175 for patients with PBC, MBC (survivors), and MBC (deceased), respectively. One-way analysis of variance for differences in absolute error among the groups was significant (<i>p</i> = 0.0102). Multiple comparisons indicated a difference of 0.068 in absolute error between patients with PBC and those with MBC (deceased) (<i>p</i> = 0.0082). Patients with end-stage breast cancer had well-controlled HSUVs 3 months before death, with a sharp decline in HSUVs in the 3 months leading up to death.