Hasil untuk "Surgery"

M. Jacobs, J. Verdeja, H. Goldstein

Nurcan Gürsoy, Ersan Gürsoy

Abstract Correctable refractive errors are a major, preventable cause of visual impairment. Refractive surgery is widely promoted online, yet how Turkish-language YouTube videos frame benefits, risks, recovery, and long-term outcomes—and how this framing differs between patient and physician narrators—remains underexplored. We aimed to qualitatively compare patient- and physician-generated Turkish-language YouTube videos on refractive surgery and to describe audience engagement. We conducted a reflexive thematic analysis (Braun & Clarke) of 64 publicly available videos (29 patient, 35 physician) meeting predefined criteria (Turkish; primarily refractive surgery; ≥1 min; ≥1,000 views; ≥240p). Searches were performed on 15 July 2025 using predefined search strings. Videos were transcribed verbatim and inductively coded in NVivo by two researchers. Between-group differences in engagement metrics were assessed with Mann–Whitney U tests, with a one-video-per-channel sensitivity analysis to address potential clustering. Patient narratives foregrounded lived experience (decision-making, perioperative discomfort, postoperative visual fluctuations, and symptoms such as dry eye and glare/halos) and often raised concerns about commercialization. Physician narratives emphasized candidacy assessment, procedure selection, recovery timelines, and risk mitigation. In the one-video-per-channel sensitivity analysis (patient n = 27; physician n = 23), patient videos received more likes (median 300 [IQR 1,639] vs. 59 [269], p = 0.009) and showed a higher like-to-view ratio (0.013 [0.01] vs. 0.006 [0.01], p < 0.001), whereas view counts were not significantly different (24,000 [98,900] vs. 18,000 [48,500], p = 0.224). Turkish-language YouTube narratives share experiential touchpoints but diverge systematically in how risks, commercialization, and expectations are framed by patients versus physicians. Findings support the need for balanced, accurate, and discoverable patient-facing materials tailored to platform dynamics.

Shinichi Mizuki, Keiko Tanaka, Yoshihiro Miyake et al.

Abstract Background Typical foot deformity patterns of patients with rheumatoid arthritis (RA) include hallux valgus, claw toes, splay foot, flat foot, and hindfoot valgus deformities. However, some patients present deformities that are different from a typical pattern, such as metatarsus primus elevatus, described as dorsal elevation of the first metatarsal in relation to the lesser metatarsals. We speculated that metatarsus primus elevatus might be associated with calcaneal inclination and hindfoot varus alignment; however, studies on the association of hindfoot alignment with metatarsus primus elevatus in patients with RA are limited. Objective To elucidate the impact of hindfoot coronal and sagittal alignment on metatarsus primus elevatus in patients with RA. Methods We performed a retrospective analysis of weight-bearing anteroposterior and lateral radiographs of 58 patients (112 feet) with rheumatoid foot deformities who underwent surgery. The degree of metatarsus primus elevatus (dMPE) was assessed based on the distance between the dorsal cortical bones of the first and second metatarsals, as measured on lateral radiographs. The intermetatarsal angle between the first and second metatarsals (M1M2), calcaneal pitch, and the naviculocuboid (N/C) overlap ratio were assessed. Patients were divided into four subgroups representing dMPE quartiles (Q1–Q4) as closely as possible. Analysis of covariance was used to calculate the adjusted means of the radiographic parameters. Logistic regression was used to assess the association between clinical and radiographic parameters and the risk of being in the highest dMPE quartile (i.e., Q4). Results The median dMPE in patients with RA was 2.0 mm (interquartile range, 0.2–5.4 mm). Analysis after adjusting for sex, age, body mass index, and disease duration revealed that the M1M2 angle and N/C overlap ratio in the Q4 subgroup were significantly smaller than those in the Q1 subgroup (p < 0.01 for both parameters). Only the N/C overlap ratio showed a significant inverse association with the risk of being in Q4 (adjusted odds ratio: 0.94, 95% confidence interval: 0.91–0.97). Conclusion A subset of patients with RA exhibits metatarsus primus elevatus, which is associated with hindfoot alignment. Recognizing this less common deformity pattern is important when planning treatment strategies for the rheumatoid foot.

Sara Venturini, Saniya Mediratta, Tobias J. Adams et al.

Objective: For patients undergoing decompressive craniectomy for TBI, cranioplasty facilitates rehabilitation and reintegration into society. Cranioplasty practice is poorly documented globally. Challenges including lack of materials and technical skills disproportionately affect LMICs. This study evaluates global cranioplasty practice and the extent to which barriers preclude patients from accessing cranial reconstruction. Methods: An international survey was disseminated to centres performing cranioplasty for TBI. Survey questions addressed baseline hospital information, cranioplasty indications, barriers and techniques, follow-up. Centres in HICs and LMICs were compared. Results: 101 responses were received (86 individual institutions, 39 countries). Variation in practice was seen globally, and between HICs and LMICs. Autologous bone was the most common material used. Titanium and polymethylmethacrylate were the most used artificial implants. LMIC sites were more likely to store bone flaps in the patient's abdomen, while HICs had more access to 3D printing. Lack of infection and good neurological recovery were the commonest eligibility criteria. Cost of materials/operation and unavailable materials were the commonest barriers. Responders suggested easier access to cheaper materials would significantly improve access. Cranioplasty associated costs were higher than the country's GNI per capita in 7 cases. Less than 50 % of patients without cranioplasty had access to protective equipment. Less than a quarter of respondents stated patients had access to brain injury charities, and over 50 % believed stigma affects their patients. Conclusions: Variation in cranioplasty practice was confirmed. Barriers limiting access were identified, specifically, availability of materials and operation-related costs. These findings can inform context-specific interventions to overcome current challenges.

Chad Brenner, Chad Brenner, Carolyn Y. Fang

Jiu Chen, Tianxiao Fu, Li Liu et al.

IntroductionAcupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The present systematic review and meta-analysis aimed to evaluate the rationality and efficacy of integrating acupuncture in the ERAS strategy to recuperate gastrointestinal function.MethodsWe searched eleven databases for relevant randomized clinical trials (RCTs) of acupuncture for the treatment of gastrointestinal dysfunction in tumor patients treated with the ERAS protocol. The quality of each article was assessed using the Cochrane Collaboration risk of bias criteria and the modified Jadad Scale. As individual symptoms, the primary outcomes were time to postoperative oral food intake, time to first flatus, time to first distension and peristaltic sound recovery time (PSRT). Pain control, adverse events, and acupoint names reported in the included studies were also investigated.ResultsOf the 211 reviewed abstracts, 9 studies (702 patients) met eligibility criteria and were included in the present systematic review and meta‑analysis. Compared to control groups, acupuncture groups showed a significant reduction in time to postoperative oral food intake [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.18 to -0.35], time to first flatus (SMD=-0.81, 95% CI -1.13 to -0.48), time to first defecation (SMD=-0.91, 95% CI -1.41 to -0.41, PSRT (SMD=-0.92, 95% CI -1.93 to 0.08), and pain intensity (SMD=-0.60, 95% CI -0.83 to -0.37).The Zusanli (ST36) and Shangjuxu (ST37) acupoints were used in eight of the nine included studies. Adverse events related to acupuncture were observed in two studies, and only one case of bruising was reported. DiscussionThe present systematic review and meta‑analysis suggested that acupuncture significantly improves recovery of gastrointestinal function and pain control in tumor patients receiving the ERAS protocol compared to the control group. Moreover, ST36 and ST37 were the most frequently used acupoints. Although the safety of acupuncture was poorly described in the included studies, the available data suggested that acupuncture is a safe treatment with only mild side effects. These findings provide evidence-based recommendations for the inclusion of acupuncture in the ERAS protocol for tumor patients.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42023430211.

Kun Wu, Xianjun Liu, Xianglong Meng et al.

ObjectiveThis study evaluated the effects of sauchinone on dextran sulfate sodium (DSS)-induced ulcerative colitis (UC) mice model and investigated the underlying mechanisms of the downstream pathway and gut microbiota.MethodsThe UC mice model was induced by DSS. The disease phenotypes were determined through pathological symptoms (body weight and disease activity index score), inflammation markers (histological and inflammatory factor detections), and colonic mucosal barrier damage (detection of tight junction proteins). The level of the NF-κB pathway was detected through marker proteins. Database and bioinformatics analyses were used to predict sauchinone-mediated downstream molecules that were previously identified by expression analysis. Mouse feces were collected to detect the V3–V4 region of the 16S rRNA gene.ResultsIn DSS-induced UC mice, sauchinone alleviated pathological symptoms, inhibited inflammation, and prevented mucosal barrier damage. Sauchinone further inhibited the NF-κB pathway by upregulating NAD (P) H dehydrogenase [quinone] 1 (NQO1) in DSS-induced UC mice. Moreover, sauchinone regulated the diversity and composition of the gut microbiota in mice, stimulating the growth of Firmicutes and inhibiting the growth of Proteobacteria and Bacteroidetes.ConclusionTherefore, sauchinone exerted therapeutic effects on UC in mice by regulating the NQO1/NF-κB pathway and altering the gut microbiota. This provides a theoretical basis for developing sauchinone as a therapeutic agent and extends our understanding of its bioactivity.

Muralidhar V., Atish Pal, Arpita Malani

Heena Chhanwal, Divya Kheskani, Parita Gandhi et al.

Abstract Background Awareness under general anesthesia is an unpleasant phenomenon that usually goes unnoticed and neglected. Numerous incidences of intraoperative awareness are not reported. Reasons for awareness might be the inadequate depth of anesthesia, less effective drugs, lack of proper anesthesia monitoring equipment, and untrained medical staff. The purpose of this study is to evaluate intraoperative awareness during general anesthesia and titrate the amount of anesthetic agents according to BIS values among patients and monitor hemodynamic parameters throughout the surgery. Results The intraoperative awareness reported was 2% in the BIS group and 8% in the non-BIS group. The total propofol consumption in the BIS group was significantly less as compared to the non-BIS group (P value<0.0001). Conclusions The incidence of definite awareness with postoperative recall and propofol consumption was reduced in the BIS group as compared to the non-BIS group.

Xiaxia Man, Xiaolin Yang, Zhentong Wei et al.

Abstract Background CXCL1 belongs to a member of the ELR + CXC chemokine subgroups that also known as GRO-alpha. It has been recognized that several types of human cancers constitutively express CXCL1, which may serve as a crucial mediator involved in cancer development and metastasis via an autocrine and/or paracrine fashion. However, the expression pattern and clinical significance of CXCL1 in human uterine cervix cancer (UCC), as well as its roles and mechanisms in UCC tumor biology remains entirely unclear. Methods The expression and clinical significance of CXCL1 in UCC tissues was explored using immunohistochemistry and bioinformatics analyses. The expression and effects of CXCL1 in HeLa UCC cells were assessed using ELISA, CCK-8 and transwell assays. Western blotting experiments were performed to evaluate the potential mechanism of CXCL1 on malignant behaviors of HeLa UCC cells. Results The current study demonstrated that CXCL1 was expressed in HeLa UCC cells, PHM1-41 human immortalized cervical stromal cells, as well as cervical tissues, with UCC tissues having an evidently high level of CXCL1. This high level of CXCL1 in cancer tissues was notably related to poor clinical stages and worse survival probability, rather than tumor infiltration and patient age. In addition, CXCL1 expression was extremely correlated with CCL20, CXCL8 and CXCL3 cancer-associated chemokines expression. In vitro, the growth and migration abilities of HeLa cells were significantly enhanced in the presence of exogenous CXCL1. Gain-function assay revealed that CXCL1 overexpression significantly promoted growth and migration response in HeLa cells in both autocrine and paracrine manners. Finally, we found that CXCL1 overexpression in HeLa cells influenced the expression of ERK signal-related genes, and HeLa cell malignant behaviors derived from CXCL1 overexpression were further interrupted in the presence of the ERK1/2 blocker. Conclusion Our findings demonstrate the potential roles of CXCL1 as a promoter and a novel understanding of the functional relationship between CXCL1 and the ERK signaling pathway in UCC.

Sultan M, Beza L, Debebe F et al.

Menbeu Sultan,1 Lemlem Beza,2 Finot Debebe,2 Getaw Worku Hassen,3 Anisha Duvvi,3 Selamawit Tilahun,4 Nura Nasser,5 Sisay Bekele6 1Department of Emergency Medicine and Critical Care, St. Paul’s hospital millennium medical College, Addis Ababa, Ethiopia; 2Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Emergency Medicine, New York Metropolitan Hospital, New York, NY, USA; 4Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 5Department of Anesthesiology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 6Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Menbeu Sultan, Department of Emergency Medicine and Critical Care, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, Email smenbeu@yahoo.comAbstract: Tracheal masses are rare in occurrence, but could lead to complications depending on the speed of growth, duration and degree of obstruction. Some of the complications are recurrent pneumonia and air trapping resulting in increased intrathoracic pressure. The latter phenomenon can result in obstruction of the venous return and pneumothorax. We are reporting a rare presentation of bilateral pneumothorax (presumed tensioned) in a young patient with a distal obstructive tracheal tumor. In the emergency department (ED) the patient was in respiratory distress and was found to have extensive subcutaneous emphysema of the neck, chest, and abdominal wall with hypotension. Respiratory failure from bilateral tension pneumothorax was suspected and the patient was intubated with simultaneous bilateral thoracostomy. These measures did not improve the patient’s ventilation and oxygenation status. Further fiberoptic investigation revealed a distal tracheal obstructive mass. An emergency surgical intervention was required to remove the tumor. We recommend considering alternative pathologies, such as an obstructive tracheal tumor, in a patient with respiratory distress. They should especially be considered when oxygenation and ventilation are difficult, particularly when endotracheal intubation and/or tube thoracostomy fail to improve the symptoms. A high index of suspicion and a timely multidisciplinary team approach are essential when managing the life-threatening presentation of a patient with a distal tracheal tumor.Keywords: bilateral pneumothorax, tracheal tumor, hypoventilation

Tomoka Ishibashi, Kentaro Nakayama, Sultana Razia et al.

Background: Given that total laparoscopic hysterectomy (TLH) is less invasive than open surgery, its popularity has increased in Japan. The aim of the present study was to determine the most appropriate uterine size for the safe completion of TLH for the treatment of uterine leiomyomas. Methods: This retrospective study included 505 patients who underwent TLH for uterine leiomyomas. Patients were divided into three groups according to the weight of the excised uterus (<500 g, n = 347; 500–1000 g, n = 125; >1000 g, n = 33). TLH procedures were performed by a resident physician under the supervision of an attending physician. Clinical outcomes including blood loss and duration of surgery were collected from patients’ electronic medical records and compared according to uterine size. Magnetic resonance imaging (MRI) was performed prior to TLH for detection, localization, and measurement of the myoma. Results: Mean operation times were shortest (<500 g: 163 min; 500–1000 g: 190 min; >1000 g: 209 min) and the mean volume of blood lost was lowest (<500 g: 116 mL; 500–1000 g: 208 mL; >1000 g: 402 mL) in patients with a uterus weighing less than 500 g. There were no significant differences in operation time or bleeding between those with a uterine weight of 500–1000 g or >1000 g. MRI revealed that myomas tended to be restricted within the sacral promontory in patients with uterine weights <500 g, whereas those in the other two groups tended to extend beyond this region. Conclusions: TLH outcomes are best when the uterine weight is <500 g. The use of MRI prior to TLH may provide insights into uterine size and/or mass and thus allow for improved surgical planning.

Y. Deepa, Mooventhan Aruchunan, T. Akshaya Mini et al.

Uterine fibroids (UFs) are common in women during their reproductive age. A 40-year-old married woman was diagnosed with UF and underwent conventional treatment in March 2019. Her symptoms began with dysmenorrhea associated with bloating of the abdomen. Initially, she visited a private hospital, underwent ultrasonogram (USG) of the pelvis in a private diagnostic center, and the report suggests the presence of bulky uterus with fibroid and features of adenomyosis. Her physician advised to undergo a surgery, but she refused and thus visited our hospital. The patient underwent yoga and naturopathy intervention for the period of 11 days. The results of the study showed a reduction in the UF size from 27 mm × 22 mm to 22 mm × 18 mm in the 11 days of yoga and naturopathy intervention. Although the results are encouraging, it may vary because of a single case study. Hence, further well-planned clinical studies are suggested with a large sample size to validate our results.

John S. Ikonomidis

Bo Du, Jianzhong Xu, Jintao Hu et al.

Objective: The surgical technique, safety, efficacy, and clinical application value of the intra-neuroendoscopic technique (INET) for the treatment of subacute-chronic and chronic septal subdural hematoma was investigated based on the structure and pathological features of the hematoma wall, and the critical factors of hematoma growth and recurrence were determined, in order to provide reference for clinical drug treatment.Methods: This was non-randomized concurrent control study. A total of 94 patients who met the inclusion criteria were recruited between May 2015 and February 2019 and were divided into the INET treatment group (INET group, 45 cases) and the burr hole drainage (BHD) treatment group (control group, 49 cases). The hematoma fluid components and the morphological structure and pathological characteristics of the hematoma wall were analyzed, and the surgical duration, subdural drainage tube (SDT) placement duration, intracranial infection rate, Bender grade at the 1 month post-operative follow-up and hematoma recurrence rate within the 6 months of post-operative follow-up were compared between the two groups. A multiple logistic regression model was established to analyze the risk factors associated with recurrence within 6 months.Results: Intraoperative endoscopy showed that the adhesion bands that formed early in the hematoma cavity were strip-like and that those that formed late were lock-column-like. The hematoma cavity was divided into different-sized chambers with by these strips/columns. Pathological sections of cyst wall reveled angiogenesis inside the cyst and mucus-like changes, rupture and hemorrhage in the vascular wall. Obvious inflammatory cell infiltration and fibrous connective tissue hyperplasia were observed in the cyst wall. The osmotic pressure of the hematoma fluid was not significantly different from that of the peripheral venous blood [(296.7 ± 10.3) mOsm/kg vs. (291.5 ± 12.4) mOsm/kg, p = 0.68]. However, the D-dimer contents which reflect the severity of fibrinolysis in the hematoma and the proinflammatory cytokine interleukin 6 (IL-6) were significantly higher in the hematoma fluid than in the peripheral venous blood. The surgery duration for the INET group was significantly longer than that for the control group [(60.4 ± 10.6) min vs. (44.1 ± 9.8) min, p = 0.00], but both the hematoma recurrence rate within 6 months of post-operative follow-up (4.4 vs. 24.5%, p = 0.00) and the SDT placement duration [(2.1 ± 0.6) d vs. (3.9 ± 0.7) d, p = 0.00] for the INET group were both lower than those for the control group. The intracranial infection rate did not differ significantly between the two groups (4.4 vs. 10.2%, p = 0.50). The overall effective rate of the Bender grade at 1 month of follow-up did not differ significantly between the two groups (95.6 vs. 87.8%, p = 0.32), but the proportion of patients who recovered to Bender grade 0 with no symptoms was significantly higher in the INET group than in the control group (86.7 vs. 67.3%, p = 0.03). Multiple logistic regression analysis showed that INET surgery [odds ratio (OR) 3.71, 95% confidence interval (CI) 1.31–9.62, p = 0.02], age of 65 years or younger (OR 1.51, 95% CI 1.05–2.87, p = 0.03) and unilateral subdural hematoma (OR 1.76, 95% CI 1.05–3.41, p = 0.02) were independent factors that reduced the post-operative recurrence rate.Conclusion: The INET surgical plan based on the structure and pathological features of the subacute-chronic and chronic subdural hematoma wall can reduce the recurrence rate and improve the clinical prognosis.Trial registration:ClinicalTrials.gov, NCT02515903. Registered 5 August, 2015.

Olufemi Ogundipe, Azuka Njokanma

Background: The Post-Operative Symptom Severity (Posse) score is useful in the assessment of patients after third molar surgery. Objective: To evaluate patients' perceptions of quality of life after surgical extraction of an impacted mandibular third molar by comparing their Post-operative Symptom Severity (PoSSe) scores at Post-operative Weeks (POW) 1 and 4. Methods: Seventy patients (age 18 to 35 years) at the Out-Patient Department were enrolled in a prospective study prior to surgical removal of third molars. Each patient was given a PoSSe questionnaire to be completed at POW 1 and POW 4. The scale assessed recovery in seven key domains on patients’ subjective feeling about pain, eating, speech, sensation, appearance, sickness and interference with daily activities. Results: All but one patient returned completely filled questionnaires. The mean age of the study population was 25.7 ± 4.5 years. The mean PoSSe score at POW 1 and POW 4 were 35.0 ± 7.2 and 33.2 ± 6.9 respectively with statistically significant difference (p = 0.010). The PoSSe score was higher among males compared to females at POW 1 (37.2 ± 7.6 vs 33.5 ± 6.6) and also higher among males at POW 4 (33.8 ± 9.4 vs 32.7 ± 4.6). Conclusion: The severity of symptoms was perceived to be worse at POW 1 when compared to POW4 but the symptoms were still severe at POW4. There is a need for surgeons need to pay more attention to management of symptoms in the post-operative intermediate period.

Chien-Yuan Huang, Kuang-Ting Yeh, Tzai-Chiu Yu et al.

Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient's Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

Shuo Yang, Jie Chen, Ying-Mo Shen et al.

OBJECTIVE: The objective of this study is to assess the prophylactic and therapeutic effects of initiative content reduction on intra-abdominal hypertension in obesity patients with huge abdominal incisional hernia. MATERIALS AND METHODS: In this study, the retrospective cohort/descriptive research methods were applied. We collected the clinical data of a total of 62 obesity patients with single-onset huge abdominal incisional hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University for treatment between January 2011 and December 2015. In the operation, the initiative content reduction was performed. Following observation indexes were recorded as follows: (1) Surgical condition: surgical duration, length of resected intestinal tract, and length of stay (LOS) in hospital; (2) postoperative recovery: cardiac, pulmonary, hepatic and renal functions, and and intravesical pressure; (3) incidence of postoperative complications: infection of incision and intestinal fistula; and (4) patients' condition in follow-up. Return visits in outpatient service were required respectively at 1 week, 1 month, 3 months and 6 months after surgery, and 1 year after follow-up, the follow-up was carried out through telephone. Recurrences of hernia and late-onset infection were the question to be asked in follow-up, and June 2016 was set as the deadline of follow-up. RESULTS: (1) Surgical condition: The surgeries were successfully carried out for 62 patients, in which surgical duration was (115 ± 22) min, the length of resected intestinal tract was (207 ± 64) cm, and LOS was (14.5 ± 1.9) d. (2) Postoperative recovery: the intravesical pressure of patients was decreased in comparison with the level before operation, and after surgery, no hepatic, renal and respiratory dysfunctions were observed. (3) Incidence of postoperative complications: There were four patients with infection of incision; however, no intestinal fistula was found in any patients. (4) Follow-up: follow-up was performed for 62 patients, and the average length of follow-up was 35 months, during which three patients suffered recurrence of incisional hernia. CONCLUSION: For obesity patients with huge abdominal hernia, the application of initiative content reduction can effectively prevent the postoperative intra-abdominal hypertension, which is considered as an effective and feasible therapeutic procedure.

Bingqian Zhang, Lianbao Cao, Lingling Ding et al.

Objective: To evaluate the effects of different treatment methods for previous ectopic pregnancies (EP) on cryopreserved embryo transfer (CET) outcomes. Materials and Methods: This was a retrospective cohort study. Patients with EP histories were divided into four groups based on their previous EP treatments: Group 1—unilateral tubal removal; Group 2—bilateral tubal removal or unilateral tubal removal with contralateral tubal ligation; Group 3—conservative surgery group; and Group 4—conservative medication group. A total of 1333 women with previous histories of being admitted to the hospital for CET treatment were consecutively enrolled between January 2009 and December 2014. Results: Patients who underwent bilateral tubal ligation or removal had a lower miscarriage rate [8.88% vs. 3.46%, p=0.006, odds ratio=2.718, 95% confidence interval (CI)=1.301–5.677] than those who underwent unilateral tubal removal. No significant difference was observed in the rate of EP after CET in the four groups in women with EP histories. (p1=0.258, 95%CI=0.113–1.836; p2=0.137, 95%CI=0.975–0.997; p3=0.314, 95%CI=0.987–1.001; p4=0.198, 95%CI=0.987–1.001). The groups were not different with regard to other pregnancy outcomes. Conclusion: There was no significant difference among EP treatment methods with regard to their impacts on CET outcomes in women with EP histories. Bilateral tubal ligation or removal surgery can decrease the miscarriage rate after CET.

Luke Mordecai, Frances H. L. Leung, Clarissa Y. M. Carvalho et al.

Background. Pain is commonly experienced following surgical procedures. Suboptimal management is multifactorial. Objectives. The primary objective was to assess whether patients used a device (Navimed) to self-report pain over and above a normal baseline of observations. Secondary outcome measures included comparison of pain scores and patient use of and feedback on the device. Methods. In a prospective randomized controlled trial, elective gynaecological surgery patients received standard postoperative pain care or standard care plus the Navimed, which allowed them to self-report pain and offered interactive self-help options. Results. 52 female patients, 26 in each of device and standard groups, did not differ in the frequency of nurse-documented pain scores or mean pain scores provided to nurses. The device group additionally reported pain on the device (means 18.50 versus 11.90 pain ratings per day, t(32)=2.75, p<0.001) that was significantly worse than reported to nurses but retrospectively rated significantly less anxiety. 80% of patients found the device useful. Discussion and Conclusion. This study demonstrates that patients used the Navimed to report pain and to help manage it. Further work is required to investigate the difference in pain scores reported and to develop more sophisticated software.