We prove Gromov's conjecture on the total mean curvature of fill-ins in various cases. Our methods are based on surgery to reduce the statement to fill-ins of spheres, which can be treated by instances of the positive mass theorem. For spin fill-ins, where we permit the mean curvature to take negative values, we build on a classical surgery result of Lawson-Michelsohn and a recent positive mass theorem with creases by Kazaras-Khuri-Lin. For non-spin fill-ins of spin manifolds, where we assume the mean curvature to be non-negative, we develop a novel quantitative surgery process to reduce the general situation to a result of Shi-Wang-Wei. We also treat the case of fill-ins of non-spin manifolds, provided there is a fixed positive lower bound on the mean curvature.
ABSTRACT Background Although surgical treatment is the primary measure for patients with perforated peptic ulcer (PPU), nonoperative management (NOM) has become a common alternative. However, risk score models predicting the success of NOM based on the analysis of a large number of patients remain scarce. We developed a clinically applicable scoring system to predict the success of NOM in patients with PPU using data from a large cohort. Method We analyzed data of the Perforated Peptic ulcer Analyzing Project (PPAP), which was a retrospective survey of adult patients with PPU between January 2011 to December 2022. The successful NOM case was defined as patients who survived until hospital discharge without requiring surgery. Factors associated with NOM were identified using a multivariable logistic regression analysis, and a scoring system to predict NOM was developed by weighting these factors based on the regression coefficients. Result Of 702 potentially eligible patients, 584 were treated with NOM, of which 130 patients (22.2%) were treated successfully. Age, sex, body temperature, heart rate, the extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis were included in the final model. Using these variables, we developed the scoring system named PPAP score, which had favorable discriminating ability with the area under receiving operating characteristic curve of 0.799. When the cut‐off was set to 56, the sensitivity and the specificity were 0.738 and 0.722, respectively. Conclusion A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability.
Surgery, Diseases of the digestive system. Gastroenterology
We exhibit a homotopy theoretic proof of the Fundamental Theorem of Poincaré surgery in the simply connected case. We also deduce the Poincaré transversality exact sequence.
We introduce the notion of contact round surgery of index $1$ on Legendrian knots in a general contact 3-manifold. It generalizes the notion of contact round surgery of index 1 on Legendrian knots introduced by Adachi. In $\left(\mathbb{S}^3, ξ_{st}\right)$, we introduce the notion of contact round surgery of index 2 on a Legendrian knot and realize Adachi's contact round 2-surgery on a convex torus as a contact round surgery of index $2$ on a Legendrian knot in $\left(\s^3, ξ_{st}\right)$. We associate surgery diagrams to contact round surgeries of indices 1 and 2 on Legendrian knots in $\left(\mathbb{S}^3, ξ_{st}\right)$. With this set-up, we show that every closed connected contact 3-manifold can be obtained by performing a sequence of contact round surgeries on some Legendrian link in $\left(\mathbb{S}^3, ξ_{st}\right)$, thus obtaining a contact round surgery diagram for each contact 3-manifold. This is analogous to the result of Ding-Geiges for contact Dehn surgeries. We also discuss a bridge between certain pairs of contact round surgery diagrams of indices 1 and 2, and contact $(\pm1)$-surgery diagrams. We use this bridge to establish the result mentioned above. In the end, we derive a corollary that gives sufficient conditions on contact round surgeries to produce symplectically fillable manifolds.
Duy Nguyen Anh Tran, Bao Tu Thai Nguyen, Hoan Le Nguyen
et al.
Background:
Preoperative cognitive function (PCF) is gaining attention as a predictor of surgical outcomes due to its association with muscle function and recovery. Its role in postoperative recovery following transforaminal lumbar interbody fusion (TLIF), however, remains unclear.
Objectives:
This study aimed to evaluate the impact of PCF on functional and quality-of-life outcomes after TLIF surgery.
Materials and Methods:
A prospective study of 89 patients undergoing TLIF assessed PCF preoperatively using the Short Portable Mental Status Questionnaire. Outcomes, including Japanese Orthopaedic Association (JOA) and EuroQol 5-Dimensions 3-Level (EQ-5D-3L) scores, were measured at baseline, 3, 6, and 12 months postsurgery. Generalized estimating equations analyzed the associations between PCF and recovery.
Results:
JOA and EQ-5D-3L scores improved significantly at all postoperative time points, reflecting enhanced functional and quality-of-life outcomes after TLIF. PCF showed a weak-to-moderate negative correlation with JOA and EQ-5D-3L scores across all time points. Greater PCF impairment was associated with lower postoperative JOA (β = −1.432, P = 0.036) and EQ-5D-3L (β = −0.065, P = 0.016) scores.
Conclusions:
PCF significantly affects postoperative outcomes following TLIF, particularly in early recovery. Assessing and addressing PCF preoperatively could enhance recovery trajectories.
One of the major indicators in evaluating the performance of hospitals and their managers is the average length of stay of patients; given the importance of this indicator, the present study has examined the factors affecting the length of stay of hospitalized patients. This study was conducted with the aim of identifying the key factors affecting the length of stay of patients and providing practical solutions for improving the management of hospital beds. Data from 26,907 patients were analyzed using clustering models, clustering algorithms (K-Means) and association rules extraction (Apriori). The data consists of 10 numerical and discrete columns. The variables include 10 items, which are respectively: gender, marital status, hospitalization department, physician specialty, insurance, blood transfusion, surgery, type of discharge, age, and length of stay. The findings showed that the variables of surgery and blood transfusion have the greatest impact on the average length of stay in the hospital.
Introduction: Retronychia is a unique type of nail ingrowth that has been described by De Berker and Renall in 1999. We present a case that was diagnosed and treated involving a multidisciplinary team consisting of dermatologist, radiologist, and a general surgeon. Furthermore, recurrence of such condition was prevented by patient education and empowerment. Case presentation: This is a young female who presented with two months history of right great toe pain and discharge. Antibiotic alone was prescribed but did not show improvement. She previously underwent left side nail avulsion for a similar complaint. In examination, she had tender hallux valgus of the right big toe, associated with turbid discharge from the nail bed. We confirmed the diagnosis of retronychia using ultrasound and treated the condition with nail avulsion. However, she had signs of recurrence during follow up, and we advised her to raise the distal end of the nail manually using a local anesthetic which was successful. Discussion: This unique condition needs timely diagnosis to choose the proper treatment. Treatment depends on the stage, and starts with topical steroids and eventually might end with nail avulsion. Recurrence is uncommon, unlike our case. We hypothesized that early lifting of the distal end of the nail can prevent full recurrence. This maneuver proved to be effective in our case and there was no recurrence. Conclusion: Retronychia is a new term that shares treatment with other nail disorders. Patient education and empowerment is crucial in the treatment. Further studies in that matter are needed.
We show that the good quantum LDPC codes of Panteleev-Kalachev \cite{PK} allow for surgery using any logical qubits, albeit incurring an asymptotic penalty which lowers the rate and distance scaling. We also prove that we can satisfy 3 of the 4 conditions for performing surgery \textit{without} incurring an asymptotic penalty. If the last condition is also satisfied then we can perform code surgery while maintaining $k, d\in Θ(n)$.
Dina H Hassanein, Ahmed Awadein, Aya Youssef
et al.
Purpose To compare the measurements of the angle of deviation through spectacles versus contact lenses and with the theoretically calculated angle.
Patients and methods A total of 20 patients with comitant strabismus, more than 20 PD with spectacles, associated with bilateral myopia (spherical equivalent >1 D in both eyes) were included. Angle of deviation was measured using prism and cover test with spectacles and with contact lenses fitted according to the cycloplegic refraction and refined by subjective refraction. Agreements between the measurements obtained with contact lenses and those obtained with spectacles as well as the theoretically calculated angle were analyzed.
Results The mean age was 15.6±10.9 years. Average spherical equivalent was −9.1±4.2 D. Measurements obtained with contact lenses were significantly lower than those with spectacles (P<0.001) with coefficient of variation of 27.7%, indicating poor agreement of both measurements. Limits of agreement in Bland–Altman plots were more than 9 PD ([INLINE:1] ± 2 s, −8.8 to 6 PD). The agreement was lower with larger angles. Measurements obtained with contact lenses were significantly lower than theoretical angles (P=0.002) but coefficient of variation between both measurements was 8.8%, indicating good agreement of measurements. There was little systematic or proportionate bias between the contact lens measurements and the theoretical angle.
Conclusions Contact lens measurements were significantly lower than spectacle measurements in myopic patients. The contact lens measurements were in good agreement with the theoretically calculated angle. This overestimation of the angle with spectacles might be responsible for overcorrection of myopic patients with exotropia after surgery.
Abstract Objective To determine whether septal perforations have an effect on nasal swell body (NSB) size. Study Design Retrospective cohort study. Setting Two tertiary academic medical centers. Methods Computed tomography maxillofacial scans of 126 patients with septal perforation and 140 control patients from November 2010 to December 2020 were evaluated. Perforation etiology was determined. Measurements included perforation length and height and swell body width, height, and length. Swell body volume was calculated. Results The width and volume of the NSB are significantly smaller in perforation patients when compared to controls. The swell body is significantly smaller and thinner in perforations exceeding 14 mm in height compared to small perforations. Perforation etiology groupings into prior septal surgery, septal trauma, septal inflammatory, and mucosal vasoconstriction categories all demonstrated decreased swell body volume and width compared to controls. Inflammatory etiology had the greatest decrease in swell body size. The hemi‐swell body on the contralateral side of a septal deviation is significantly thicker than the ipsilateral side. Conclusion The NSB is smaller in patients with septal perforation regardless of perforation size or etiology.
Abstract Background In recent years, high flow nasal oxygen (HFNO) has been widely used in clinic, especially in perioperative period. Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial. Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis of RCTs. Methods EMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevant randomized controlled trails (RCTs) on the effectiveness of HFNO versus standard facemask ventilation (FMV) in pre- and apenic oxygenation. Studies involving one of the following six indicators: (1) Arterial oxygen partial pressure (PaO2), (2) End expiratory oxygen concentration (EtO2), (3) Safe apnoea time, (4) Minimum pulse oxygen saturation (SpO2min), (5) Oxygenation (O2) desaturation, (6) End expiratory carbon dioxide (EtCO2) or Arterial carbon dioxide partial pressure(PaCO2) were included. Due to the source of clinical heterogeneity in the observed indicators in this study, we adopt random-effects model for analysis, and express it as the mean difference (MD) or risk ratio (RR) with a confidence interval of 95% (95%CI). We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome. Results Fourteen RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMV group with a MD (95% CI) of 57.38 mmHg (25.65 to 89.10; p = 0.0004) after preoxygenation and the safe apnoea time was significantly longer with a MD (95% CI) of 86.93 s (44.35 to 129.51; p < 0.0001) during anesthesia induction. There were no significant statistical difference in the minimum SpO2, CO2 accumulation, EtO2 and O2 desaturation rate during anesthesia induction between the two groups. Conclusions This systematic review and meta-analysis suggests that HFNO should be considered as an oxygenation tool for patients during anesthesia induction. Compared with FMV, continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safe apnoea time in surgical patients.
Background: To evaluate the feasibility and efficacy of sequential portal vein embolization (PVE) and radiofrequency ablation (RFA) (PVE+RFA) as a minimally invasive variant for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) stage-1 in treatment of cirrhosis-related hepatocellular carcinoma (HCC).Methods: For HCC patients with insufficient FLR, right-sided PVE was first performed, followed by percutaneous RFA to the tumor as a means to trigger FLR growth. When the FLR reached a safe level (at least 40%) and the blood biochemistry tests were in good condition, the hepatectomy was performed. FLR dynamic changes and serum biochemical tests were evaluated. Postoperative complications, mortality, intraoperative data and long-term oncological outcome were also recorded.Results: Seven patients underwent PVE+RFA for FLR growth between March 2016 and December 2019. The median baseline of FLR was 353 ml (28%), which increased to 539 (44%) ml after 8 (7–18) days of this strategy (p < 0.05). The increase of FLR ranged from 40% to 140% (median 47%). Five patients completed hepatectomy. The median interval between PVE+RFA and hepatectomy was 19 (15–27) days. No major morbidity ≥ III of Clavien-Dindo classification or in-hospital mortality occurred. One patient who did not proceed to surgery died within 90 days after discharge. After a median follow-up of 18 (range 3–50) months, five patients were alive.Conclusion: Sequential PVE+RFA is a feasible and effective strategy for FLR growth prior to extended hepatectomy and may provide a minimally invasive alternative for ALPPS stage-1 for treatment of patients with cirrhosis-related HCC.
We examine questions about surgery on links which arise naturally from the trisection decomposition of 4-manifolds developed by Gay and Kirby. These links lie on Heegaard surfaces in $\#^j S^1 \times S^2$ and have surgeries yielding $\#^k S^1 \times S^2$. We describe families of links which have such surgeries. One can ask whether all links with such surgeries lie in these families; the answer is almost certainly no. We nevertheless give a small piece of evidence in favor of a positive answer.
In this paper, we analyze L-space surgeries on two component L-space links. We show that if one surgery coefficient is negative for the L-space surgery, then the corresponding link component is an unknot. If the link admits very negative (i.e. $d_{1}, d_{2}\ll0$) L-space surgeries, it is the Hopf link. We also give a way to characterize the torus link $T(2, 2l)$ by observing an L-space surgery $S^{3}_{d_{1}, d_{2}}(\mathcal{L})$ with $d_{1}d_{2}<0$ on a 2-component L-space link with unknotted components. For some 2-component L-space links, we give explicit descriptions of the L-space surgery sets.
Diego Pozzer, Ersilia Varone, Alexander Chernorudskiy
et al.
Selenoprotein N (SELENON) is an endoplasmic reticulum (ER) protein whose loss of function leads to human SELENON-related myopathies. SelenoN knockout (KO) mouse limb muscles, however, are protected from the disease, and display no major alterations in muscle histology or contractile properties. Interestingly, we find that the highly active diaphragm muscle shows impaired force production, in line with the human phenotype. In addition, after repeated stimulation with a protocol which induces muscle fatigue, also hind limb muscles show altered relaxation times. Mechanistically, muscle SELENON loss alters activity-dependent calcium handling selectively impinging on the Ca2+ uptake of the sarcoplasmic reticulum and elicits an ER stress response, including the expression of the maladaptive CHOP-induced ERO1. In SELENON-devoid models, ERO1 shifts ER redox to a more oxidised poise, and further affects Ca2+ uptake. Importantly, CHOP ablation in SelenoN KO mice completely prevents diaphragm dysfunction, the prolonged limb muscle relaxation after fatigue, and restores Ca2+ uptake by attenuating the induction of ERO1. These findings suggest that SELENON is part of an ER stress-dependent antioxidant response and that the CHOP/ERO1 branch of the ER stress response is a novel pathogenic mechanism underlying SELENON-related myopathies. Key words: Diaphragm dysfunction, ER stress response, SELENON
Nicolas Arej, Wassef Chanbour, Karen Zaarour
et al.
A review of 31 eyes with keratoconus who developed cataract and underwent phacoemulsification. Visual acuities were measured 1mo postoperatively. Six eyes with a history of good corrected distance visual acuity (CDVA) and a similar refractive and topographic astigmatic axis were implanted with toric intraocular lenses (IOLs). The mean postoperative uncorrected distance visual acuity (UDVA) was 0.2 logMAR with a spherical equivalent (SE): 0.75D. Eleven eyes with a history of good CDVA and different refractive and topographic axis were implanted with monofocal IOL+/-Toric implantable collamer lenses to treat anisometropia and ametropia; mean UDVA was 0.25 logMAR with a mean SE: -0.51 D postoperatively. Six eyes with poor CDVA were first treated with intra-corneal ring segments, followed by phacoemulsification, the mean postoperative UDVA was 0.82 logMAR with an SE: 0.22 D. Eight eyes had advanced ectesia and received combined phacoemulsification and penetrating keratoplasty. Our approach is efficient in addressing ametropia after cataract surgery in keratoconic eyes.
We examine surgery on a knot in $S^3$ to determine surgery obstructions to Seifert fibered integral homology spheres. We find such surgery obstructions using Heegaard Floer, Knot Floer homology and the mapping cone formula for computing Heegaard Floer homology of surgery on a knot. Here however, we take a different approach and use the number of singular fibers of a Seifert fibered integral homology sphere, which is the toroidal structure, to find obstructions. This approach allows us to show that genus one knots cannot yield Seifert fibered integral homology spheres with six or more singular fibers. Some other obstructions are also presented for higher genus knots.