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Ngan Thi Kim Nguyen ◽  
Nguyen-Phong Vo ◽  
Shih-Yi Huang ◽  
Weu Wang

Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex differences in FFM and SM changes of type 2 diabetes (T2D) remission at 12 months post-LSG. This cohort study recruited 119 patients (53.7% females) with T2D and obesity (body mass index 42.2 ± 7.0 kg/m2) who underwent LSG. Fat-mass (FM) loss was higher in males than in females (−12.8 ± 6.2% vs. −9.9 ± 5.0%, p = 0.02) after one-year post-operation. Regardless of the weight-loss difference, males had higher FFM and SM gain than did females (12.8 ± 8.0 vs. 9.9 ± 5.0% p = 0.02 and 6.5 ± 4.3% vs. 4.9 ± 6.2%, p = 0.03, respectively). Positive correlations of triglyceride reduction with FM loss (r = 0.47, p = 0.01) and SM gain (r = 0.44, p = 0.02) over 12 months post-operation were observed in males who achieved T2D remission. The T2D remission rate significantly increased 16% and 26% for each additional percentage of FFM and SM gain one year after LSG, which only happened in males. Increased FFM and SM were remarkably associated with T2D remission in males, but evidence lacks for females.

2022 ◽  
Vol 8 ◽  
Chao-Hung Kuo ◽  
Yi-Hsuan Kuo ◽  
Chih-Chang Chang ◽  
Hsuan-Kan Chang ◽  
Li-Yu Fay ◽  

Objective:Cervical myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) is not uncommon among Asian ethnic groups. Despite reports comparing the pros and cons of anterior- and posterior-only approaches, the optimal management remains debatable. This study aimed to evaluate the outcomes of patients who underwent a combined anterior and posterior approach, simultaneous circumferential decompression and fixation, for cervical OPLL.Method:The study retrospectively reviewed patients with OPLL and who underwent circumferential decompression and fixation, combined anterior corpectomy and posterior laminectomy. The clinical outcomes were evaluated by the Visual Analog Scale of neck and arm pain, the Japanese Orthopedic Association scores, Neck Disability Index, and Nurick scores at each time-point of evaluation. Radiological evaluations included plain and dynamic radiographs and computed tomography for every patient within 2 years post-operation. Subgroup analyses were further performed between the groups, with and without intra-operative cerebrospinal fluid (CSF) leakage.Results:A total of 41 patients completed the follow-up for more than 2 years (mean = 39.8 months) and were analyzed. Continuous-type OPLL was the most common (44%), followed by segmental (27%), mixed (22%), and localized types (7%) in the cohort. Myelopathy and all other functional outcomes improved significantly at 2 years post-operation (all p < 0.05). There were 13 (32%) patients who had intra-operative CSF leakage. At 2 years post-operation, there were no differences in the demographics, functional outcomes, and complication rates between the CSF-leakage and no-leakage groups. The CSF-leakage group had more patients with continuous-type OPLL than the no-leakage group (77 vs. 29%, p = 0.004 < 0.05). During the follow-up, there was no secondary or revision surgery for pseudomeningocele, pseudarthrosis, or other surgery-related complications.Conclusions:Simultaneous circumferential decompression and fixation combine the surgical benefits of sufficient decompression by the posterior approach and direct decompression of OPLL by the anterior approach. It is an effective surgical option for patients with cervical myelopathy caused by OPLL, given that myelopathy unanimously improved without neurological complications in this study. The fusion rates were high, and reoperation rates were low. Despite higher rates of CSF leakage, there were no related long-term sequelae, and minimal wound complications.

2022 ◽  
Vol 18 (1) ◽  
Eun-Ha Kang ◽  
Seol-Hee Park ◽  
Ye-In Oh ◽  
Kyoung-Won Seo

Abstract Background The use of salivary biomarkers has garnered attention because the composition of saliva reflects the body’s physiological state. Saliva contains a wide range of components, including peptides, nucleic acids, electrolytes, enzymes, and hormones. It has been reported that salivary alpha-amylase and cortisol are biomarkers of stress related biomarker in diseased dogs; however, evaluation of salivary alpha-amylase and cortisol pre- and post- operation has not been studied yet. The aim of this study was to evaluate salivary alpha-amylase and cortisol levels in dogs before and after they underwent surgery and investigate the association between the salivary alpha-amylase and cortisol activity and pain intensity. For this purpose, a total of 35 dogs with disease-related pain undergoing orthopedic and soft tissue surgeries were recruited. Alpha-amylase and cortisol levels in the dogs’ saliva and serum were measured for each using a commercially available canine-specific enzyme-linked immunosorbent assay kit, and physical examinations (measurement of heart rate and blood pressure) were performed. In addition, the dogs’ pre- and post-operative pain scores determined using the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF) were evaluated. Results After surgery, there was a significant decrease in the dogs’ pain scores (0.4-fold for the CMPS-SF, p < 0.001) and serum cortisol levels (0.73-fold, p < 0.01). Based on their pre-operative CMPS-SF scores, the dogs were included in either a high-pain-score group or a low-pain-score group. After the dogs in the high-pain-score group underwent surgical intervention, there was a significant decrease in their CMPS-SF scores and levels of salivary alpha-amylase, serum alpha-amylase, and serum cortisol. Additionally, there was a positive correlation between salivary alpha-amylase levels and CMPS-SF scores in both the high- and low-pain-score groups. Conclusions The measurement of salivary alpha amylase can be considered an important non-invasive tool for the evaluation of pain-related stress in dogs.

2022 ◽  
Feng-Fang Tsai ◽  
Jou-Wei Lin ◽  
Sheng-Nan Chang ◽  
Chun-Lin Chu ◽  
Ling-Ping Lai ◽  

Abstract Background Great efforts were made to collect information and identify risk factors in predicting post-anesthetic mortality. In this study, we use national health insurance data base, including medications, underlying comorbidities and surgical factors to assess the relationship between these factors and mortality after surgery. Methods This is a retrospective, population based study. The study population who underwent general anesthesia (GA) were retrieved from the National Health Insurance Research Database in Taiwan between January 1, 2005 and December 31, 2013. We classified the study patients into 4 major comparison groups by surgical procedures, including major organ transplantation (heart, liver, lung, kidney, or pancreas), CV surgery, major neurosurgery, and others according to the diagnostic codes of the international classification of diseases, ninth revision, clinical modification (ICD-9-CM) codes. We proposed a logistic regression model with valuable variables which can significantly predicts the post-anesthesia mortality. We also designed different models for 4 subgroups according the results. Results A total of 833,685 subjects were included in this study, and the most common comorbidity was hypertension. Age was an important determinant associated with post-operation mortality among different surgical types. Perioperative prescription could reduce risks of operation. The prediction model based on the preliminary training group also performed well in the validation group (AUROC=0.8753 for in-hospital mortality; AUROC= 0.8767 for 30-days mortality). A reliable predicting model can help anesthesiologists to decide the anesthesia method or monitors, as well as helping physicians to take care of their patients after operation. Conclusions While GA is commonly used for the majority of the patients undergoing operations, the prediction model that we proposed from this nationwide study could identify the predictors for post-operation mortality. The potentially protective effects of anti-lipid, hypoglycemic, and anti-hypertensive agents were encouraging in geriatric preoperative group. It is expected that applying this prediction model and prescription into clinical practice could improve surgical risk stratification and further improve patient outcomes. Trial registration The protocol of this study was approved by the National Taiwan University Hospital Research Ethics Committee (Trial Registration 201411078RINC). Informed consent was waived by the National Taiwan University Hospital Research Ethics Committee due to the retrospective and anonymous nature of the claims data.

2022 ◽  
Vol 11 (1) ◽  
Vahid Salehi ◽  
Mohammad Javad Yavari Barhaghtalab ◽  
Saadat Mehrabi ◽  
Aida Iraji ◽  
Seyed Alimohammad Sadat ◽  

Abstract Background Pilonidal sinus disease (PSD) is a common chronic inflammatory debilitating illness caused by ingrowth of hair into the skin. Excision and healing by secondary intention is one of the acceptable managements. The post-operative wound care needs frequent and time-consuming follow-ups. Honey is considered to be a traditional remedy for wound healing. The current study aimed at finding if application of honey could improve surgical outcome in pilonidal cyst excision with secondary intention healing. Methods This study was designed as a randomized placebo-controlled parallel assignment interventional (clinical trial) study conducted at the surgical ward of Shahid Beheshti Hospital affiliated to the Yasuj University of Medical sciences, Yasuj, Iran, and was consisted of the 48 patients who underwent surgical resection for PSD with secondary intention healing (24 patients in intervention and placebo-controlled groups). The main element of honey medicinal gel was the unheated natural honey of Dena Biosphere Reserve within the Zagros Mountains. Patients' wounds were visited by a surgeon and a nurse on the days 7, 15, 30, 45, 60, and 90 post-operation. The surgical outcomes including the time to complete wound healing, pain intensity, odor, discharge at the site of surgery, use of analgesics, the time of to return to the daily activities, and occurring of any side effects including infection, erythema, and bleeding were all recorded. Results In intervention group, there was significantly lower wound healing time, the lower time to return to the daily activities, lower mean wound volume at the days of 30, 45, 60, and 90 of the follow-up, higher mean post-operative pain level at the days of 15, 30, 45, 60, and 90 of the follow-up, and more usage of analgesics at the days of 15, 30, 45, and 60 of the follow-up. There was no significant difference between intervention and placebo-controlled groups according to the foul smell and fluid discharge at the site of the operation. There were no side effects and complications in both groups of the study. Conclusions Application of honey after resection surgery with secondary wound healing is associated with a better surgical outcome and could eventually decrease healing time and reduce duration of return to normal activities, but could increase post-operation pain and analgesic consumption, and no effect on foul smell and discharge. Trial registration The project was found to be in accordance to the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.YUMS.REC.1399.088 and 2020.05.30 respectively, and is the result of a residency dissertation to get the specialty in general surgery, which has been registered with the research project number 960508 in the Vice Chancellor for Research and Technology Development of Yasuj University of Medical Sciences, Yasuj, Iran, URL:

2022 ◽  
HAN Lei ◽  
WANG Can-feng ◽  
HU Yun-geng ◽  
FAGN Wei-li ◽  
Song Zhou-feng

Abstract Background In this retrospective study we analyzed a consecutive series of patients affected by isolated radial head Mason III fractures and treated with an on-table reconstruction technique combined with miniplate internal fixation or prosthesis. Methods This study included 42 patients affected by isolated radial head Mason III fractures and treated between Jan 2012 and Jan 2019. Twenty-four patients (average age 45.6 years) were treated with an on-table reconstruction technique combined with miniplate internal fixation. The remaining 18 (average age 44.5 years) were treated with prosthesis. From a clinical point of view, we evaluated the patients according to the Broberg–Morrey scoring system and the (disabilities of the arm, shoulder, and hand) DASH questionnaire for parameters. Results We found similar results in both the groups according to Broberg–Morrey score system and the DASH questionnaire at the last follow-up. The scores of the prosthesis group were better than those of the internal fixation group at the 1st, 3rd, and 6th month follow-up post-operation. Conclusion Both the on-table reconstruction technique combined with the miniplate internal fixation and prosthesis can be effective in treating patients with isolated Mason III radial head fractures. There was no difference in elbow function between the two groups at the last follow-up; however, a prosthesis favors early functional recovery of the elbow.

2022 ◽  
Vol 12 (1) ◽  
Kai Tai Derek Yeung ◽  
Nicholas Penney ◽  
Luke Whiley ◽  
Hutan Ashrafian ◽  
Matthew R. Lewis ◽  

AbstractThis study aims to explore the immediate effects of bariatric surgery on serum tryptophan–kynurenine pathway metabolites in individuals with type 2 diabetes and BMI > 30. With the goal of providing insight into the link between tryptophan pathway metabolites, type 2 diabetes, and chronic obesity-induced inflammation. This longitudinal study included 20 participants. Half were diagnosed with type 2 diabetes. 11 and 9 underwent RYGB and SG respectively. Blood samples were obtained at pre-operative and 3 months post-operative timepoints. Tryptophan and downstream metabolites of the kynurenine pathway were quantified with an ultrahigh-performance liquid chromatography tandem mass spectrometry with electrospray ionisation method. At 3 months post-operation, RYGB led to significant reductions in tryptophan, kynurenic acid and xanthurenic acid levels when compared to baseline. Significant reductions of the same metabolites after surgery were also observed in individuals with T2D irrespective of surgical procedure. These metabolites were significantly correlated with serum HbA1c levels and BMI. Bariatric surgery, in particular RYGB reduces serum levels of tryptophan and its downstream kynurenine metabolites. These metabolites are associated with T2D and thought to be potentially mechanistic in the systemic processes of obesity induced inflammation leading to insulin resistance. Its reduction after surgery is associated with an improvement in glycaemic control (HbA1c).

2022 ◽  
Vol 12 ◽  
Bo Li ◽  
Zhe Yan ◽  
Hui Huang

Ectopic adrenocorticotrophic hormone (ACTH) syndrome is not common, which is more unusual when caused by paraganglioma. We herein present a 40-year-old Chinese male who was diagnosed with ACTH-dependent Cushing’s syndrome. However, the localization of the ACTH source was troublesome due to the inconsistent results of the high-dose dexamethasone suppression test and the desmopressin stimulation test. Bilateral inferior petrosal sinus sampling was performed, and ectopic ACTH syndrome was diagnosed. After 68Ga-DOTATATE-PET/CT and 18F-FDG-PET/CT were performed, it was localized in the anterior mediastinum. Post-operation histopathology demonstrated an ACTH-secreting mediastinal paraganglioma. The patient obtained complete clinical remission after a mediastinal tumorectomy.

2021 ◽  
Vol 10 (1) ◽  
pp. 82
Hen Y. Sela ◽  
Vered Seri ◽  
Frederic S. Zimmerman ◽  
Andrea Cortegiani ◽  
Philip D. Levin ◽  

The Surviving Sepsis Campaign recently recommended that qSOFA not be used as a single parameter for identification of sepsis. Thus, we evaluated the efficacy of SIRS and qSOFA scores in identifying intrauterine infection. This case–control study evaluates SIRS and qSOFA criteria fulfillment in preterm premature rupture of membranes (n = 453)—at high infection risk—versus elective cesarean—at low infection risk (n = 2004); secondary outcomes included intrauterine infection and positive culture rates. At admission, 14.8% of the study group and 4.6% of control met SIRS criteria (p = 0.001), as did 12.5% and 5.5% on post-operation day (POD) 1 (p = 0.001), with no significant differences on POD 0 or 2. Medical records did not suffice for qSOFA calculation. In the study group, more cultures (29.8% versus 1.9%—cervix; 27.4% versus 1.1%—placenta; 7.5% versus 1.7%—blood; p = 0.001—all differences) and positive cultures (5.5% versus 3.0%—urine—p = 0.008; 4.2% versus 0.2%—cervix—p = 0.001; 7.3% versus 0.0%—placenta—p = 0.001; 0.9% versus 0.1%—blood—p = 0.008) were obtained. Overall, 10.6% of the study group and 0.4% of control met the intrauterine infection criteria (p = 0.001). Though a significant difference was noted in SIRS criteria fulfillment in the study group versus control, there was considerable between-group overlap, questioning the utility of SIRS in intrauterine infection diagnosis. Furthermore, the qSOFA scores could not be assessed.

2021 ◽  
Rong Chen ◽  
Hong Cao ◽  
Zhibo Sun ◽  
Liangbo Jiang ◽  
Xiangwei Li ◽  

Abstract Objective: The patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture.Methods: We conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss,intra-operative number of C-arm fluoroscopies conducted, Insall-Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation.Results:A total of 94 patients with patellar inferior pole fracture and a minimum 1-year followup were recruited. Following operation, the control group had 33(71.74%) patients with a fracture gap of 0-2 mm and 13(28.26%)patients with a fracture gapgreater than 2 mm(P=0.002). Conversely,the experimental grouphad46(95.83%)patients with a fracture gap of 0-2 mm and 2(4.17%) patients with a fracture gapgreater than 2 mm(P=0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P=0.811, P=0.823). The Insall-Salvati ratio and initial range of motion in the experimental group were larger than the control group (P=0.037, P=0.000). Alternately, the number of intra-operative C-arm fluoroscopies conductedand fracture healing time of the experimental group were considerably less than the control group (P=0.003,P=0.000).Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P< 0.05).At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group(P=0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P=0.005).Lastly, complications were detected in 3 cases (6.52%;1 case of internal fixation loss,2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in eithergroup.Conclusion: Managingthe patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.

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