Comparison of Drainage Methods After Pyeloplasty in Children: A 14-Year Study

Objective: To summarize our experiences with drainage methods after laparoscopic pyeloplasty with a 14-year study.Methods: We reviewed the data of the 838 children operated on for hydronephrosis due to congenital ureteropelvic junction obstruction (UPJO) between July 2007 and July 2020. Patients' demographics, perioperative details, postoperative drainage stents [including double-J stent, percutaneous trans-anastomotic (PU) stent, and trans-uretero-cystic external urethral stent (TEUS)], complications, hospital stay, and long-term follow-up outcomes were analyzed. Long-term follow-up was performed by outpatient visits and telephone follow-up. Moreover, we reviewed the details of nine cases of recurrence after laparoscopic pyeloplasty.Results: Comparison of preoperative general data among the three groups indicated that there was no statistical difference in age, gender, and surgical side of the three groups. Statistical differences were found in the incidence of postoperative complications from the three postoperative drainage method groups, especially the incidence of reoperations (p < 0.01): there were six cases (3.19%) of recurrences in the TEUS group, two cases (0.36%) in the DJ group, and one case (0.93%) in the PU group. In the six recurrent cases from the TEUS group, four cases (44.4%) were found to have stenosis, and two cases (22.2%) have iatrogenic valvular formation.Conclusion: Not all three types of drainage methods are suitable for drainage after pyeloplasty. Based on our findings, TEUS is not recommended.

Aortic Valve Replacement in Patients with Small Aortic Annulus: New Pericardial Stented Valves vs Aortic Root Enlargement Procedures.

Objectives: Newer generations of stented pericardial valves may offer hemodynamic benefit in patients with small aortic annulus. The aim of this study was to determine the effectiveness of isolated aortic valve replacement with one such valve, the Trifecta valve, when compared to Aortic root enlargement surgery in reducing postoperative gradients and the severity of PPM in patients with small aortic annulus. Patients and methods: A prospective observational study of 100 patients with SAA who underwent AVR from March 2020 to October 2021 in Cairo university hospitals and other centers. The cohort was divided into two groups based on surgical technique: Isolated AVR using Trifecta valve or ARE and mechanical valve placement. Preoperative characteristics, intraoperative times and postoperative outcomes were recorded and compared in all patients, including a pre-discharge echocardiography. Results: Increased operative times, increased ICU stay and need for blood products were observed in the ARE group and operative time was determined as an independent risk factor. Higher rate of complications such as need for permanent pacemaker as well increased postoperative drainage was also recorded in ARE group, with no difference between groups in in-hospital mortality. Higher incidence of PPM was recorded in the Trifecta group (24%) compared to the ARE group (8%). but, the severity of PPM within the Trifecta group was reduced compared to the ARE group, and no degree of PPM was observed in Trifecta valves sized 21. Conclusion The Trifecta valve offers excellent postoperative hemodynamics and significant reduction in severity of PPM in patients with SAA undergoing AVR, with gradients and iEOA almost comparable to larger sized valves implanted after ARE, making the increased surgical burden of ARE unnecessary in most patients.

Postoperative Drainage for 6, 12, or 24 Hours After Burr-Hole Evacuation of Chronic Subdural Hematoma in Symptomatic Patients (DRAIN-TIME 2): Study Protocol for a Nationwide Randomized Controlled Trial

Background: Chronic subdural hematoma (CSDH) is a common acute or subacute neurosurgical condition, typically treated by burr-hole evacuation and drainage. Recurrent CSDH occurs in 5-20 % of cases and requires reoperation in symptomatic patients, sometimes repeatedly. Postoperative subdural drainage of maximal 48 hours is effective in reducing recurrent hematomas. However, the shortest possible drainage time without increasing the recurrence rate is unknown.Methods: DRAIN-TIME 2 is a Danish multi-center, randomized controlled trial of postoperative drainage time including all four neurosurgical departments in Denmark. Both incapacitated and mentally competent patients are enrolled. Patients older than 18 years, free of other intracranial pathologies or history of previous brain surgery, are recruited at time of admission or no later than 6 hours after surgery. Each patient is randomized to either 6, 12, or 24 hours of passive subdural drainage following single burr-hole evacuation of a CSDH. Mentally competent patients are asked to complete the SF-36 questionnaire. The primary endpoint is CSDH recurrence rate at 90 days. Secondary outcome measures include SF-36 at 90 days, length of hospital stay, drain-related complications, and complications related to immobilization and mortality.Discussion: This multi-center trial will provide evidence regarding shortest possible drainage time without increasing the recurrence rate. The potential impact of this study is significant as we believe that a shorter drainage period may be associated with fewer drain-related complications, faster mobilization, fewer complications related to immobilization, and shorter hospital stays—thus reducing the overall health service burden from this condition. The expected benefits for patients’ lives and health costs will increase as the CSDH patient population grows.Trial registration: ISRCTN15186366. https://doi.org/10.1186/ISRCTN15186366. Registered in December 2020 and updated in October 2021.This protocol was developed in accordance with the SPIRIT checklist and by use of the structured study protocol template provided by BMC Trials.

Denoising of Degenerative Lumbar Spine Lesions MRI Images Using Block-Matching and 3D Filtering

This work was aimed to explore the application of the L2-block-matching and 3-dimentional filtering (BM3D) (L2-BM3D) denoising algorithm in the treatment of lumbar degeneration with long- and short-segment fixation of posterior decompression. 120 patients with degenerative lumbar scoliosis were randomly divided into group A (MRI images were not processed), group B (MRI images were processed by the BM3D denoising algorithm), and group C (MRI images were processed by the BM3D denoising algorithm based on weighted norm L2). This denoising algorithm was comprehensively evaluated in terms of mean square error (MSE), peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and running time. Besides, the results of surgeries based on different denoising methods were assessed through the surgical time, intraoperative blood loss, postoperative drainage, and postoperative follow-up. The results showed the following: (1) PSNR (peak signal-to-noise ratio) and SSIM (structural similarity index measure) of the L2-BM3D algorithm are better than those of the BM3D algorithm (31.21 dB versus 29.33 dB, 0.83 versus 0.72), while mean square error (MSE) was less than that of the BM3D algorithm ( P < 0.05 ). (2) The operation time, intraoperative bleeding, and postoperative drainage volume in group C were lower than those in group B and group A ( P < 0.05 ). The postoperative follow-up results showed that, in group C, the postoperative VAS (visual analysis scale) score (1.03 ± 0.29) and ODI (Oswestry disability index) (9.29 ± 0.32) were lower, indicating that the postoperative recovery effect of patients was better. Therefore, the patient’s postoperative recovery effect was better. In conclusion, the L2-BM3D algorithm had an ideal denoising effect on MRI images of lumbar degeneration and was worthy of clinical promotion.

Complete Thoracoscopic Segmentectomy and Pulmonary Lobectomy in the Treatment of Small Pulmonary Nodules

Objective: To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules. Methods: In this study, 176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021; according to the type of surgery, the patients were divided into group A (complete thoracoscopic segmentectomy) and group B (complete thoracoscopic pulmonary lobectomy), and the clinical effects were analyzed. Results: The intraoperative blood loss, postoperative drainage volume, postoperative hospitalization days, and lung function of patients in group A were significantly better than those in group B (P < 0.05), while there was no significant difference in the number of dissected lymph nodes. Conclusion: The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant; it does not only ensure lymph node dissection, but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function. Its clinical application value is worthy of key analysis by medical institutions.

Effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life

Objectives: To investigate and analyze the effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life. Methods: Fifty patients with thoracolumbar vertebral fracture admitted to our hospital from January 2015 to December 2018 were selected and divided into two groups according to different treatment regimens. The observation group was treated with minimally invasive percutaneous pedicle screw internal fixation, while the control group was treated with traditional posterior approach open pedicle screw internal fixation. The surgery time, incision length, intraoperative blood loss, postoperative drainage, hospitalization time, ambulation time, fracture healing time and postoperative VAS scores were compared between the two groups. In addition, the cobb angle, the sagittal plane index, and the anterior vertebral height were compared between the two groups before and after surgery, as were the Oswestry Disability Index (ODI) at 1d, 3 months, and 6 months postoperatively. Results: The surgery time, incision length, postoperative pain level, postoperative drainage and intraoperative blood loss of the observation group were less than those of the control group (P<0.05). The postoperative Cobb angle of the two groups decreased, the sagittal plane index as well as the anterior vertebral height increased (P<0.05). The Oswestry index of the observation group was better than that of the control group at one day and three months postoperatively, with a statistical significance between the two groups (P<0.05). The complication rate of the observation group was significantly lower than that of the control group (P<0.05). Conclusion: Percutaneous minimally invasive pedicle screw internal fixation is safer than the traditional open pedicle screw internal fixation, and it is more worthy of clinical promotion. doi: https://doi.org/10.12669/pjms.38.1.4329 How to cite this:Tu P, Yan C, Hao J, Cao S, Jiang C. Effect of percutaneous minimally invasive pedicle screw internal fixation in the treatment of thoracolumbar vertebral fractures and its impact on quality of life. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4329 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Blumgart-Anastomosis Based Half-Invagination Pancreaticoenterostomy With Better Applicability to Laparoscopy and Lower Incidence of Pancreatic Leakage

Background The Blumgart anastomosis has been established as one of the safest anastomoses for pancreas remnant reconstruction, with low rates of postoperative pancreatic fistula (POPF) and postoperative complications. However, how to make laparoscopic pancreaticoenterostomy easier and safer is still a subject to be discussed. Methods Data of patients undergoing laparoscopic pancreaticoduodenectomy from April 2014 to December 2019 were retrospectively analyzed. Results 20 cases of half-invagination anastomosis (Group HI) and 26 cases of Cattell-warren anastomosis (Group CW) were included. Intraoperative blood loss, Operative time and Postoperative drainage tube placement time of Group HI was significantly less than those of Group CW. Patients of Clavien-Dindo grade III and above in Group HI was significantly less than Control Group. Group Incidence of POPF in Group HI was significantly lower than that in Group CW. No high-risk group emerged during Fistula risk score analytical phase, and the highest risk of moderate-risk group was pancreatic leakage. Respectively, incidence of pancreatic leakage in Group HI and Group CW was 7.7% and 46.67%, while incidence of Group HI was significantly lower than that in the Group CW. Conclusions The Blumgart-anastomosis based half-invagination pancreaticoenterostomy with better applicability to laparoscopy can effectively reduce the incidence of postoperative pancreatic leakage.

Artificial Intelligence-Assisted Visual Sensing Technology under Duodenoscopy of Gallbladder Stones

Objective. This study is aimed at exploring the application effect of duodenoscopy assisted by visual sensing technology based on convolutional neural network (CNN) segmentation algorithm in the diagnosis and treatment of gallbladder stones, so as to provide safer and more effective treatment methods for patients with gallstones. Methods. 188 patients with gallstones and choledocholithiasis who were admitted to our hospital from January 2016 to April 2021 were selected as the research objects. Based on whether the patients were willing to use AI-assisted visual sensing technology during the treatment process, all patients were divided into two groups, namely, the AI group and the conventional group. Various surgical indicators of patients in two groups were compared. Results. The precision, recall, and mean intersection ratio of the M-Unet-based segmentation algorithm were 94.56%, 96.56%, and 98.92%, respectively. In the AI group, the operation time ( 2.74 ± 0.45 h ), postoperative drainage tube placement time ( 4.31 ± 1.15 d ), time required for recovery of gastrointestinal function ( 1.74 ± 0.54 d ), time required to get out of bed ( 1.14 ± 0.55 h ), and time spent in hospital ( 9.94 ± 1.45 d ) were all shorter compared with those in the conventional group, which were 3.21 ± 0.32 h , 12.14 ± 2.98 d , 2.89 ± 0.67 d , 2.09 ± 0.87 h , and 14.14 ± 1.15 h , showing statistical differences ( P < 0.05 ); the intraoperative blood loss ( 79.74 ± 6.45 mL ) and residual status of stones (0%) in the AI group were much lower than those in the conventional group ( P < 0.05 ). In addition, the incidence of complications (10.26%) and the indicators of postoperative gallbladder function of patients in the AI group were lower greatly than those in the conventional group ( P < 0.05 ). Conclusion. The visual sensing technology assisted by the CNN algorithm showed a good effect on image processing, and endoscopic technology can effectively improve the treatment effect of gallbladder stones combined with choledocholithiasis with the aid of this technology. Therefore, the conclusion in this study proved that visual sensing technology based on intelligent algorithms showed a good future in the medical field.

Minimally invasive versus open transforaminal lumbar interbody fusion for single segmental lumbar disc herniation: A meta-analysis

BACKGROUND: Numerous studies on the comparison of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-transforaminal lumbar interbody fusion (O-TLIF) for the treatment of lumbar disc herniation (LDH) have been published, but there is no clear conclusion. OBJECTIVE: The aim of this study was to evaluate the efficacy of MIS-TLIF compared with O-TLIF in the treatment of LDH in the Chinese population by meta-analysis. METHODS: Studies on the treatment of LDH by MIS-TLIF versus O-TLIF were searched in Pubmed, Web of Science, Medline, Embase, CNKI, VIP and China Wanfang databases from the establishment of the databases to January 2020. The meta-analysis was used to analyze the pooled operation time, intraoperative blood loss, postoperative drainage, postoperative ground movement time, Waist and leg Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and Japanese orthopaedic association (JOA) score. Mean difference (MD) and standard mean difference (SMD) were used as the effect size. RESULTS: Eleven studies with 1132 patients were included. The results showed that MIS-TLIF compared with O-TLIF, MD =-133.82 (95% CI: -167.10 ∼-100.53, P< 0.05) in intraoperative blood loss, MD =-114.43 (95% CI: -141.12 ∼-87.84, P< 0.05) in postoperative drainage, MD =-3.30 (95% CI: -4.31 ∼-2.28, P< 0.05) in postoperative ground movement time, SMD =-1.44 (95% CI: -2.63 ∼-0.34, P< 0.05) in postoperative low back pain VAS score, SMD = 0.41 (95% CI: 0.15 ∼ 0.66, P< 0.05) in postoperative JOA score, MD = 4.12 (95% CI: -11.64 ∼ 19.87, P> 0.05) in the average operation time, SMD =-0.00 (95% CI: -0.36 ∼ 0.36, P> 0.05) in leg pain VAS score, and SMD =-0.59 (95% CI: -1.22 ∼ 0.03, P> 0.05) in ODI score. CONCLUSION: MIS-TLIF was superior to O-TLIF in the treatment of LDH, especially in the intraoperative blood loss, postoperative drainage, postoperative ground movement time and low back pain in the Chinese population.