Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound

ObjectiveThis study aimed to investigate the effects of stellate ganglion block (SGB) through different approaches under guidance of ultrasound.MethodsA total of 130 patients undergoing SGB in our hospital between February 2019 and February 2020 were enrolled as the research subjects. According to the random number table method, these subjects were divided into two groups: a modified 6th cervical vertebra (C6) group (n = 65) and a 7th cervical vertebra (C7) group (n = 65). Under the guidance of ultrasound, the subjects in the modified C6 group were punctured at the level of the C6 transverse process, and the subjects in the C7 group were punctured at the level of the C7 transverse process. The operation duration, number of puncture angle adjustments, block effects, and adverse reactions for SGB were compared between the two groups.ResultsThe modified C6 group showed shorter SGB operation duration and a lower number of puncture angle adjustments than the C7 group, and the differences were statistically significant (P < 0.05). Horner Syndrome occurred in both groups after SGB. The incidence of adverse reactions in the modified C6 group was 4.62%, comprising 1 case of hoarseness and 2 cases of slowed pulse, while that in the C7 group was 6.15%, with 1 case of hoarseness and 3 cases of slowed pulse; the difference between the two groups was not statistically significant (P > 0.05).ConclusionThe operation duration for modified SGB guided by ultrasound puncturing at the C6 transverse process is shorter and requires fewer puncture angle adjustments than puncturing at the C7 transverse process; however, there is no significant difference between the incidence of adverse reactions or the blocking effects of the two methods.

Transcatheter Closure of Patent Ductus Arteriosus via Different Approaches

Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies.Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA).Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups.Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.

Evaluation and comparison of S.T.O.N.E. and Guy’s scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position

Background: Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. Patients and methods: Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy’s scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. Result: In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Conclusion: Our findings revealed that S.T.O.N.E. nephrolithometry and Guy’s score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

Efficacy of Complete Laparoscopic Ileal Augmentation Cystoplasty for the Treatment of Low Bladder Capacity and Compliance: a Case Series

Objectives: To investigate the safety and efficacy of complete laparoscopic ileal augmentation cystoplasty for the treatment of low bladder capacity and compliance.Methods: The clinical data of 13 patients with low bladder capacity and compliance were retrospectively analyzed. Therapeutic efficacy was evaluated at follow-up. The Clavien system was used to evaluate the severity of postoperative complications.Results: All 13 operations were successfully completed laparoscopically. The operation duration was 140-248 min (average: 189.9 ± 29.6 min), the time to postoperative recovery of bowel function was 1-10 days (average: 2.9 ± 2.3 days). There were 4 cases of grade I complications and 1 case of grade II complications (i.e., paralytic ileus caused by urinary leakage from the anastomosis of the augmented bladder). Cystography showed that the morphology of the bladder was close to normal, and the maximum safe capacity and compliance of the bladder were significantly increased [103.8 ± 16.6 mL and 332.3 ± 20.5 mL, p < 0.01; 7.0 ± 1.3 mL/cm H2O and 32.4 ± 2.1 mL/cm H2O, p < 0.01]. All patients were able to urinate spontaneously after catheter removal.Conclusions: Complete laparoscopic ileal augmentation cystoplasty is a safe and feasible treatment for low bladder capacity and compliance, and has the advantages of less trauma, less bleeding, faster recovery of intestinal function, and fewer postoperative complications. This treatment effectively increases bladder capacity, protects upper urinary tract function, and improves patient quality of life, and thus warrants clinical application.

Association Between Operation Duration of Total Knee Arthroplasty and Risk of Blood Transfusion Events: A Secondary Analysis Based on Cohort Study in Singapore

BackgroundThe purpose of our research is to explore the association between operation duration and the risk of blood transfusion in the patients undergoing TKA.MethodsThis study was a secondary analysis based on the data of a single-center retrospective cohort study in Singapore. The independent variable was the operation duration, and the dependent variable was the risk of blood transfusion events in the perioperation. we analyzed the risk factors of blood transfusion in the Perioperative period by univariate logistic regression, then, multivariable logistic regression analysis was performed adjusting for variables that might affect the operation duration of TKA and the risk of blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models.ResultsAmong 2,622 patients, 153 (5.8%) had blood transfusion in perioperative period. The older (OR=1.051 ,95% CI:1.030, 1.073), the lower BMI (OR=0.939,95% CI: 0.903,0.976),the lower Hb (OR=0.603,95% CI: 0.541 6.132), the DM on insulin (OR=2.542,95%CI:1.054, 6.132), the Bilateral TKA(OR=3.202, 95%CI:2.087, 4.913), the within CHF (OR=4.600, 95% CI :1.685, 12.563), the Cr≥2mg/dl (OR=7.246, 95% CI:2.739, 19.166), the higher ASA status (OR=6.439, 95% CI:2.403, 17.249), the higher risk of blood transfusion (P<0.05).The operation duration was positively correlated with perioperative blood transfusion. We demonstrated that the risk of blood transfusion increased by 1.1% for 1-minute increase in operation duration (OR = 1.011,95% CI: 1.004,1.018). ConclusionOur research shows that the longer the TKA operation duration, the higher the incidence of blood transfusion. The risk of blood transfusion events increases by 66% for every 1-hour increase in operation duration. Compared with patients with operation duration＜100 minutes, patients with operation duration more than 100 minutes have an increased risk of blood transfusion events by 56.8%.

Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study

Objective. To explore the related risk factors of postoperative delirium (POD) after hip or knee arthroplasty in elderly orthopedic patients and the predictive value of related risk factors. Material and Methods. In total, 309 patients (≥60 years) who received knee and hip arthroplasty between January 2017 and May 2020 were consecutively selected into the POD and nonpostoperative delirium (NPOD) groups. Group bias was eliminated through propensity score matching. Univariate and multivariable logistic analysis was used to determine the risk factors for POD. The nomogram was made by R. Results. 58 patients were included in each group after propensity score matching; multivariable analysis demonstrated that LDH ( OR = 4.364 , P = 0.017 ), CHE ( OR = 4.640 , P = 0.004 ), Cystatin C ( OR = 5.283 , P = 0.006 ), arrhythmia ( OR = 5.253 , P = 0.002 ), and operation duration ( OR = 1.017 , P = 0.050 ) were independent risk factors of POD. LDH, CHE, Cystatin C, and arrhythmia were used to construct a nomogram to predict the POD. The nomogram was well calibrated and had moderate discriminative ability ( AUC = 0.821 , 95% CI: 0.760~0.883). Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions. Our study revealed that arrhythmia, operation duration, the increase of lactate dehydrogenase and Cystatin C, and the decrease of cholinesterase were reliable factors for predicting postoperative delirium after elderly hip and knee arthroplasty. Meanwhile, the nomogram we developed can assist the clinician to filtrate potential patients with postoperative delirium.

Bone Defects in Tibia Managed by the Bifocal Versus Trifocal Bone Transport Technique

Background: The purpose of this study was to evaluate the clinical effectiveness and determine the differences, if any, between trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8±12.4 years (range 19 to 65 years). 32 patients were treated by bifocal bone transport (BFT) technique, and the other 21 patients were managed by trifocal bone transport (TFT) technique. The demographic data, operation duration, docking time, external fixation time, and external fixation index were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in demographic data and both ASAMI bone and functional scores (P>0.05). The mean defect size and operation duration in TFT (9.4±1.5 cm, 161.9±8.9 minutes) were larger than that in BFT (7.8±1.8 cm, 122.5±11.2 minutes) (P<0.05). The mean docking time, external fixation time, and external fixation index in TFT (65.9±10.8 days, 328.0±57.2 days, 34.8±2.1 days/cm) were all less than those in BFT (96.8±22.6 days, 474.5±103.2 days, 60.8±1.9 days/cm) (P<0.05). Difficulties and complications were more prevalent in the BFT group, while less in the TFT group (P<0.05). Conclusions: Both the trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator achieve satisfactory clinical outcomes. The trifocal bone transport technique can significantly decrease the docking time, external fixation time, external fixation index, difficulties, and complications compared with the bifocal bone transport technique.

The Risk Factors and Predictive Nomogram for Length Of Stay More than 14 Days in Undergoing TKA Patients: A Secondary Analysis Based on a Cohort Study in Singapore

Objective: The aim was to explore the risk factors and establish a predictive nomogram of length of stay (LOS) more than 14 days in a undergoing Total knee arthroplasty (TKA) cohort .Methods: We used the raw data, a retrospective cohort study of 2622 patients undergoing TKA in Singapore, for secondary analysis. The LASSO regression was used to optimize feature selection for the LOS more than 14 days. The Multivariable logistic regression analysis was applied to build a predicting nomogram by using the feature selected in the LASSO regression model. In order to evaluate the prediction ability of the model, we calculated the C-index. Simultaneously, the ROC curve, the Calibration curve and the DCA curve was draw to assess the model. Finally, we used 1000 times bootstrap method to verify the accuracy of the model. Results: Finally, 100(3.81%) patients were hospitalized for more than 14 days and 2522 patients (96.19%) were less 14 days. Patient age, ASA status, type of anesthesia, operation duration, procedure description, DM, IHD, CHF, day of operation and blood transfusion were determined and incorporated into the diagnostic nomogram. The C-index was 0.797(95% CI: 0.755-0.839).The calibration curve showed that the model had good recognition ability.The DCA curve analysis showed that the risk nomogram of length of stay more than 14 days was clinically useful.The C-index is 0.763 through 1000 times bootstrapping validation.Conclusion:We used the age, ASA status, type of anesthesia, operation duration, procedure description, DM, IHD, CHF, day of operation and blood transfusion to establish the clinical prediction model , this method can conveniently predict the risk of individual patients with total knee arthroplasty length of stay for more than 14 days.

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery

Background The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration. Material and Methods This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017. Results The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 – 7) minutes in group 1 and 8.23 ± 1.26 (8 – 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001). Conclusions The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

Objective: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Methods: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. Results: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Conclusion: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.