Ability of prophylactic clipping to reduce the incidence of delayed bleeding in patients undergoing endoscopic resection of colonic polyps: a rapid evidence assessment review

Background: Delayed bleeding is a recognised complicationf ollowing colonic endoscopic resection. Prophylactic clip application is often used to reduce this. However, there is a lack of guidelines to support this. Aims: This article aims to review the most recent evidence on the question: 'In patients undergoing endoscopic resection of colonic polyps, does prophylactic clipping of the resection, compared with not clipping, reduce the incidence of delayed bleeding?'. Methods: A rapid assessment was undertaken regarding prophylactic clipping efficacy to reduce delayed bleeding. A search of three databases (Medline, the University of Derby Library Plus and the Cochrane Library) was undertaken to identify articles from the past 4 years. Findings: Eight publications were reviewed: three meta-analyses and five randomised control trials. Five publications recommended against prophylactic clipping following colonic endoscopic resection and three, the most recent publications, strongly recommended it, specifically for those at high risk of delayed bleeding. Conclusion: Prophylactic clip application to reduce delayed bleeding is not effective across all colonic resections. However, there is evidence in favour of clipping for patients with high risk of delayed bleeding.

Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm—From the Standpoint of Hemodynamic Integrity and Perforator Preservation

During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.

Feasibility and safety of partial resection of the anterior insular cortex for microsurgical treatment of middle cerebral artery aneurysms located in the limen recess: patient series

BACKGROUND When performing clip ligation of superior projecting aneurysms of the proximal (M1) segment of the middle cerebral artery (MCA), meticulous sylvian fissure dissection alone may be inadequate for safe clip application, especially in cases in which the aneurysm is buried in the limen recess, since the limen insulae may be positioned lateral to the aneurysm. In the present patient series, the authors present their surgical technique for clip ligation of aneurysms located in the limen recess, with partial resection of the limen insulae. OBSERVATIONS A retrospective analysis of patients who had undergone clip ligation of MCA aneurysms located at the limen recess at a single institute was performed. Patients with angiographic and clinical follow-up data were considered eligible. A total of 11 aneurysms (4 ruptured and 7 unruptured aneurysms) in 11 patients were evaluated. Postoperative ischemic lesions were observed on images obtained within 1 week after surgery in 5 (45.5%) patients who had undergone partial resection of the limen insulae, although none of them presented with neurological deterioration. LESSONS Partial resection of limen insulae may be feasible to avoid severe ischemic complications following clip ligation of M1 aneurysms embedded in the limen recess.

Students' perceptions of content and language integrated pedagogy via electronic communication (e-CLIP)

e-CLIP or Content and Language Integrated Pedagogy via Electronic Communication is an innovation in the Thai education system which supports the integration of electronic media and content-based English. e-CLIP is one of the tools developed to cope with the 21st century and has been integrated into several Thai schools in recent years. This research aims to compare students' perceptions of e-CLIP application in two distinct settings: a small and large-sized school. This study was conducted in Secondary Educational Service Area 39 Thailand. The data were collected through a survey, focus group interviews, and observations. The collected qualitative data were analyzed through content analysis. Additionally, descriptive and inferential statistics were performed to interpret the quantitative data. The quantitative findings exposed that students from both schools showed positive perceptions of integrating electronic media and content-based English in their classes. However, qualitative data showed that small-sized students were more motivated to participate in activities utilizing the e-CLIP model than those in the large-sized school. Keywords: e-CLIP Model, electronic media, content-based English

The Risk of Pregnancy After Tubal Sterilization

The CREST Study, conducted from 1978 to 1986, used a prospective cohort design to determine the risk of pregnancy after different methods of tubal sterilization. This landmark study followed a cohort of over 10,000 women who underwent tubal sterilization via laparoscopic unipolar coagulation, laparoscopic bipolar coagulation, laparoscopic silicone rubber band application, laparoscopic spring clip application, or partial salpingectomy by laparotomy (postpartum tubal ligation) at 9 participating medical centers across the United States. Follow-up interviews identified women who subsequently became pregnant. The study demonstrated that rates of sterilization failure were higher than previously thought and that failure rates varied by method of tubal sterilization. More effective methods included postpartum partial salpingectomy and laparoscopic unipolar and band procedures. It further demonstrated that younger women and Black women were at increased risk of sterilization failure.

Low-dose adenosine-induced transient asystole during intracranial aneurysm surgery

Background: Few studies have evaluated the adenosine dose that induces cardiac arrest during intracranial aneurysm surgery. We present our experiences with adenosine-induced transient asystole (AiTA) during intracranial aneurysm surgery and dosage recommendations. Methods: We retrospectively reviewed the medical records of all patients who underwent intracranial aneurysm surgery between July 2016 and December 2018. Patients who experienced AiTA during intracranial aneurysm surgery were included in the study. Results: Our study included nine intracranial aneurysm surgeries performed in eight patients. Thirteen episodes of AiTA were reported. Five of these were performed to facilitate bleeding control due to intraoperative aneurysm rupture (IAR), and adenosine doses were 9 mg (0.20 mg/kg), 12 mg (0.25 mg/kg), 12 mg (0.26 mg/kg), 18 mg (0.34 mg/kg), and 18 mg (0.39 mg/kg), resulted in transient asystole for 12, 14, 9, 44, and 18 s, respectively. For episodes without IAR, adenosine doses ranging from 6 to 18 mg (0.11–0.39 mg/kg) caused asystole for 8–33 s. In five episodes without IAR, low-dose adenosine (lower than 0.2 mg/kg) was used and caused asystole ranging from 8 to 12 s. Postoperatively, two patients had elevated cardiac troponin T levels but normal electrocardiograms. Conclusion: AiTA can facilitate the clipping of intracranial aneurysms at low-risk of serious cardiac complications. An adenosine dose of 0.2–0.4 mg/kg is safe and effective in both IAR and non IAR situations. In non IAR cases, we propose that low-dose AiTA is an option to facilitate aneurysm clipping. A starting dose of 6 mg or 0.1–0.2 mg/kg can adequately induce brief asystole by softening the aneurysmal sac during clip application.