medRxiv - Surgery最新文献

{"title":"The VIPR-1 trial (Visualizing Ischemia in the Pancreatic Remnant) - Assessing the role of intraoperative indocyanine green perfusion of the transected pancreas in predicting postoperative pancreatic leaks: protocol for a prospective phase II trial.","authors":"Gustavo Salgado-Garza, Annika Willy, Flavio G. Rocha, Skye C. Mayo, Brett C. Sheppard, Patrick J. Worth","doi":"10.1101/2024.09.13.24313603","DOIUrl":"https://doi.org/10.1101/2024.09.13.24313603","url":null,"abstract":"Surgery of the pancreas has come a long way since its inception; however, postoperative morbidity is still high. Pancreatic leaks and fistulas are common complications in patients undergoing surgery to remove the pancreas. Fistulas delay subsequent oncological care after surgery and prolong the hospital stay. Hypoperfusion to the pancreas has been characterized as one factor leading to fistulas. Indocyanine green (ICG) injection allows the surgeon to evaluate blood perfusion to tissue in real-time. This protocol describes a trial that aims to assess the effectiveness of intraoperative ICG metrics of the cut edge of the pancreas to predict postoperative fistulas. A single group will participate in an observational, surgeon-blinded, phase II trial. ICG measurements of the cut edge of the pancreas will be recorded before reconstruction. International Study Group on Pancreatic Surgery criteria for pancreatic fistula will be used to define leaks and fistulas. The primary outcome will be the correlation between ICG measurements and the development or absence of fistula formation. Currently, limited objective intraoperative predictors exist for predicting postoperative fistulas. Having a reliable predictive tool could decrease the healthcare burden posed by fistulas. The findings of this trial will provide conclusions on the usefulness of ICG measurements in predicting postoperative pancreatic fistulas and leaks. This clinical trial is registered in ClinicalTrials.gov with the ID NCT06084013. The current protocol version is v1.0.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin-dependence as a Predictor of Shortened Cancer-specific Survival in Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study from the United States Neuroendocrine Study Group","authors":"Muhammad Bilal Mirza, Jordan Baechle, Paula Marincola Smith, Danish Ali, Mary Dillhoff, George Poultsides, Flavio Rocha, Clifford Cho, Emily Winslow, Ryan Fields, Shishir Maithel, Kamran Idrees","doi":"10.1101/2024.09.11.24313436","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313436","url":null,"abstract":"Introduction: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to delineate the impact of insulin dependent (IDDM) and non\t-insulin dependent (NIDDM) on poor oncological outcomes. Methods: Utilizing the U.S. Neuroendocrine Tumor Study Group database (1999-2016), we performed a retrospective cohort study of adult patients who underwent primary surgical resection of PNETs. Patients were categorized based on preoperative diagnosis into non-DM, NIDDM, and IDDM cohorts. We used the Kaplan-Meier method and log-rank test to study cancer-specific survival (CSS). Cox proportional Hazards models were used to assess the impact of IDDM on CSS. Results: Of the 1,122 patients included in the analysis, 870 (77%) were non-DM, 168 (15%) were NIDDM, and 84 (8%) were IDDM. The groups were similar in tumor stage and grade. However, they differed in sex, BMI, age, ASA class, tumor location, preoperative HbA1c and serum glucose (p-value <0.05). Patients with IDDM had significantly decreased 5-year CSS compared to patients without IDDM (CSS: IDDM 85%, NIDDM 94%, non-DM 93%, NIDDM + non-DM 93%; P <0.01). On multivariate analysis, IDDM was independently associated with worse CSS (HR 2.27, 95% Confidence Interval 1.15-4.45, P=0.02). Conclusion: Insulin dependence is associated with worse cancer-specific survival in PNET patients following surgical resection compared to PNET patients with NIDDM or without DM.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chyme Reinfusion Practices in the Neonatal Population","authors":"Alexandria H Lim, Georges Tinawi, Taylor Harrington, Emma Ludlow, Helen Evans, Ian Bisset, Celia Keane","doi":"10.1101/2024.09.06.24312922","DOIUrl":"https://doi.org/10.1101/2024.09.06.24312922","url":null,"abstract":"Abstract Introduction: The utilisation of chyme reinfusion therapy (CRT) by returning the output from the proximal limb into the distal limb of double enterostomies is a safe and effective method to improve nutritional uptake and maintain intestinal integrity in adult populations. This technique is also particularly suitable for neonatal patients with life-threatening conditions such as congenital bowel abnormalities and necrotising enterocolitis (NEC). Despite its promise, it has only had irregular uptake in neonatal patients. We aimed to identify the frequency, methodology and adverse events associated with CRT in the appropriate neonatal population. Methods: A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded. Results: Of the 49 neonates identified with double enterostomy 23 (47%) underwent CRT for high stoma output, risk of short gut syndrome or as a routine protocol before re-anastomosis. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50 - 22.89) to 24.37 (19.68 - 29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). The rate of non-infectious adverse events was 24, with 7% remaining free from any adverse events. Conclusion: Chyme reinfusion is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Amputations - A Nationwide Epidemiological Analysis of a developing country over 16 years","authors":"Marcella Moura Ceratti, Carolina Carvalho Jansen Sorbello, Isabela Roskamp Sunye, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Miguel Cendoroglo Neto, Nelson Wolosker","doi":"10.1101/2024.09.05.24313153","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313153","url":null,"abstract":"<strong>Background</strong> Defining the impact of amputation is essential for developing cost-effective preventive health policies. Trauma is one of the most common causes of limb loss, affecting mainly the young working population. To date, few studies have investigated the epidemiology of patients undergoing trauma-related amputations and their public health implications in developing countries. The aim of this study was to analyze all limb amputations due to traumatic injuries performed in the Brazilian public health system over a 16-year period, studying their incidence, demographics, hospitalization and costs.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of Collaborative Robot-assisted Cutting Method for Iliac Crest Flap Raising: Randomized Crossover Trial","authors":"Paulina Becker, Yao Li, Sergey Drobinsky, Jan Egger, Kunpeng Xie, Ashkan Rashad, Klaus Radermacher, Rainer Röhrig, Matías de la Fuente, Frank Hölzle, Behrus Puladi","doi":"10.1101/2024.09.04.24312594","DOIUrl":"https://doi.org/10.1101/2024.09.04.24312594","url":null,"abstract":"The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREVALENCE AND TREATMENT OUTCOME OF ANORECTAL MALFORMATION AT MNAZI MMOJA REFERRAL HOSPITAL 2018-2022","authors":"Ahmad Moshi Chongera, Abdulkarim Hamad Ally, Mwanakhamis Vuai Mussa, Yasinta Edison Mnyaruge, Said A Said, Mwanabaraka Saleh Haji","doi":"10.1101/2024.09.03.24310510","DOIUrl":"https://doi.org/10.1101/2024.09.03.24310510","url":null,"abstract":"<strong>BACKGROUND</strong> Anorectal Malformations (ARM) are congenital defects where the anus and rectum do not form correctly, presenting a range of complexities that often necessitate intricate surgical interventionist global incidence of ARM is approximately 1 in 2000 to 5000 live births. In developing countries like Tanzania, managing ARMs poses significant challenges due to late presentations, shortage of trained pediatric surgeons and inadequate diagnostic facilities. This study aimed to evaluate the prevalence and treatment outcomes of ARM at Mnazi Mmoja Hospital (MMH) over five years 2018 to 2022","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Analysis of Lower Limb Vascular Trauma over 16 years in Brazil - A Nationwide View","authors":"Carolina Carvalho Jansen Sorbello, Marcella Moura Ceratti, Felipe Soares Portela, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Antonio Eduardo Zerati, Nelson Wolosker","doi":"10.1101/2024.09.02.24312947","DOIUrl":"https://doi.org/10.1101/2024.09.02.24312947","url":null,"abstract":"<strong>Background</strong> Lower limb vascular trauma (LLVT) represents a significant public health challenge due to its potential to cause complex injuries that are difficult to manage, leading to increased morbidity, mortality and healthcare costs.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Application of Large Language Models for Breast Conditions: A Systematic Review","authors":"Billy Ho Hung Cheung, Karen Gwyn Poon, Cheuk Fai Lai, Ka Chun Lam, Michael Co, Ava Kwong","doi":"10.1101/2024.08.31.24312542","DOIUrl":"https://doi.org/10.1101/2024.08.31.24312542","url":null,"abstract":"<strong>Background</strong> The application of artificial intelligence (AI) like Large Language Models (LLM) into the healthcare system has been a frequently discussed topic in recent years.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic Aortic Shape: A Data-Driven Scale Space Approach","authors":"Joseph A. Pugar, Junsung Kim, Kameel Khabaz, Karen Yuan, Luka Pocivavsek","doi":"10.1101/2024.08.30.24312310","DOIUrl":"https://doi.org/10.1101/2024.08.30.24312310","url":null,"abstract":"The scale and resolution of anatomical features extracted from medical CT images are crucial for advancing clinical decision-making tools. While traditional metrics, such as maximum aortic diameter, have long been the standard for classifying aortic diseases, these one-dimensional measures often fall short in capturing the rich geometrical nuances available in progressively advancing imaging modalities. Recent advancements in computational methods and imaging have introduced more sophisticated geometric signatures, in particular scale-invariant measures of aortic shape. Among these, the normalized fluctuation in total integrated Gaussian curvature <span><span><img alt=\"Embedded Image\" data-src=\"https://www.medrxiv.org/sites/default/files/highwire/medrxiv/early/2024/08/31/2024.08.30.24312310/embed/inline-graphic-1.gif\" src=\"data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\"/><noscript><img alt=\"Embedded Image\" src=\"https://www.medrxiv.org/sites/default/files/highwire/medrxiv/early/2024/08/31/2024.08.30.24312310/embed/inline-graphic-1.gif\"/></noscript></span></span> over a surface mesh model of the aorta has emerged as a particularly promising metric. However, there exists a critical tradeoff between noise reduction and shape signal preservation within the scale space parameters – namely, smoothing intensity, meshing density, and partitioning size. Through a comprehensive analysis of over 1200 unique scale space constructions derived from a cohort of 185 aortic dissection patients, this work pinpoints optimal resolution scales at which shape variations are most strongly correlated with surgical outcomes. Importantly, these findings emphasize the pivotal role of a secondary discretization step, which consistently yield the most robust signal when scaled to approximately 1 cm. The results presented here not only enhance the interpretability and predictive power of data-driven models but also introduce a methodological framework that integrates statistical reinforcement with domain-specific knowledge to optimize feature extraction across scales. This approach enables the development of models that are not only clinically effective but also inherently resilient to biases introduced by patient population heterogeneity. By focusing on the appropriate intermediate scales for analysis, this study paves the way for more precise and reliable tools in medical imaging, ultimately contributing to improved patient outcomes in cardiovascular surgery.","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Determinants of Outcomes in Cervical Spine Injury Patients: A Retrospective Study at AaBET Hospital, Addis Ababa, Ethiopia","authors":"Alemayehu Beharu Tekle, Nikodimos Eshetu Dabe, Molla Asnake Kebede, Ayalew Zewde Tadesse, Bisrat Solomon Zewge, Melaku Tsediew Berhanu","doi":"10.1101/2024.08.29.24312801","DOIUrl":"https://doi.org/10.1101/2024.08.29.24312801","url":null,"abstract":"A cervical spinal cord injury is a tragic occurrence for the sufferer and their loved ones. Because so many resources are needed to manage the patient during both the acute and rehabilitative stages, it has a significant impact on society and it is mainly related to cervical spine fractures and the most frequent kind of spinal fractures are those to the cervical spine. Automobile accidents, followed by diving into shallow water, firearm injuries, and sports activities are common causes of cervical spine injury. In developing countries like Ethiopia, little is known about the prevalence of cervical spinal injuries. An understanding of the prevalence of spinal injury is fundamental to developing possible preventive strategies and improving our primary trauma care. Assessing the pattern, outcome, and associated factors of patients with cervical spine injury who have visited AaBET Hospital from January 1, 2018 to November 30, 2023 is the primary objective of this study. Institution-based cross-sectional study was conducted at AaBET Hospital, Addis Ababa, Ethiopia. The study included patients who presented to the emergency department with a diagnosis of cervical spine injury from January 1, 2018, to November 30, 2023. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine associations between dependent and independent variables. A p-value &lt;0.05 was considered statistically significant. A total data of 149 patients were analyzed, with an average age of 36.3 ± 14.9 years (ranges 9-85 years) and the male-to-female ratio was 2.9:1. Road traffic accident occurs in 49.7% of patients as a mechanism of injury followed by falling down accident (39.6%) of patients. Seventy-eight (52.3%) patients sustained with a total of 114 associated injuries (ASOI). Head injury was the commonly associated injury followed by chest and extremity injury. The most frequently injured cervical vertebra was C7 followed by C6 and T1. 68.5% of the patients have multilevel injuries. 33.6% of patients have neurological impairment ASIA class A followed by ASIA class E (29.5%). The overall hospital mortality is 7.4%. The level of cervical spine injury, the ASIA class of the patient, and the presence of associated injury were strongly associated with mortality. The mean ± SD length of hospital stay was 13.6 ± 16.4 days. And 30.2% of patients have prolonged lengths of hospital stay (PLOS). Neurosurgical intervention and the presence of associated injury have been significantly associated with PLOS. This study showed the common mechanism was RTA and C7 was the common injury level. C3 injury level, ASIA A neurologic deficit, and having associated injury were associated with mortality. Undergoing neurosurgical intervention and the presence of associated injury were associated with prolonged length of hospital stay (PLOS).","PeriodicalId":501051,"journal":{"name":"medRxiv - Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142204032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}