Relationship between immediate post-operative appearance and 6-week operative outcome in trichiasis surgery

Background

Surgical technique, including suture placement and tension, is believed to contribute to the outcome of bilamellar tarsal rotation surgery for trachomatous trichiasis. However, the immediate post-operative appearance that minimizes the chance of recurrence and other adverse outcomes has not been investigated.

Methodology/Principal Findings

To explore whether the degree of correction immediately after surgery is predictive of surgical outcome at the 6-week post-operative visit, photographs taken immediately after surgery were used to predict surgical outcomes, including the severity of eyelid contour abnormality and trichiasis recurrence. Both eyelid contour abnormalities and recurrence were accurately predicted from the immediate post-operative photographs by an experienced oculoplastic surgeon 85% and 70% of the time, respectively. Participants with a “slight over-correction” that resulted in no eyelid contour abnormality and no recurrence were used to identify immediate post-operative contours that lead to a successful surgical outcome.

Conclusions/Significance

The immediate post-operative eyelid contour is an important indicator of post-operative success of BLTR surgery. Based upon our findings, we developed a Surgery Photocard. This card illustrates some examples of immediate post-surgical appearances, which led to a successful outcome, as well as sub-optimal appearances, which led to poor surgical outcomes. The card also provides suggestions for improving the appearance by adjusting the suture placement or tension based upon standard oculoplastic principles.     

Evaluating operative mortality of cardiac surgery: first define operative mortality

The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and its American counterpart, the Society of Thoracic Surgeons (STS) score, are currently the most used risk scores to predict operative mortality of adult cardiac surgery     

The impact of computer and imaging technology on stereotactic surgery

Computers, particularly medical imaging techniques, have created a renaissance in stereotactic surgery. Human stereotaxis was primarily developed and performed beginning in the 1940s for functional disorders. Interest waned in the 1960s following the introduction of L-dopa until computer-based three-dimensionally precise tomographic modalities (specifically computed tomography) were introduced beginning in the mid-1970s as a routine diagnostic aid. New image-compatible hardware and instrumentation were introduced along with techniques and associated software for relating points and volumes appearing on these diagnostic images into stereotactic space. This paper reviews the computer and imaging technology that has led to this renaissance and discusses some of the important features of a computer-interactive stereotactic system.     

The impact of oxacarbenium ion conformers on the stereochemical outcome of glycosylations

The search for stereoselective glycosylation reactions has occupied synthetic carbohydrate chemists for decades. Traditionally, most attention has been focused on controlling the S_N2-like substitution of anomeric leaving groups as highlighted by Lemieux’s in situ anomerization protocol and by the discovery of anomeric triflates as reactive intermediates in the stereoselective formation of β-mannosides. Recently, it has become clear that also S_N1-like reaction pathways can lead to highly selective glycosylation reactions. This review describes some recent examples of stereoselective glycosylations in which oxacarbenium ions are believed to be at the basis of the selectivity. Special attention is paid to the stereodirecting effect of substituents on a pyranosyl ring with an emphasis on the role of the C-5 carboxylate ester in the condensations of mannuronate ester donors.     

The impact of variable stoichiometry on predator-prey interactions: a multinutrient approach

A model for prey and predators is formulated in which three essential nutrients can limit growth of both populations. Prey take up dissolved nutrients, while predators ingest prey, assimilate a fraction of ingested nutrients that depends on their current nutrient status, and recycle the balance. Although individuals are modeled as identical within populations, amounts of nutrients within individuals vary over time in both populations, with reproductive rates increasing with these amounts. Equilibria and their stability depend on nutrient supply conditions. When nutrient supply increases, unusual results can occur, such as a decrease of prey density. This phenomenon occurs if, with increasing nutrient, predators sequester rather than recycle nutrients. Furthermore, despite use of a linear functional response for predators, high nutrient supply can destabilize equilibria. Responses to nutrient supply depend on the balance between assimilation and recycling of nutrients by predators, which differs depending on the identity of the limiting nutrient. Applied to microbial ecosystems, the model predicts that the efficiency of organic carbon mineralization is reduced when supply of mineral nutrients is low and when equilibria are unstable. The extent to which predators recycle or sequester limiting nutrients for their prey is of critical importance for the stability of predator-prey systems and their response to enrichment.     

Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs

ABSTRACT: BACKGROUND: Oral or enteral dietary supplementation with arginine, omega 3 fatty acids and nucleotides (known as immunonutrition) significantly improve outcomes in patients undergoing elective surgery. The objective of the study was to determine the impact on hospital costs of immunonutrition formulas used in patients undergoing elective surgery for gastrointestinal cancer. METHODS: US hospital costs of stay with and without surgical infectious complications, and average cost per day in the hospital for patients undergoing elective surgery for gastrointestinal cancer were estimated using data from the Healthcare Cost and Utilization Project's 2008 Nationwide Inpatient Sample. These costs were then used to estimate the impact of perioperative immunonutrition on hospital costs using estimates of reduction in infectious complications or length of stay from a meta-analysis of clinical trials in patients undergoing elective surgery for gastrointestinal cancer. Sensitivity of the results to changes in baseline complication rates or length of stay was tested. RESULTS: From the meta-analysis estimates, use of immunonutrition resulted in savings per patient of $3,300 with costs based on reduction in infectious complication rates or $6,000 with costs based on length of hospital stay. Cost savings per patient were present for baseline complication rates above 3.5% or when baseline length of stay and infectious complication rates were reduced to reflect recent US data for those with upper and lower GI elective cancer surgery (range, $1,200 to $6,300). CONCLUSIONS: Use of immunonutrition for patients undergoing elective surgery for gastrointestinal cancer is an effective and cost-saving intervention.     

The associated factors to endometrial cavity fluid and the relevant impact on the IVF-ET outcome

Background  

Endometrial cavity fluid (ECF) is a fluid accumulation within the endometrial cavity. The significance of ECF remains unclear during the program of in vitro fertilization-embryo transfer (IVF-ET). The aim of the present study was to investigate the associated factors to ECF, visualized through ultrasound at the day of oocyte retrieval, and the relevant impact on the outcome of IVF-ET.     

The implementation and impact of a pilot hydrocele surgery camp for LF-endemic communities in Ethiopia

BackgroundEthiopia aims to eliminate lymphatic filariasis by 2020, through a dual approach of mass drug administration to interrupt transmission and morbidity control which includes making hydrocele surgery available in all endemic areas. Locating patients requiring surgery, providing high quality surgeries, and following up patients are all formidable challenges for many resource-challenged or difficult-to-reach communities. To date, hydrocele surgery in Ethiopia has only occurred when a patient has the knowledge, time and resources to travel to regional hospitals. Ethiopia tested the novel approach of using a surgical camp, defined as mobilizing, transporting, providing surgery at a static site, and following up of a large cohort of hydrocele patients within a hospital’s catchment area, to address delays in seeking and receiving care.Methodology and resultsHealth extension workers mobilized 252 patients with scrotal swelling from a list of 385 suspected hydrocele cases from seven endemic districts in the region of Beneshangul-Gumuz. Clinical health workers and surgeons confirmed 119 as eligible for surgery. Of 70 additional patients who self-referred, 56 were eligible for surgery. Over a two-week period at a regional hospital, 175 hydrocele excision surgeries were conducted. After discharge three days after surgery, trained clinical health workers followed up with the patients on Day 5, Day 8, Day 14 and 1st-month benchmarks with a randomized follow-up of a selection of patients conducted at 9–12 months. There were no post-operative complications upon discharge at Day 3 and 22, while minor complications occurred (12.6%) between Day 3 and one month. The 9–12 month follow-up found patients self-reported an improvement in quality of life, health and economic status.ConclusionA hydrocele surgery camp was effective at providing a large number of quality surgeries in a short time. Using peripheral health workers to mobilize and follow up patients helped address delays in seeking and receiving quality care. Mainstreaming patient mobilization and follow-up into a community health system could be effective in other countries. The camp’s results also influenced two regions in Ethiopia to change their policies in order to offer free hydrocele surgery (including patient transport, consultation, surgery, diagnostic tests and necessary medications).     

Experimental approach for assessing the outcome accuracy of antibody microarray experiments

An experimental strategy for quality control of antibody microarray analyses is proposed. The method utilizes proteins that are prepared for regular antibody microarray experiments. There is no need to use exogenous positive or negative reference markers and no need to determine the absolute concentration of each individual protein in the sample. Validation experiments support the basic principle of the proposed approach. This method can be a useful tool for assessing the outcome accuracy of microarray experiments.     

不同类型的下颌骨骨折的手术治疗

目的：评估不同类型的下颌骨骨折的手术入路及固定方法。方法：对于52例不同类型下颌骨骨折患者采用不同的口外或口内切口及相应的固定方法。结果：52例患者伤口全部一期愈合,51例咬合关系恢复到伤前咬合关系,1例出现咬合关系不良,X线检查骨折线队位良好。结论：对于不同部位的下颌骨骨折应采用相应的手术切口及固定方法,以获得最好的疗效。     

Criteria and outcome of limb salvage surgery

When sufficient margins of resection surrounding the tumor can be achieved, limb salvage surgery, as opposed to amputation, has become the standard of care in treating patients with bone and soft tissue sarcoma of the extremities. Currently, 90-95% of patients with primary malignant bone and soft-tissue tumors involving the extremities can be treated safely with wide resection and limb salvage surgery with a low risk of recurrence and the same disease-free survival rate as amputative surgery. However, discussions persist regarding the indications and criteria, and whether limb salvage provides superior functional results and quality of life for cancer patients. In this study we aimed to review and update the current criteria, indications and contraindications of limb salvage surgery and discuss its role in the quality of life of cancer patients.     

Psychosocial outcome of craniofacial surgery in children

Thirty-four children between the ages of 7 and 15 years with congenital craniofacial anomalies underwent psychosocial evaluation before and 12 to 18 months after surgery. Also evaluated were healthy children matched to the craniofacial subjects by sex, age, intelligence, and economic background. Preoperative assessment revealed the craniofacial group to have multiple but not severe psychosocial limitations. At follow-up, only a measure of social functioning still differentiated the groups, with the craniofacial subjects experiencing more negative social encounters. Comparison of initial and follow-up scores for the craniofacial group revealed a significant reduction in trait anxiety and trends toward reduction in parent-reported inhibited and hyperactive behavior. Scores on measures of extraversion and social functioning tended to be positively correlated with age for the comparison subjects only. Results suggest a modest improvement in psychological adjustment following surgery with a residual, possibly increasing, deficit in social functioning.