A method for the assessment of time-varying brain shift during navigated epilepsy surgery

Image guidance is widely used in neurosurgery. Tracking systems (neuronavigators) allow registering the preoperative image space to the surgical space. The localization accuracy is influenced by technical and clinical factors, such as brain shift. This paper aims at providing quantitative measure of the time-varying brain shift during open epilepsy surgery, and at measuring the pattern of brain deformation with respect to three potentially meaningful parameters: craniotomy area, craniotomy orientation and gravity vector direction in the images reference frame

Histopathology and Exercise: A Winning Combination in Pulmonary Fibrosis: A Case Report

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Dispersion chromium product Summary report

Vapor deposition and precipitation hardening methods for producing dispersion chromium alloy

Predictive significance of the six-minute walk distance for long-term survival in chronic hypercapnic respiratory failure

Background: The 6-min walk distance ( 6-MWD) is a global marker of functional capacity and prognosis in chronic obstructive pulmonary disease ( COPD), but less explored in other chronic respiratory diseases. Objective: To study the role of 6-MWD in chronic hypercapnic respiratory failure ( CHRF). Methods: In 424 stable patients with CHRF and non-invasive ventilation ( NIV) comprising COPD ( n = 197), restrictive diseases ( RD; n = 112) and obesity-hypoventilation- syndrome ( OHS; n = 115), the prognostic value of 6-MWD for long- term survival was assessed in relation to that of body mass index (BMI), lung function, respiratory muscle function and laboratory parameters. Results: 6-MWD was reduced in patients with COPD ( median 280 m; quartiles 204/350 m) and RD ( 290 m; 204/362 m) compared to OHS ( 360 m; 275/440 m; p <0.001 each). Overall mortality during 24.9 (13.1/40.5) months was 22.9%. In the 424 patients with CHRF, 6-MWD independently predicted mortality in addition to BMI, leukocytes and forced expiratory volume in 1 s ( p <0.05 each). In COPD, 6-MWD was strongly associated with mortality using the median {[} p <0.001, hazard ratio ( HR) = 3.75, 95% confidence interval (CI): 2.24-6.38] or quartiles as cutoff levels. In contrast, 6-MWD was only significantly associated with impaired survival in RD patients when it was reduced to 204 m or less (1st quartile; p = 0.003, HR = 3.31, 95% CI: 1.73-14.10), while in OHS 6-MWD had not any prognostic value. Conclusions: In patients with CHRF and NIV, 6-MWD was predictive for long- term survival particularly in COPD. In RD only severely reduced 6-MWD predicted mortality, while in OHS 6-MWD was relatively high and had no prognostic value. These results support a disease-specific use of 6-MWD in the routine assessment of patients with CHRF. Copyright (C) 2007 S. Karger AG, Basel

Abdominal versus perineal approach for external rectal prolapse: systematic review with meta-analysis

External rectal prolapse; SurgeryProlapso rectal externo; CirurgíaProlapse rectal extern; CirurgiaBackground External rectal prolapse (ERP) is a debilitating condition in which surgery plays an important role. The aim of this study was to evaluate the outcomes of abdominal approaches (AA) and perineal approaches (PA) to ERP. Methods This was a PRISMA-compliant systematic review with meta-analysis. Studies published between 1990 and 2021 were retrieved. The primary endpoint was recurrence at the last available follow-up. Secondary endpoints included factors associated with recurrence and function. All studies were assessed for bias using the Newcastle–Ottawa Scale and Cochrane tool. Results Fifteen studies involving 1611 patients (AA = 817; PA = 794) treated for ERP were included, three of which were randomized controlled trials (RCTs; 114 patients (AA = 54; PA = 60)). Duration of follow-up ranged from 12 to 82 months. Recurrence in non-randomized studies was 7.7 per cent in AA versus 20.1 per cent in PA (odds ratio (OR) 0.29, 95 per cent confidence interval (c.i.) 0.17 to 0.50; P < 0.001, I2 = 45 per cent). In RCTs, there was no significant difference (9.8 per cent versus 16.3 per cent, AA versus PA (OR 0.82, 95 per cent c.i. 0.29 to 2.37; P = 0.72, I2 = 0.0 per cent)). Age at surgery and duration of follow-up were risk factors for recurrence. Following AA, the recurrence rates were 10.1 per cent and 6.2 per cent in patients aged 65 years and older and less than 65 years of age, respectively (effect size [e.s.] 7.7, 95 per cent c.i. 4.5 to 11.5). Following PA, rates were 27 per cent and 16.3 per cent (e.s. 20.1, 95 per cent c.i. 13 to 28.2). Extending follow-up to at least 40 months increased the likelihood of recurrence. The median duration of hospital stay was 4.9 days after PA versus 7.2 days after AA. Overall, incontinence was less likely after AA (OR 0.32), but constipation occurred more frequently (OR 1.68). Most studies were retrospective, and several outcomes from RCTs were not consistent with those observed in non-RCTs. Conclusion The overall risk of recurrence of ERP appears to be higher with PA versus AA. Incontinence is less frequent after AA but at the cost of increased constipation. Age at surgery and duration of follow-up are associated with increased risk of recurrence, which warrants adequate reporting of future studies on this topic

Severe Respiratory and Skeletal Muscles Involvement in a Carrier of Dysferlinopathy With Chronic Obstructive Pulmonary Disease

The natural course of progressive neuromuscular diseases can be complicated by respiratory muscle involvement. In muscular dystrophies such as Duchenne muscular dystrophy and myotonic dystrophy, respiratory muscle involvement is common. In others such as Becker, limb-girdle, and facioscapulo-humeral dystrophies, respiratory muscle involvement is infrequent and generally occurs in the more severe cases. Recently, it was reported that a mutation in the dysferlin gene and/or dysferlin deficiency causes proximal and distal forms of muscular dystrophy, which are known by the term dysferlinopathy. We describe a case of severe weakness of both limb-girdle and respiratory muscles in a patient who was carrier of the dysferlin gene mutation and who also had COPD. We suggest that the systemic inflammatory response of COPD and the dysferlin deficit interact and are responsible for both the skeletal and respiratory muscle impairment

Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis

Anal fistula; Complications; Endoanal flapFístula anal; Complicaciones; Colgajo endoanalFístula anal; Complicacions; Empelt endoanalBackground Several techniques are available to reduce the risk of sphincter injury when treating anal fistula, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC) and endoanal flap (EAF). The aim of this meta-analysis is to provide data on the safety, complications and failure of these techniques. Methods Studies published after 2017, with patients undergoing at least one among LIFT, VAAFT, FiLaC and EAF for perianal fistula and providing data regarding failure, were retrieved from PubMed and EMBASE. Primary outcome was failure; other outcomes included continence disturbance and complications. Results Forty-nine articles with 3520 patients were included. The failure rates were 28.6% (range 3.8–75) for LIFT, 22.3% (6.2–65.2) for VAAFT, 43.9% (11.1–80) for FiLaC and 25.9% (4.7–100) for EAF, with a mean follow-up of 35.4 (6–80.4), 32.4 (6–48), 31.6(6.3–60) and 42.4 (12–155) months. The available network meta-analysis on failure showed RD of –0.08 (95% CI − 0.58 to 0.42) comparing LIFT vs VAAFT and 0.30 (95% CI 0.03 to 0.58) comparing LIFT vs EAF. No patients undergoing VAAFT or FiLaC reported worsening continence, while for LIFT and EAF, the continence disturbance rate was 1.5% and 7.3%, respectively. No major complications were observed. The most common minor complications were pain (1.4%), bleeding (1.1%) and wound infection (1.2%). Overall, minor complication rates were 4.3% for LIFT, 7.2% for VAAFT, 10.2% for FiLaC and 6.2% for EAF. Crohn's disease was associated with a higher failure rate (39.5% vs 31.4%). Conclusions FiLaC, VAAFT, LIFT and EAF may represent a valid option in the treatment of anal fistula. VAAFT showed the lowest rate of failure but with no differences from network metanalysis. Wider homogeneous studies with long-term follow-up are necessary to obtain more robust data. PROSPERO number CRD42022375600.Open Access Funding provided by Universitat Autonoma de Barcelona

Metabolomics of COPD Pulmonary Rehabilitation Outcomes via Exhaled Breath Condensate

: Chronic obstructive pulmonary disease (COPD) is characterized by different phenotypes and clinical presentations. Therefore, a single strategy of pulmonary rehabilitation (PR) does not always yield the expected clinical outcomes as some individuals respond excellently, others discreetly, or do not respond at all. Fifty consecutive COPD patients were enrolled. Of them, 35 starting a 5-week PR program were sampled at admission (T0), after 2 (T2W) and 5 (T5W) weeks, while 15 controls not yet on PR were tested at T0 and T5W. Nuclear magnetic resonance (NMR) profiling of exhaled breath condensate (EBC) and multivariate statistical analysis were applied to investigate the relationship between biomarkers and clinical parameters. The model including the three classes correctly located T2W between T0 and T5W, but 38.71% of samples partially overlapped with T0 and 32.26% with T5W, suggesting that for some patients PR is already beneficial at T2W (32.26% overlapping with T5W), while for others (38.71% overlapping with T0) more time is required. Rehabilitated patients presented several altered biomarkers. In particular, methanol from T0 to T5W decreased in parallel with dyspnea and fatigue, while the walk distance increased. Methanol could be ascribed to lung inflammation. We demonstrated that the metabolic COPD phenotype clearly evolves during PR, with a strict relationship between clinical and molecular parameters. Methanol, correlating with clinical parameters, represents a useful biomarker for monitoring personalized outcomes and establishing more targeted protocols

Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis

Ostomy closure; Postoperative complications; Surgical wound infectionCierre de ostomía; Complicaciones postoperatorias; Infección de herida quirúrgicaTancament d'ostomia; Complicacions postoperatòries; Infecció de la ferida quirúrgicaBackground Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure. Method A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia. Results Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06–0.21; p < 0.00001, I2 = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD − 0.17, 95% CI − 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD − 0.34, 95% CI − 0.55, − 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31). Conclusion CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery