Aim: Conventional femoral artery cannulation with retrograde perfusion may increase the incidence of cerebral embolism in treating Stanford type A aortic dissection (STAAD). This study aimed to compare the neuroprotective effect of combined axillary-femoral artery cannulation utilizing an antegrade-retrograde perfusion strategy with femoral artery single cannulation in STAAD surgery.
Methods: This was a two-center, retrospective cohort study including 120 patients who underwent STAAD surgery between January 2021 and January 2025. Among them, 63 patients received combined axillary-femoral artery cannulation (double arterial cannulation group, DAC group), while 57 patients underwent conventional femoral artery single cannulation (single arterial cannulation group, SAC group). Perioperative parameters, neurological outcomes, including incidences of permanent/transient neurological dysfunction (PND/TND), delirium and coma duration, modified Rankin Scale (mRS) score, and Montreal Cognitive Assessment (MoCA) score, were evaluated. Serum biomarkers of brain injury, including neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) protein levels, as well as postoperative general complications, were also analyzed.
Results: There was no significant difference in the key perioperative time parameters between the two groups (p > 0.05). Regarding neuroprotection, the DAC group exhibited superior outcomes, with significantly lower incidences of PND and TND, and shorter coma and delirium durations (p < 0.05). The DAC group also achieved better mRS and MoCA scores at 30 and 90 days postoperatively (p < 0.001). Peak postoperative levels of NSE and S100B were significantly lower in the DAC group (p < 0.001). Multivariate linear regression analyses revealed that the DAC strategy was an independent protective factor associated with improved neurological function (mRS), enhanced cognitive performance (MoCA), lower brain injury biomarker levels (NSE and S100B), and reduced coma and delirium durations (p < 0.001). There was no significant difference in the overall incidence of postoperative general complications between the two groups (p > 0.05). However, the incidence of postoperative limb ischemia was significantly lower in the DAC group (p < 0.05).
Conclusions: Compared with conventional femoral artery single cannulation, combined axillary-femoral artery cannulation provides superior and independent cerebral protection during STAAD surgery. This approach reduces permanent and transient neurological deficits, mitigates early brain injury, enhances neurological and cognitive recovery, and lowers the incidence of postoperative limb ischemia. It holds promise as a safe and effective cerebral protective perfusion strategy in STAAD surgical management.
Aim: This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal hernia (HH) repair in gastroesophageal reflux disease (GERD) patients.
Methods: This retrospective cohort study included 103 patients with HH and GERD who underwent surgery between January 2020 and May 2024. Patients were divided into two groups based on surgical technique: the Toupet group (n = 53) and the Nissen group (n = 50). Outcomes included surgical metrics, pre/postoperative high-resolution manometry, 24-hour pH-impedance, gastroesophageal reflux disease symptom questionnaire (GERD-Q) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and complications. Multivariable regression adjusted for baseline differences.
Results: The Toupet group demonstrated significantly shorter time to first postoperative oral intake (p = 0.012) and hospital stays (p = 0.023) compared to the Nissen group. At 6 months postoperatively, both groups showed significant increases in minimum lower esophageal sphincter (LES) resting pressure and respiratory mean values, along with decreases in reflux-related parameters and ineffective swallowing ratio (p < 0.001). Intergroup comparison revealed that the Toupet group had lower minimum LES resting pressure, respiratory mean LES pressure, and ineffective swallowing ratio, but higher 24-hour reflux episodes, percentage acid exposure time, and mean DeMeester scores than the Nissen group (p < 0.001). At 1 year postoperatively, both groups exhibited significant improvements in GERD-Q and GERD-HRQL scores (p < 0.001), with no intergroup differences observed (p > 0.05). The Toupet group had significantly lower overall complication rates (p = 0.031) and a lower incidence of dysphagia than the Nissen group (p = 0.019). Multivariable regression analyses confirmed that the Toupet procedure was an independent predictor for shorter time to first postoperative oral intake (p = 0.015), shorter hospital stays (p = 0.017), and lower overall complication rates (p = 0.020).
Conclusions: In summary, when performed with 3D laparoscopy, Toupet and Nissen fundoplication show distinct and meaningful clinical profiles. Nissen fundoplication is the preferred option for achieving maximal anti-reflux efficacy in patients with normal esophageal motility, whereas Toupet fundoplication is preferred for minimizing postoperative dysphagia and enhancing rapid recovery, particularly in cases with impaired or borderline motility.
Aim: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence.
Methods: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II-III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates.
Results: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05).
Conclusions: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.
Aim: Spinal cord injury (SCI), particularly traumatic spinal cord injury (TSCI), is a globally prevalent neurological condition and often causes severe functional and physical disabilities. Neuromuscular electrical stimulation (NMES), when combined with rehabilitation training, has been reported to enhance functional recovery in patients with SCI. However, its specific clinical advantages and safety profile require further validation through robust empirical data. Therefore, this study aims to investigate the synergistic effects of NMES combined with rehabilitation training on improving motor function and reducing muscle atrophy in SCI patients.
Methods: This retrospective study enrolled 856 patients with TSCI. All patients received either surgical intervention or conservative treatment based on injury severity. Among them, 472 patients received NMES combined with rehabilitation training (intervention group), while the remaining 384 patients received rehabilitation training alone (control group). Several parameters, including neurological function score, muscle mass, and quality of life (QoL) were compared pre- and post-interventions to evaluate the rehabilitation outcomes of the two groups.
Results: After treatment, the patients in the intervention group showed higher motor and sensory function scores (American Spinal Injury Association [ASIA] motor and ASIA sensory scores), walking speed on the 10-Meter Walk Test (10MWT), and muscle cross-sectional area (CSA) value than those in the control group (p < 0.05). However, no significant differences were observed between the two groups in Spinal Cord Independence Measure III (SCIM-III) scores, muscle quality index (MQI), and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) scores (p > 0.05).
Conclusions: Combining NMES with rehabilitation training can enhance motor function recovery, attenuate muscle atrophy, and improve walking ability in individuals with SCI. NMES-augmented rehabilitation offers superior benefits compared to rehabilitation alone.
Aim: This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation type C3 distal humeral fractures, providing evidence for selecting optimal surgical approaches and fixation methods.
Methods: This retrospective analysis included 31 patients with AO type C3 distal humeral fractures treated at the Department of Orthopaedic Trauma, Orthopaedic Center, the First Hospital of Jilin University between June 2018 and May 2024. All patients underwent open reduction and internal fixation with orthogonal double plates placed dorsally on the radial column and medially on the ulnar column. Based on surgical approach, patients were divided into the BTA group (n = 16) and OOA group (n = 15). The parameters evaluated during this study included injury-to-surgery interval, operative time, intraoperative blood loss, postoperative complications (iatrogenic nerve injury, wound infection, elbow stiffness), and Mayo Elbow Performance Score (MEPS) at 6 and 12 months postoperatively.
Results: All patients achieved bony union and their fractures healed with complete follow-up. No statistically significant differences were observed in gender, age, or injury-to-surgery interval between groups (p > 0.05). Operative time was significantly shorter in the BTA group compared to the OOA group (p < 0.05). Similarly, there were no significant differences between the groups regarding intraoperative blood loss, postoperative complication rates, or excellent/good rates of MEPS at 6 or 12 months (all p > 0.05).
Conclusions: For AO type C3 distal humeral fractures without metaphyseal defects, orthogonal double plating provides rigid fixation enabling early postoperative mobilization. For fractures with intact trochlear articular surfaces (no coronal/horizontal split) where fragments can be directly fixed by distal screws from the plates, the bilateral triceps approach may be prioritized. For severely comminuted trochlear fractures with articular fragmentation (coronal/horizontal split) requiring separate fixation of split fragments with headless compression screws, the olecranon osteotomy approach may provide better exposure.
Aim: Managing partial defects of the finger is crucial for both function and aesthetics, especially when bone or tendon is exposed. Permacol Enhanced Layer for Neodermis and Coverage (PELNAC), an artificial dermis, serves as a promising scaffold in surgical procedures, providing wound protection and promoting tissue healing. This study assesses the effectiveness of PELNAC in treating a range of partial finger defects.
Methods: We assessed PELNAC's morphology and microstructure using scanning electron microscopy, characterized its degradation profile over six weeks in simulated body fluid, and confirmed its cytocompatibility with L929 cell cultures. In the clinical setting, 47 patients with 56 partial finger defects (both superficial and deep) were treated using PELNAC alone. Outcome measures included wound closure time, range of motion (ROM), sensory recovery (two-point discrimination), Vancouver Scar Scale (VSS) scores, and patient satisfaction.
Results: Scanning electron microscopy revealed interconnected micropores in PELNAC, with a porosity of 81.3 ± 2.1% and aperture sizes of 40-70 µm (top view) and 60-100 µm (section view). After six weeks in simulated body fluid, PELNAC retained 86.4 ± 1.5% of its weight, and cells proliferated well on its surface. All treated wounds healed without the need for split-thickness skin grafts, with an average closure time of 58.7 ± 12.8 days (range: 30-84 days). Age showed weak positive correlation with healing time (r = 0.152, p < 0.01) and weak negative correlation with two-point discrimination (r = -0.55, p < 0.01). Longer healing times correlated with reduced ROM (r = -0.143, p < 0.01), while higher VSS scores were linked to poorer functional outcomes (r = -0.22, p < 0.01). The average ROM in patients with distal interphalangeal joint (DIPJ) defects was 49° (IQR: 45-56.25°). Sensory recovery averaged 5.95 mm (IQR: 5.175-6.7 mm). The mean VSS score was 2 (IQR: 1-3), indicating minimal scarring. Patient satisfaction was high (functional score: 9 (IQR: 8-9.25)), with no severe complications reported.
Conclusions: This study evaluates the clinical and biomechanical effectiveness of PELNAC as a single-stage reconstructive material for partial finger defects. PELNAC facilitates wound healing without secondary skin grafts, preserving joint mobility, promoting sensory recovery, and minimizing scarring. The results highlight PELNAC as a simple, safe, and effective alternative to traditional approaches, reducing donor site morbidity and eliminating the need for multiple surgeries.
Aim: This study aimed to identify the risk factors for peristomal moisture-associated skin damage (PMASD) in older patients with enterostomies and to develop a predictive model.
Methods: This is a retrospective study. Data were collected from older patients who underwent enterostomy at The Fifth Affiliated Hospital of Wenzhou Medical University in Lishui between January 2021 and December 2022. With peristomal moisture-associated skin damage as the outcome variable, predictors identified as significant in the univariate analysis were incorporated into a multivariate logistic regression model. The model's goodness-of-fit and discriminative ability were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve (AUC). To further evaluate the model's stability and predictive performance, an internal validation was conducted using a time-stratified cohort of 68 patients consecutively recruited from the same hospital between January 2023 and December 2023.
Results: The incidence of PMASD was 42.59% in the model development group (n = 162) and 41.18% in the validation group (n = 68). Independent predictors of PMASD included surgical incision in the stoma baseplate area (odds ratio [OR] = 4.80; 95% confidence interval [CI], 1.04-7.51), ileostomy (OR = 3.49; 95% CI, 1.27-7.99), history of radiotherapy (OR = 1.49; 95% CI, 1.05-2.10), lack of preoperative stoma marking (OR = 5.07; 95% CI, 2.50-8.30), and peristomal skin folds (OR = 3.96; 95% CI, 2.53-16.10), while stoma height ≥1.3 cm (OR = 0.11; 95% CI, 0.04-0.29) and continuity of care (OR = 0.60; 95% CI, 0.45-0.80) were protective factors. The model showed good discrimination (area under the receiver operating characteristic curve [AUC] = 0.90; 95% CI, 0.86-0.95) and calibration (Hosmer-Lemeshow p = 0.851) in the model development group and maintained strong performance in the validation group (AUC = 0.91; Hosmer-Lemeshow p = 0.875).
Conclusions: The validated prediction model demonstrated high discrimination (AUC >0.90) and good calibration, providing an effective tool for the early identification of older patients undergoing enterostomy at high risk of PMASD. This model may guide individualized preventive strategies and optimize the continuity of care. Further multicenter prospective studies are needed to confirm the generalizability and clinical utility of our findings.
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