Pub Date : 2024-07-25DOI: 10.3390/surgeries5030045
E. Clemente, Marcello Della Corte, M. Ferrara, Elisa Cerchia, Massimo Catti, Silvia Garazzino, Simona Gerocarni Nappo, Stefano Bonora
Urinary tract infections (UTIs) are the most common bacterial infections in children, occurring both in children with normal urinary tracts and in ones with urinary tract abnormalities. Children with UTIs can present relevant clinical symptoms and risk long-term consequences. Current recommended preventive measures include chemoprophylaxis and dietary supplements such as cranberry, probiotics and vitamins A and E. Although chemoprophylaxis still represents the gold standard, it raises concerns about antimicrobial resistance. N-acetylcysteine (NAC), a precursor of the antioxidant glutathione, has been proven both to inhibit biofilm formation and to destroy developed biofilms. In adults, NAC has been demonstrated to prevent UTIs and to improve the effect of antibiotics, but so far it has not been analyzed as an antimicrobial option for pediatric UTIs. In this work, we aim to discuss the current applications of NAC in adult urology and its future possible evolutions in pediatric urology.
尿路感染（UTI）是儿童最常见的细菌感染，既发生在尿路正常的儿童身上，也发生在尿路异常的儿童身上。患尿路感染的儿童会出现相关的临床症状，并有可能造成长期后果。目前推荐的预防措施包括化学预防以及蔓越莓、益生菌、维生素 A 和 E 等膳食补充剂。虽然化学预防仍是金标准，但它引发了对抗菌素耐药性的担忧。N- 乙酰半胱氨酸（NAC）是抗氧化剂谷胱甘肽的前体，已被证实可以抑制生物膜的形成并破坏已形成的生物膜。在成人中，NAC 已被证明可以预防 UTI 并改善抗生素的效果，但迄今为止，还没有将其作为一种抗菌剂用于分析小儿 UTI。在这项工作中，我们旨在讨论 NAC 目前在成人泌尿科中的应用及其未来在儿科泌尿科中的可能发展。
{"title":"N-Acetylcysteine’s Potential Role in Prophylaxis and Treatment of Pediatric Urinary Tract Infections: From Evidence to Patient-Side Research","authors":"E. Clemente, Marcello Della Corte, M. Ferrara, Elisa Cerchia, Massimo Catti, Silvia Garazzino, Simona Gerocarni Nappo, Stefano Bonora","doi":"10.3390/surgeries5030045","DOIUrl":"https://doi.org/10.3390/surgeries5030045","url":null,"abstract":"Urinary tract infections (UTIs) are the most common bacterial infections in children, occurring both in children with normal urinary tracts and in ones with urinary tract abnormalities. Children with UTIs can present relevant clinical symptoms and risk long-term consequences. Current recommended preventive measures include chemoprophylaxis and dietary supplements such as cranberry, probiotics and vitamins A and E. Although chemoprophylaxis still represents the gold standard, it raises concerns about antimicrobial resistance. N-acetylcysteine (NAC), a precursor of the antioxidant glutathione, has been proven both to inhibit biofilm formation and to destroy developed biofilms. In adults, NAC has been demonstrated to prevent UTIs and to improve the effect of antibiotics, but so far it has not been analyzed as an antimicrobial option for pediatric UTIs. In this work, we aim to discuss the current applications of NAC in adult urology and its future possible evolutions in pediatric urology.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"107 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802263","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}
Pub Date : 2024-07-24DOI: 10.3390/surgeries5030044
S. Izwan, Tanishk Malhotra, Ujvala Vemuru, Michelle Cooper
Laparoscopic cholecystectomy (LC) is the gold standard of treatments for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with transversus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was conducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. An amount of 40 mL of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data, and postoperative opioid use were collected from the medical record. In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05). Optimisation of postoperative pain allows for early recovery, improved patient satisfaction, and improved cost-effectiveness for the health service. With a trend towards multimodal analgesia, the uptake of TAP and RS regional anaesthesia may help to achieve this goal.
{"title":"Transversus Abdominis Plane with Rectus Sheath Blocks Versus Port Site Infiltration of Local Anaesthesia in Emergency Laparoscopic Cholecystectomy—Does It Reduce Postoperative Opiate Requirement? A Pilot Study","authors":"S. Izwan, Tanishk Malhotra, Ujvala Vemuru, Michelle Cooper","doi":"10.3390/surgeries5030044","DOIUrl":"https://doi.org/10.3390/surgeries5030044","url":null,"abstract":"Laparoscopic cholecystectomy (LC) is the gold standard of treatments for symptomatic gallstone disease. The aim of this study is to determine if postoperative opiate use is reduced with transversus abdominus plane (TAP) and rectus sheath (RS) regional anaesthetic blocks compared to port site local anaesthetic (LA) infiltration. A prospective, randomised cohort study was conducted of adult patients who underwent an emergency LC between 25 April 2022 and 25 May 2023. An amount of 40 mL of 0.375% ropivacaine was infiltrated as either TAP and RS blocks or to port sites. Patient demographics, operative data, and postoperative opioid use were collected from the medical record. In total, 138 patients were enrolled in this study: 73 patients allocated to the LA to port sites cohort (52.9%) and 65 patients in the TAP and RS cohort (43.5%). The most common indication for surgery was acute cholecystitis. The average amount of opiate analgesia use was 115.2 mg in the LA group compared to 61.2 mg in the TAP and RS group (p < 0.05). Optimisation of postoperative pain allows for early recovery, improved patient satisfaction, and improved cost-effectiveness for the health service. With a trend towards multimodal analgesia, the uptake of TAP and RS regional anaesthesia may help to achieve this goal.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"93 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808132","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}
Pub Date : 2024-07-15DOI: 10.3390/surgeries5030043
Maria Catarino, Filipe Castro, José Paulo Macedo, Otília Lopes, Jorge Pereira, Pedro Lopes, G. Fernandes
Objective: The goal of this systematic review was to identify the mechanisms associated with the enzymatic degradation of collagen and gelatin biomaterials and the possible associated flaws. Methods: Four databases (PubMed, B-On, Cochrane Library, and ResearchGate) were used for the bibliographic search of articles. The research question was formulated using the PCC method, (P): collagen or gelatin sponges, hydrogels, and scaffolds; concept (C): enzymatic degradation of collagen or gelatin sponges, hydrogels, and scaffolds; and context (C): effect of enzymatic action on degradation time of collagen or gelatin sponges, hydrogels, and scaffolds. The search was contextualized according to PRISMA recommendations. The identification and exclusion of evidence followed the PRISMA criteria, with specific inclusion and exclusion factors being stipulated for the selection of articles. The risk of bias assessment was performed using the QUIN Scale. Results: The initial search was composed of 13,830 articles after removing duplicates; 56 articles followed for the full-text reading; 45 were excluded; then, 11 articles were obtained, constituting the results of this systematic review. All studies evaluated the materials using gravimetric analysis, and collagenases were the proteases used for the degradation solution. The materials tested were as follows: human-like collagen (HLC) hydrogel with microbial transglutaminase (MTGase), gelatin sponges subjected to different types of crosslinking, and collagen scaffolds with different types of crosslinking. The period of analysis varied between 0.25 h and 35 days. It was possible to highlight the lack of uniformity in the protocols used, which varied largely, thus influencing the degradation times. The risk of bias was low in nine studies and medium in two studies. Conclusions: This systematic review identified a gap in the literature, highlighting the absence of in vitro studies using human saliva and a collagenase concentration close to the physiological levels to simulate oral dynamics. However, based on existing literature, the mechanisms associated with collagen enzymatic degradation in collagen and gelatin biomaterials were comprehensively understood, answering the first research question postulated. In response to the second research question, the main shortcomings identified in the laboratory evaluation of mechanisms associated with collagen enzymatic degradation in collagen and gelatin biomaterials included the lack of standardization in degradation test protocols; this limited inter-study comparisons, which increased heterogeneity. Additionally, variations in collagenase concentrations and types influenced collagen degradation rates, and inappropriate evaluation intervals hindered the identification of total degradation time.
{"title":"Mechanisms of Degradation of Collagen or Gelatin Materials (Hemostatic Sponges) in Oral Surgery: A Systematic Review","authors":"Maria Catarino, Filipe Castro, José Paulo Macedo, Otília Lopes, Jorge Pereira, Pedro Lopes, G. Fernandes","doi":"10.3390/surgeries5030043","DOIUrl":"https://doi.org/10.3390/surgeries5030043","url":null,"abstract":"Objective: The goal of this systematic review was to identify the mechanisms associated with the enzymatic degradation of collagen and gelatin biomaterials and the possible associated flaws. Methods: Four databases (PubMed, B-On, Cochrane Library, and ResearchGate) were used for the bibliographic search of articles. The research question was formulated using the PCC method, (P): collagen or gelatin sponges, hydrogels, and scaffolds; concept (C): enzymatic degradation of collagen or gelatin sponges, hydrogels, and scaffolds; and context (C): effect of enzymatic action on degradation time of collagen or gelatin sponges, hydrogels, and scaffolds. The search was contextualized according to PRISMA recommendations. The identification and exclusion of evidence followed the PRISMA criteria, with specific inclusion and exclusion factors being stipulated for the selection of articles. The risk of bias assessment was performed using the QUIN Scale. Results: The initial search was composed of 13,830 articles after removing duplicates; 56 articles followed for the full-text reading; 45 were excluded; then, 11 articles were obtained, constituting the results of this systematic review. All studies evaluated the materials using gravimetric analysis, and collagenases were the proteases used for the degradation solution. The materials tested were as follows: human-like collagen (HLC) hydrogel with microbial transglutaminase (MTGase), gelatin sponges subjected to different types of crosslinking, and collagen scaffolds with different types of crosslinking. The period of analysis varied between 0.25 h and 35 days. It was possible to highlight the lack of uniformity in the protocols used, which varied largely, thus influencing the degradation times. The risk of bias was low in nine studies and medium in two studies. Conclusions: This systematic review identified a gap in the literature, highlighting the absence of in vitro studies using human saliva and a collagenase concentration close to the physiological levels to simulate oral dynamics. However, based on existing literature, the mechanisms associated with collagen enzymatic degradation in collagen and gelatin biomaterials were comprehensively understood, answering the first research question postulated. In response to the second research question, the main shortcomings identified in the laboratory evaluation of mechanisms associated with collagen enzymatic degradation in collagen and gelatin biomaterials included the lack of standardization in degradation test protocols; this limited inter-study comparisons, which increased heterogeneity. Additionally, variations in collagenase concentrations and types influenced collagen degradation rates, and inappropriate evaluation intervals hindered the identification of total degradation time.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"29 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645696","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}
Pub Date : 2024-07-12DOI: 10.3390/surgeries5030042
P. de Leyva, Paula Dios-Díez, Cristina Cárdenas-Serres, Ángela Bueno-de Vicente, Álvaro Ranz-Colio, Eduardo Sánchez-Jáuregui, Fernando Almeida-Parra, Julio Acero-Sanz
Necrotizing fasciitis (NF) is a life-threatening soft-tissue infection affecting the deep fascia and subcutaneous tissue. It is characterized by a fulminant course and high mortality rates. NF of the head and neck is very rare, with most cases being odontogenic in origin. The purpose of this study is to comprehensively review the most important features of cervical necrotizing fasciitis (CNF) in adults and add our experience in the management of this entity. The most common isolated organisms are Streptococcus spp. and Staphylococcus spp. If the infection progresses to descending mediastinitis, the prognosis becomes very poor. Since the initial clinical features can be similar to those of a non-necrotizing deep cervical infection, a high degree of suspicion is critical for an early diagnosis. A computed tomography scan is essential for the diagnosis and to define the extent of the infection/rule out descending mediastinitis. Early and aggressive surgical debridement of all compromised tissue and antibiotic therapy and fluid resuscitation are essential and should not wait for bacterial culture results. Despite prompt and adequate treatment, the mortality of CNF can be as high as 35%.
{"title":"Cervical Necrotizing Fasciitis in Adults: A Life-Threatening Emergency in Oral and Maxillofacial Surgery","authors":"P. de Leyva, Paula Dios-Díez, Cristina Cárdenas-Serres, Ángela Bueno-de Vicente, Álvaro Ranz-Colio, Eduardo Sánchez-Jáuregui, Fernando Almeida-Parra, Julio Acero-Sanz","doi":"10.3390/surgeries5030042","DOIUrl":"https://doi.org/10.3390/surgeries5030042","url":null,"abstract":"Necrotizing fasciitis (NF) is a life-threatening soft-tissue infection affecting the deep fascia and subcutaneous tissue. It is characterized by a fulminant course and high mortality rates. NF of the head and neck is very rare, with most cases being odontogenic in origin. The purpose of this study is to comprehensively review the most important features of cervical necrotizing fasciitis (CNF) in adults and add our experience in the management of this entity. The most common isolated organisms are Streptococcus spp. and Staphylococcus spp. If the infection progresses to descending mediastinitis, the prognosis becomes very poor. Since the initial clinical features can be similar to those of a non-necrotizing deep cervical infection, a high degree of suspicion is critical for an early diagnosis. A computed tomography scan is essential for the diagnosis and to define the extent of the infection/rule out descending mediastinitis. Early and aggressive surgical debridement of all compromised tissue and antibiotic therapy and fluid resuscitation are essential and should not wait for bacterial culture results. Despite prompt and adequate treatment, the mortality of CNF can be as high as 35%.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"46 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654625","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}
Pub Date : 2024-03-12DOI: 10.3390/surgeries5010012
Girolamo Raso, N. Santos, L. Nassani, A. C. Mello-Moura, Juliana Campos Hasse Fernandes, G. Fernandes
This systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition.
{"title":"The Influence of Root Prominence on the Onset of Gingival Recession: A Systematic Review","authors":"Girolamo Raso, N. Santos, L. Nassani, A. C. Mello-Moura, Juliana Campos Hasse Fernandes, G. Fernandes","doi":"10.3390/surgeries5010012","DOIUrl":"https://doi.org/10.3390/surgeries5010012","url":null,"abstract":"This systematic review aimed to identify, evaluate, and summarize the results of relevant studies on radicular prominence and its relationship with gingival recessions. This review was conducted according to the PRISMA (Preferred Reporting Reviews and Meta-Analysis) guidelines, and the focused PICO question was “In teeth with vestibular site-specific root or alveolar bone prominence, what are the chances that this will lead to gingival recession or difficulty in root coverage procedures, compared to teeth correctly positioned in the alveolar bone or without anatomical root prominence?”. A search was carried out on three databases: Embase, PubMed/MedLine, and Wiley Library. This initial search was complemented with manual research. It included any clinical study, such as a randomized clinical trial, controlled clinical trial, prospective/retrospective clinical study, case series, or case report, published in English from January 2012 to December 2023, which reported any involvement of the root/bone prominence approach. The exclusion criteria were clinical studies without report results/details of the case(s), studies based on questionnaires, editorial letters, any review, in vitro/in silica and animal studies, and interviews. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was applied for quality assessment. A total of 163 articles were found, but only three articles were included (k = 0.98). The included studies observed negative correlations when comparing the variables root prominence with linear root coverage, root surface area covered, and linear tissue thickness gain. It suggested a significant reduction in root coverage for prominences greater than 1 mm; therefore, relevant keratinized tissue gains can be achieved in gingival recession treatment after the application of the odontoplasty. The STROBE checklist evaluated 22 items, and all the included studies had a high-quality assessment (greater than 75%) with values greater than 85%. Then, it was not possible to draw conclusions due to the number of articles included, even though they had high-quality assessments. Otherwise, it is possible to suggest that the root prominence may impact gingival recession. Therefore, new and well-designed studies must be developed to establish a significant conclusion about this condition.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"117 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140250747","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}
Pub Date : 2024-03-07DOI: 10.3390/surgeries5010010
Aleksandra Polikarpova, Harinder K. Bains, Samuel R Thomson, Yijun Gao, David L. Morris
Accessory liver lobe is a rare finding, with the most common cases being accessory liver tissue on the gallbladder wall separate from the orthotopic liver. As the incidence of the ectopic liver is low there are only several case reports in published literature that describe similar presentations. We report a case of intrathoracic liver lobe that was connected to the main liver by a thick pedicle. Due to benign presentation, the patient was discharged without any surgical intervention. This case highlights the importance of understanding anatomical variability of internal organs, understanding the risks of torsion and malignant transformation of the accessory liver tissue. The literature review provides an excellent overview of published case series and reports, and outlines current recommendations on imaging, diagnosis, and management.
{"title":"An Incidental Discovery of the Intrathoracic Accessory Liver Lobe in a 72-Year-Old Man: Case Report and Literature Review","authors":"Aleksandra Polikarpova, Harinder K. Bains, Samuel R Thomson, Yijun Gao, David L. Morris","doi":"10.3390/surgeries5010010","DOIUrl":"https://doi.org/10.3390/surgeries5010010","url":null,"abstract":"Accessory liver lobe is a rare finding, with the most common cases being accessory liver tissue on the gallbladder wall separate from the orthotopic liver. As the incidence of the ectopic liver is low there are only several case reports in published literature that describe similar presentations. We report a case of intrathoracic liver lobe that was connected to the main liver by a thick pedicle. Due to benign presentation, the patient was discharged without any surgical intervention. This case highlights the importance of understanding anatomical variability of internal organs, understanding the risks of torsion and malignant transformation of the accessory liver tissue. The literature review provides an excellent overview of published case series and reports, and outlines current recommendations on imaging, diagnosis, and management.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"24 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260673","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}
Pub Date : 2024-01-16DOI: 10.3390/surgeries5010005
Marnix C. L. van den Broek, Jorn H. Buijs, Liselotte F. M. Schmitz, Mathieu M E Wijffels
Artificial intelligence (AI) is a promising tool for diagnosing rib fractures. To date, only a few studies have quantified its performance. The objective of this systematic review was to assess the accuracy of AI as an independent tool for rib fracture detection on CT scans or radiographs. This was defined as the combination of sensitivity and specificity. PubMed (including MEDLINE and PubMed Central) was systematically reviewed according to the PRISMA statement followed by citation searching among studies up to December 2022. Methods of the analysis and inclusion criteria were prespecified in a protocol and published on PROSPERO (CRD42023479590). Only diagnostic studies of independent AI tools for rib fracture detection on CT scans and X-rays reporting on sensitivity and/or specificity and written in English were included. Twelve studies met these criteria, which included 11,510 rib fractures in total. A quality assessment was performed using an altered version of QUADAS-2. Random-effects meta-analyses were performed on the included data. If specificity was not reported, it was calculated on a set of assumptions. Pooled sensitivity and specificity were 0.85 (95% CI, 0.78–0.92) and 0.96 (95% CI, 0.94–0.97), respectively. None of the included studies used X-rays. Thus, it can be concluded that AI is accurate in detecting rib fractures on CT scans. Overall, these findings seemed quite robust, as can be concluded from the study quality assessment, therefore AI could potentially play a substantial role in the future of radiological diagnostics.
人工智能（AI）是诊断肋骨骨折的一种前景广阔的工具。迄今为止，只有少数研究对其性能进行了量化。本系统性综述的目的是评估人工智能作为一种独立工具在 CT 扫描或射线照片上检测肋骨骨折的准确性。其定义为灵敏度和特异性的结合。根据PRISMA声明对PubMed（包括MEDLINE和PubMed Central）进行了系统性回顾，随后对截至2022年12月的研究进行了引文检索。分析方法和纳入标准在协议中预先规定，并发布在 PROSPERO (CRD42023479590) 上。只有对 CT 扫描和 X 光片进行肋骨骨折检测的独立 AI 工具的诊断研究才被纳入，这些研究报告了灵敏度和/或特异性，并且是用英语撰写的。有 12 项研究符合上述标准，共纳入 11,510 例肋骨骨折。研究采用QUADAS-2的改进版进行了质量评估。对纳入的数据进行了随机效应荟萃分析。如果未报告特异性，则根据一组假设计算特异性。汇总灵敏度和特异度分别为 0.85（95% CI，0.78-0.92）和 0.96（95% CI，0.94-0.97）。所纳入的研究均未使用 X 射线。因此，可以得出结论，人工智能能准确检测出 CT 扫描中的肋骨骨折。总之，从研究质量评估中可以得出结论，这些发现似乎相当可靠，因此人工智能有可能在未来的放射诊断中发挥重要作用。
{"title":"Diagnostic Performance of Artificial Intelligence in Rib Fracture Detection: Systematic Review and Meta-Analysis","authors":"Marnix C. L. van den Broek, Jorn H. Buijs, Liselotte F. M. Schmitz, Mathieu M E Wijffels","doi":"10.3390/surgeries5010005","DOIUrl":"https://doi.org/10.3390/surgeries5010005","url":null,"abstract":"Artificial intelligence (AI) is a promising tool for diagnosing rib fractures. To date, only a few studies have quantified its performance. The objective of this systematic review was to assess the accuracy of AI as an independent tool for rib fracture detection on CT scans or radiographs. This was defined as the combination of sensitivity and specificity. PubMed (including MEDLINE and PubMed Central) was systematically reviewed according to the PRISMA statement followed by citation searching among studies up to December 2022. Methods of the analysis and inclusion criteria were prespecified in a protocol and published on PROSPERO (CRD42023479590). Only diagnostic studies of independent AI tools for rib fracture detection on CT scans and X-rays reporting on sensitivity and/or specificity and written in English were included. Twelve studies met these criteria, which included 11,510 rib fractures in total. A quality assessment was performed using an altered version of QUADAS-2. Random-effects meta-analyses were performed on the included data. If specificity was not reported, it was calculated on a set of assumptions. Pooled sensitivity and specificity were 0.85 (95% CI, 0.78–0.92) and 0.96 (95% CI, 0.94–0.97), respectively. None of the included studies used X-rays. Thus, it can be concluded that AI is accurate in detecting rib fractures on CT scans. Overall, these findings seemed quite robust, as can be concluded from the study quality assessment, therefore AI could potentially play a substantial role in the future of radiological diagnostics.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"42 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139528067","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}
Pub Date : 2024-01-16DOI: 10.3390/surgeries5010006
A. Labouchère, W. Raffoul
Online artificial intelligence (AI) tools have recently gained in popularity. So-called “generative AI” chatbots unlock new opportunities to access vast realms of knowledge when being prompted by users. Here, we test the capabilities of two such AIs in order to determine the benefits for plastic surgery while also assessing the potential risks. Future developments are outlined. We used the online portals of OpenAI’s ChatGPT (version 3.5) and Google’s Bard to ask a set of questions and give specific commands. The results provided by the two tools were compared and analyzed by a committee. For professional plastic surgeons, we found that ChatGPT and Bard can be of help when it comes to conducting scientific reviews and helping with scientific writing but are of limited use due to the superficiality of their answers in specific domains. For medical students, in addition to the above, they provide useful educational material with respect to surgical methods and exam preparation. For patients, they can help when it comes to preparing for an intervention, weighing the risks and benefits, while providing guidance on optimal post-operative care. ChatGPT and Bard open widely accessible data to every internet user. While they might create a sense of “magic” due to their chatbot interfaces, they nonetheless can help to increase productivity. For professional surgeons, they produce superficial answers—for now—albeit providing help with scientific writing and literature reviews. For medical students, they are great tools to deepen their knowledge about specific topics such as surgical methods and exam preparation. For patients, they can help in translating complicated medical jargon into understandable lingo and provide support for pre-operative as well as post-operative care. Such AI tools should be used cautiously, as their answers are not always precise or accurate, and should always be used in combination with expert medical guidance.
{"title":"ChatGPT and Bard in Plastic Surgery: Hype or Hope?","authors":"A. Labouchère, W. Raffoul","doi":"10.3390/surgeries5010006","DOIUrl":"https://doi.org/10.3390/surgeries5010006","url":null,"abstract":"Online artificial intelligence (AI) tools have recently gained in popularity. So-called “generative AI” chatbots unlock new opportunities to access vast realms of knowledge when being prompted by users. Here, we test the capabilities of two such AIs in order to determine the benefits for plastic surgery while also assessing the potential risks. Future developments are outlined. We used the online portals of OpenAI’s ChatGPT (version 3.5) and Google’s Bard to ask a set of questions and give specific commands. The results provided by the two tools were compared and analyzed by a committee. For professional plastic surgeons, we found that ChatGPT and Bard can be of help when it comes to conducting scientific reviews and helping with scientific writing but are of limited use due to the superficiality of their answers in specific domains. For medical students, in addition to the above, they provide useful educational material with respect to surgical methods and exam preparation. For patients, they can help when it comes to preparing for an intervention, weighing the risks and benefits, while providing guidance on optimal post-operative care. ChatGPT and Bard open widely accessible data to every internet user. While they might create a sense of “magic” due to their chatbot interfaces, they nonetheless can help to increase productivity. For professional surgeons, they produce superficial answers—for now—albeit providing help with scientific writing and literature reviews. For medical students, they are great tools to deepen their knowledge about specific topics such as surgical methods and exam preparation. For patients, they can help in translating complicated medical jargon into understandable lingo and provide support for pre-operative as well as post-operative care. Such AI tools should be used cautiously, as their answers are not always precise or accurate, and should always be used in combination with expert medical guidance.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139618491","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}
Pub Date : 2024-01-11DOI: 10.3390/surgeries5010004
Kylie A. Limback, Alyssa H. Kendell, M. Motzko, Christopher C. Surek, Jennifer F. Dennis
The supratrochlear artery (STA) demonstrates anatomical variability that impacts facial reconstruction with a paramedian forehead flap. STA branching patterns and the distance to the midline have been reported, but the STA pedicle has not been characterized. Our aim was to triangulate the STA pedicle relative to known anatomical landmarks and identify a danger zone to aid surgeons in creating viable tissue flaps. The upper facial region was dissected bilaterally on 38 cadaveric donors. Measurements from the supraorbital neurovascular bundle, orbital rim, and medial canthus to the STA pedicle were collected. Data were tallied and statistically analyzed. Measurement means, range, and standard deviations were calculated; no significant differences were found in the laterality of the measurements (p > 0.05). Statistically significant, sex-based differences were identified for all measurements collected among male and female donors. This study characterizes a surgical danger zone for the STA pedicle specific to a paramedian forehead flap and identifies important differences within this danger zone among male versus female donors that surgeons should consider to prevent pedicle violation and enhance surgical success while maximizing flap length and mobility.
蝶骨上动脉（STA）在解剖学上的多变性影响了额旁皮瓣的面部重建。STA的分支模式和到中线的距离已有报道，但STA动脉蒂的特征尚未确定。我们的目的是根据已知的解剖标志物对STA蒂部进行三角测量，并确定危险区域，以帮助外科医生创建可行的组织瓣。我们对 38 名尸体捐献者的双侧上面部区域进行了解剖。收集了从眶上神经血管束、眶缘和内侧眦部到 STA 基底节的测量数据。对数据进行统计和分析。计算了测量的平均值、范围和标准偏差；在测量的侧向性方面没有发现显著差异（P > 0.05）。在收集的所有测量数据中，男性和女性捐献者的性别差异具有统计学意义。这项研究描述了STA基底的手术危险区，该危险区是前额旁皮瓣的特有区域，并确定了男性和女性供体在该危险区内的重要差异，外科医生应考虑这些差异，以防止基底侵犯，提高手术成功率，同时最大限度地增加皮瓣的长度和活动度。
{"title":"Danger Zone for Paramedian Forehead Flap Elevation: Maximizing Flap Length and Viability","authors":"Kylie A. Limback, Alyssa H. Kendell, M. Motzko, Christopher C. Surek, Jennifer F. Dennis","doi":"10.3390/surgeries5010004","DOIUrl":"https://doi.org/10.3390/surgeries5010004","url":null,"abstract":"The supratrochlear artery (STA) demonstrates anatomical variability that impacts facial reconstruction with a paramedian forehead flap. STA branching patterns and the distance to the midline have been reported, but the STA pedicle has not been characterized. Our aim was to triangulate the STA pedicle relative to known anatomical landmarks and identify a danger zone to aid surgeons in creating viable tissue flaps. The upper facial region was dissected bilaterally on 38 cadaveric donors. Measurements from the supraorbital neurovascular bundle, orbital rim, and medial canthus to the STA pedicle were collected. Data were tallied and statistically analyzed. Measurement means, range, and standard deviations were calculated; no significant differences were found in the laterality of the measurements (p > 0.05). Statistically significant, sex-based differences were identified for all measurements collected among male and female donors. This study characterizes a surgical danger zone for the STA pedicle specific to a paramedian forehead flap and identifies important differences within this danger zone among male versus female donors that surgeons should consider to prevent pedicle violation and enhance surgical success while maximizing flap length and mobility.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"53 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533638","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}
Pub Date : 2024-01-04DOI: 10.3390/surgeries5010003
Vishnu Bharani, Hannah Sidoti, Michelle B. Titunick
Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava’s junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care.
{"title":"Unique Constellation of Vascular Anomalies in a Female Cadaver: IVC, Renal Vein, and Left Colic Artery Variation","authors":"Vishnu Bharani, Hannah Sidoti, Michelle B. Titunick","doi":"10.3390/surgeries5010003","DOIUrl":"https://doi.org/10.3390/surgeries5010003","url":null,"abstract":"Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava’s junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care.","PeriodicalId":93623,"journal":{"name":"Surgeries","volume":"43 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139385705","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}
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