Transvaginal natural orifice transluminal endoscopic surgery for presacral-uterosacral ligament compound suspension in apical compartment prolapse.

INTRODUCTION AND HYPOTHESIS: We aimed to describe a novel mesh-free pelvic repair surgery for apical prolapse and to evaluate the effect of this technique and early outcomes. METHODS: We demonstrate the key techniques in a video: exposing the anterior longitudinal ligament (ALL) of the presacral space; securing a non-absorbable suture to the ALL by horoscope stitch; shortening the right uterosacral ligament (USL); placing a non-absorbable suture around the intermediate portion of the left USL for three stitches; placing the non-absorbable suture in the transverse portion of the pubocervical and rectovaginal fascia; locking sutures in place to approximate anterior to posterior connective tissue. Fifteen patients were enrolled to undergo this procedure between December 2020 and April 2021. RESULTS: The mean age of the patients was 60.67 (range 46-69) years, the mean body mass index was 24.25 kg/m2 (range 19.61-30.08). The mean operation time was 103.6 min (range 65-166), and the mean blood loss was 82 ml (range 50-200). No intraoperative complications occurred. All patients gained a significant improvement in anatomical and objective outcomes during a mean 9.93-month follow-up, and there was no recurrence. CONCLUSIONS: Our experience showed that this mesh-free repair surgery was a feasible and safe technique for apical prolapse.

Clinical signs to predict the severity of dysphagia in Acute Ischemic Stroke patients.

OBJECTIVES: In the current era, clinicians working in areas with limited and/or without facilities are only able to manage their patients based on clinical signs to detect dysphagia. This study assesses the performance of 5 simple clinical signs for predicting the severity of dysphagia. METHODS: We systematically documented 5 targeted bedside clinical signs within 24 h after admission in 737 consecutive patients with acute stroke. We examined the median onset of each sign and calculated their ratios associated with severe dysphagia. The performance and significance of these special clinical signs were evaluated by further computation. RESULTS: In total, 184 of 737 AIS patients were screened positive dysphagia by the modified V-VST. The 5 targeted bedside clinical signs were differed among the patients with and without dysphagia. Patients with serious dysphagia (n = 61,33.15%) showed higher positive percentages of larynx movement disorders than those classified as moderate (73.77% [60.99%-83.50%] vs 29.27% [21.82%-38.03%], p < 0.001). Logistic regression analyses conducted in the subsets confirmed larynx movement disorders as an independent predictor of dysphagia severity. CONCLUSIONS: Larynx movement disorders is correlated with a higher probability of severe dysphagia as measured by the modified V-VST in AIS patients.