Comparison of Postoperative outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons. SUMMARY BACKGROUND DATA: It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons. METHODS: We conducted a meta-analysis to compare patients' clinical outcomes-including patients' postoperative mortality, readmission, and complication rates-between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty. RESULTS: A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower post-operative mortality compared with patients treated by male surgeons (8 studies; adjusted odds ratio [aOR], 0.93; 95%CI, 0.88 - 0.97; I2=27%; moderate certainty of the evidence). We found a similar pattern for both elective and non-elective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P=0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95%CI, 0.83 - 1.74; I2=92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95%CI, 0.88 - 1.01: I2=38%; very low certainty of the evidence). CONCLUSIONS: This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.

Changes in mandibular position during midface distraction in patients with syndromic craniosynostosis.

The purpose of this study was to evaluate changes in mandibular position during midface distraction. Midface distraction was performed in patients with syndromic craniosynostosis to increase upper airway volume. Although this treatment resulted in changes in occlusion, the concomitant changes in mandibular position were poorly understood. In this retrospective study, three-dimensional (3D) cephalograms were obtained before and after midface distraction in 15 patients with syndromic craniosynostosis. Perioperative polysomnography scores and changes in maxillary and mandibular position, mandibular volume, and upper airway volume were analyzed. Results showed a significant improvement in apnea-hypopnea index (AHI) (from 20.6 ± 21.3 to 6.9 ± 5.1, p < 0.05) and upper airway volume (from 2951.65 ± 2286.38 to 5218.04 ± 3150.05 mm3, p < 0.001). When the lowest point of the sella turcica was set as the reference point, the mandible moved significantly in an anterior direction (from 47.9 ± 11.5 to 51.9 ± 9.8 mm, p < 0.05). Mandibular volume did not change significantly perioperatively (from 32530.19 ± 10726.01 to 35590.50 ± 14879.21 mm3, p = 0.10). There were positive correlations between the rates of improvement in AHI and the amount of mandibular movement in the anterior and inferior directions (both p < 0.05). Within the limitations of the study, it seems that the mandible moved in the anterior-inferior direction after midface distraction, and the amount of movement correlated with improvement in respiratory function. Therefore, it is important to consider the position of the mandible when determining the direction of midface distraction, as it may influence the therapeutic effect.

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study.

Aim: The incidence and characteristics of thiopental-related adverse events (AEs) in elderly patients during procedural sedation and analgesia (PSA) have not been well studied. We aimed to characterize thiopental-related AE in elderly patients during PSA and compare the incidence of AE in elderly patients with non-elderly adults. Methods: This is a secondary analysis of the Japanese Procedural Sedation and Analgesia Registry (JPSTAR). We included all adult patients who received thiopental for PSA in the emergency departments and excluded patients who received concomitant sedative(s) in addition to thiopental or patients with missing body weight data. We compared the incidence of AE between the non-elderly (18-64 years) and elderly groups (≥65 years). Results: The JPSTAR had data on 379 patients who received thiopental for PSA and included 311 patients for analysis. Most (222/311, 71.3%) were elderly. Cardioversion was the most common reason for PSA (96.1%). The AE incidence between groups overall was similar, however, hypoxia was significantly more frequent in the elderly compared with the non-elderly group (10.3% versus 2.2%; adjusted odds 5.63, 95% confidence interval 1.27-25.0). The initial and total doses of thiopental were significantly lower in the elderly group than in the non-elderly group (1.95 mg/kg versus 2.21 mg/kg and 2.33 mg/kg versus 2.93 mg/kg, respectively). Conclusions: Although elderly patients received lower doses of thiopental, hypoxic events were significantly more frequent in this group compared with the non-elderly patients. However, the AE incidence was similar.

Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study.

Aim: Emergency physicians (EPs) often treat anterior shoulder dislocation, but epidemiology of anterior shoulder dislocation in the emergency department of Japan remains unclear. In this study, we clarified the success rate of anterior shoulder reduction performed by EPs. Methods: This single-center cohort study included patients with anterior shoulder dislocation for whom the EP performed initial reduction. The period was from January 2006 to March 2021 and we used the electronic medical record data of the tertiary care hospital. Our primary outcome was the success rate of the shoulder reduction performed by EP. The secondary outcome was to compare the success of reduction with the failure of the reduction. Results: In total, 293 eligible patients were identified. Of these patients, 244 were included in this study. The success rate of the shoulder reduction performed by EP was 92.2% (225/244). EPs failed in successfully performing reduction in 19 (7.8%) cases of anterior shoulder dislocations. The failure group was older (P = 0.017), had a higher frequency of fall down in the mechanism of dislocation (P = 0.019), used intravenous analgesics more frequently (P = 0.004), used peripheral nerve blocks more frequently (P = 0.006), and had fewer patients who did not use drugs (P = 0.002). We could not perform statical adjustment because the sample size was small. Conclusion: The success rate of the shoulder reduction performed by EPs was 92.2%. Older age might be associated with failure of shoulder reduction.

Thickness Measurement at High Lift-Off for Underwater Corroded Iron-Steel Structures Using a Magnetic Sensor Probe.

Infrastructure facilities that were built approximately half a century ago have rapidly aged. Steel sheet piles, the inspection object in this study, are severely corroded, resulting in cave-in damages at wharfs. To solve such a problem, non-destructive inspection techniques are required. We previously demonstrated plate thickness measurement using extremely low-frequency eddy current testing. However, when the steel sheet piles are located in water, shellfish adhere to their surface, causing a lift-off of several tens of millimeters. Therefore, this large lift-off hinders the thickness measurement owing to fluctuations of magnetic signals. In this study, sensor probes with different coil diameters were prototyped and the optimum size for measuring steel sheet piles at high lift-off was investigated. Using the probes, the magnetic field was applied with a lift-off range from 0 to 80 mm, and the intensity and phase of the detected magnetic field were analyzed. Subsequently, by increasing the probe diameter, a good sensitivity was obtained for the thickness estimation with a lift-off of up to 60 mm. Moreover, these probes were used to measure the thickness of actual steel sheet piles, and measurements were successfully obtained at a high lift-off.

Absence of calvarial fracture could predict the need for tracheostomy in traumatic brain injury.

AIM: Tracheostomy is a common procedure for intubated patients with traumatic brain injury (TBI) in the intensive care unit (ICU) but optimal timing and the predictors of tracheostomy are still unclear. The aim of our study was to explore whether the traumatic variables of head injury predict the need for tracheostomy in intubated TBI patients. METHODS: A single-center, retrospective observational study including a series of TBI patients admitted to Fukui Prefectural Hospital from April 1, 2004 to March 31, 2020 was carried out. Our primary outcome was tracheostomy. Patients with TBI who were intubated and admitted into the ICU within 24 h after injury were enrolled. Exclusion criteria were age less than 18 years, pregnancy, mortality within 24 h, post-cardiac arrest syndrome, and patients for whom life-sustaining interventions were withheld. Radiologic images were also reviewed and the morphology of the head injury was categorized. RESULTS: Seventy-six patients were included. Forty-six patients (60.5%) underwent tracheostomy and 30 patients (39.5%) were successfully extubated. Calvarial fracture (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.13-0.88; P = 0.03), Injury Severity Score (OR 1.07; 95% CI, 1.00-1.15; P = 0.04), and Glasgow Comas Scale score (OR 0.84; 95% CI, 0.73-0.96) were statistically significant in the univariable analysis. Multivariate logistic regression identified calvarial fracture as an independent predictor for tracheostomy. The model involving calvarial fracture, Injury Severity Score ≥16, and Glasgow Coma Scale score ≤8 showed the area under the receiver operating characteristic curve for the model was 0.737 (95% CI, 0.629-0.846). CONCLUSIONS: The absence of calvarial fracture could predict the necessity for tracheostomy in intubated TBI patients when combined with other factors. Further prospective randomized trials are necessary to confirm the findings.

Point-of-care procalcitonin may predict the need for surgical treatment in patients with small bowel obstruction.

BACKGROUND: The early identification of patients with small bowel obstruction who require surgical treatment could potentially lead to improved patient outcomes. We evaluated the efficacy of point-of-care procalcitonin for predicting surgical treatment among patients with small bowel obstruction. METHODS: This was a prospective observational study. We measured serum procalcitonin levels in patients who presented to the emergency department and were diagnosed with small bowel obstruction from April 1, 2018 through March 31, 2019. Patients were grouped into two groups: the elevated procalcitonin and normal procalcitonin groups. Our primary outcome was surgical treatment. RESULTS: A total of 53 patients with small bowel obstruction were included in the study, and 11 patients (20.8%) were treated operatively. Baseline characteristics were similar, except for age, between the elevated procalcitonin (≥0.12 ng/ml) and normal procalcitonin groups. The elevated procalcitonin level was significantly correlated with surgical treatment and hospital length of stay (p < 0.05). The sensitivity, specificity, and positive likelihood of procalcitonin for the former were 45.5%, 85.7%, and 5.0 respectively. CONCLUSION: The patients with small bowel obstruction who had elevated procalcitonin levels on presentation showed significantly higher rate of surgical treatment than those who had normal procalcitonin levels. Point-of-care procalcitonin might predict the need for surgical treatment in patients with small bowel obstruction and could be used as an additional diagnostic test. Further studies with more patients are needed to investigate the predictive value of point-of-care procalcitonin for surgical treatment.

Reconstruction of the pelvis after traumatically induced bilateral partial hemipelvectomy: a case report.

BACKGROUND: Traumatic hemipelvectomy is a catastrophic fracture of the pelvis as a result of high-energy trauma, such as in a car accident. There have been few case reports of traumatic hemipelvectomy because many of these patients die before they are transferred to a hospital. However, an increasing number of patients are being saved and admitted to hospital due to improvements in resuscitation and the emergency response system. Accordingly, there has been a growing body of reports on the management and reconstruction of traumatic hemipelvectomy. CASE PRESENTATION: A healthy 20-year-old Japanese man was trapped beneath a 3-ton steel frame while working on a crane. We describe here a very challenging case of traumatically induced bilateral partial hemipelvectomy with successful reconstruction of our patient's pelvis using a unilateral anterolateral thigh flap. CONCLUSION: To the best of our knowledge, there have been few reports of bilateral hemipelvectomy and our case is the first to be successfully treated with a unilateral anterolateral thigh flap.

Extraction Method of Crack Signal for Inspection of Complicated Steel Structures Using A Dual-Channel Magnetic Sensor.

Conventional eddy current testing (ECT) using a pickup coil probe is widely employed for the detection of structural cracks. However, the inspection of conventional ECT for steel structures is difficult because of the magnetic noise caused by the nonuniform permeability of steel. To combat this challenge, we have developed a small magnetic sensor probe with a dual-channel tunneling magnetoresistance sensor that is capable of reducing magnetic noise. Applying this probe to a complicated component of steel structures-such as the welds joining a U-shaped rib and deck plate together-requires the reduction of signal fluctuation caused by the distance (liftoff) variations between the sensor probe and the subject. In this study, the fundamental crack signal and the liftoff signal were investigated with the dual-channel sensor. The results showed that the liftoff signals could be reduced and differentiated from the crack signals by the differential parameters of the dual-channel sensor. In addition, we proposed an extraction technique for the crack signal using the Lissajous curve of the differential parameters. The extraction technique could be applied to the inspections not only for flat plates but also for welded angles to detect cracks without the influence of the liftoff signal.

Combination of meshed dermis graft and cultured epithelial autograft for massive burns: Three case reports.

RATIONALE: This study reviewed the use of a combination of meshed dermis graft and cultured epithelial autografts (CEA) made in Japan "JACE" (JACE; Japan Tissue Engineering Co., Ltd. Japan) for the treatment of massively burns. JACE is a Green-type CEA. We recently described a method in which we prepare the wound bed for burned patients by using artificial dermis and graft with JACE on a meshed 6:1 split-thickness autograft. In this report, we used a meshed 3:1 split-thickness dermis graft without epithelial cells. There are several reports of combination of using CEA on meshed split-thickness autograft, however this is the first report of using CEA on meshed split-thickness dermis graft. PATIENT CONCERNS AND DIAGNOSIS: Between March 2015 and August 2017, 3 burn patients were enrolled in this study. The patients ranged in age from 51 to 66 years. All 3 patients suffered severe burn injury that caused by flame. % Total Body Surface Area (TBSA) burned were ranged from 37.5% to 69%. INTERVENTIONS: All patients received surgical treatment with tangential excision within a week from admission. We implanted artificial dermis immediately after debridement. Basically, we applied meshed 6:1 split-thickness autografts to the wound bed and covered with JACE. However, in the absence of split-thickness autografts, we used a meshed 3:1 split-thickness dermis graft instead of a meshed 6:1 split-thickness autograft. OUTCOMES: At 3 weeks after the transplantation of JACE, the take rate for JACE sheets was >60% on the meshed 3:1 split-thickness dermis graft. Furthermore, almost all of the burn wounds had healed at 6 weeks after surgery. LESSONS: We observed good results by grafting JACE on meshed 3:1 dermis graft. With this new method, it is possible to cover a large burn wound by harvesting tissue from only a small site.

DANFIN functions as an inhibitor of transcription factor NF-κB and potentiates the antitumor effect of bortezomib in multiple myeloma.

Nuclear factor-κB (NF-κB) proteins are transcription factors that play key roles in regulating most immune responses and cell death. Constitutively active NF-κB has been shown to exhibit chemoresistance by inducing anti-apoptosis in tumor cells. Multiple myeloma is known as a constitutive NF-κB activating disease, and the proteasome inhibitor bortezomib is used to treat multiple myeloma and mantle cell lymphoma. We demonstrate here that DANFIN (N,N'-bis-(2,4-dimethyl-phenyl)-ethane-1,2-diamine) functions as an inhibitor of the p65 family proteins and induces chemosensitization to bortezomib in multiple myeloma. DANFIN was found to be an inhibitor of interactions between p65 and IκBα without the inhibition of the DNA binding activity of the p65 protein. In addition, DANFIN affected the IκBα binding region in Rel Homology Domain (RHD) and suppressed the nuclear translocalization of the p65 protein in cells. Furthermore, in multiple myeloma cells, DANFIN suppressed the expression level of NF-κB target genes and induced apoptosis. The combination therapy of DANFIN with bortezomib dramatically enhanced the apoptosis of multiple myeloma cells and indicated a remarkable anti-tumor effect in a multiple-myeloma xenograft mouse model.

Changes in the Dermal Structure during Cultured Epidermal Autograft Engraftment Process.

The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE). METHODS: We undertook a skin biopsy at 2, 4, and 6 weeks after transplantation with JACE. By using electron microscopy we observed the engraftment process. RESULTS: In transmission electron microscope findings, we recognized the engraftment process of JACE. Keratinocytes matured gradually. Collagen fibers formed thick bundles in the dermis layer. In scanning electron microscope findings, we observed papillary dermis development on the artificial dermis. CONCLUSIONS: After managing wound bed preparation by using artificial dermis, we were able to recognize the good result of grafting JACE on meshed 6:1 split thickness autografts. This is because the auto dermis from autograft extended under the JACE, binding between JACE, and the dermis became strong.

Experience of using cultured epithelial autografts for the extensive burn wounds in eight patients.

UNLABELLED: In Japan, the cultured epithelial autografts "JACE" was accepted as a health insurance adaptation from January 1, 2009. We examined the extensive burn wounds in 8 patients by using a combination of autograft and JACE. After debridement, we managed the wound bed preparation by using artificial dermis. The wound bed was covered with fine tissue 2 weeks after we implanted artificial dermis and trafermin was used every day. Meshed 6:1 split-thickness autografts were placed onto the recipient wound bed under the JACE. The epidermalization was nearly complete within 3 to 4 weeks. RESULTS: A total of 39 patients underwent medical treatment of burns. All patients burned more than 30% total body surface area (TBSA). We divided them into 2 groups. The control group consisted of 31 patient, 23 men and 8 women. They underwent operation not using JACE but only autograft. The average age of the patients was 59.61 (3.85) years. The TBSA burned in this control group was 58.94% (3.89%). Operation times were 2.16 (0.24) hours. The overall survival rate was 35.5%. The study group consisted of 8 patients, 5 men and 3 women. The average age of the patients was 56.38 (7.04) years. The TBSA burned in this study group was 51.63% (4.17%). Operation times were 4.25 (0.59) hours, and the overall survival rate in this study group was 87.5%. The average take rate of JACE was 80.0% (3.09%) 4 weeks postoperatively. CONCLUSIONS: JACE is one of the cultured epithelial autografts. Although we managed the wound bed preparation by using artificial dermis instead of cryopreserved cadaver allograft, we were able to recognize a good result from grafting JACE on meshed 6:1 split-thickness autografts. The study group observed a significant difference in operation times compared with the control group. However, this treatment contributed to reducing the area of the donor site.

Changes in the blood flow of the femoral artery by botulinum toxin A in rats.

We examined the changes in blood flow in the femoral artery caused by botulinum toxin A in rats. Blood flow was measured using laser Doppler flowmetry. We used male Sprague-Dawley-derived rats weighing between 350 and 400 g. The study was performed on 6 groups; each of them consisted of 30 rats (control and botulinum toxin A 0.5, 1, 2, 4, and 8 units). The laser Doppler flowmetry revealed that blood flow in the femoral artery increased by the third day in the groups injected with 1 or more units of botulinum toxin A. In the groups injected with 8 units of botulinum toxin A, we recognized an increase of blood flow from the second day. Our results suggest that botulinum toxin A is concerned in improving blood flow.

Surgical treatment of facial fracture by using unsintered hydroxyapatite particles/poly l-lactide composite device (OSTEOTRANS MX(®)): a clinical study on 17 cases.

BACKGROUND: In Japan we currently use absorption properties for facial fractures. OSTEOTRANS MX(®) (Takiron co., ltd, Japan) is an absorption device, which is called Super FIXSORB MX(®) in Japan. This absorbable osteosynthetic device constitutes unsintered hydroxyapatite particles/poly l-lactide (u-HA/PLLA) composites. This study focuses on reporting clinical cases of using OSTEOTRANS MX(®). MATERIALS AND METHODS: Seventeen patients (16 men and 1 woman) aged 10-80 years (mean: 39.9 years, SD: ±20.7) with 86 fracture sites were treated. In all cases we used 1.0 mm plates and 5 mm or 7 mm screws. The postoperative observation period was 6-60 months (mean: 21.8 months, SD: ±14.5). RESULTS: The fracture site recovered in all cases. Complications included one bone excess on the forehead and one foreign-body reaction on the frontozygomatic suture, but the fracture sites were recovered and had no problems. In the case with the longest observation time 60 months, the plate was almost fully absorbed. However, in other cases the plate was not fully absorbed because of a shorter observation time. CONCLUSION: OSTEOTRANS MX(®) is a useful device because of its suitable intensity, thinness, radiopaque, and few complications. A longer observation time is required for a plate to be absorbed completely.

Acute pancreatitis in a patient treated with micafungin.

CASE SUMMARY: A 73-year-old man (height, 158.2 cm; weight, 49.8 kg) presented with upper abdominal tenderness after 3 weeks of treatment with 150 mg/d of micafungin (3 mg/kg . d) (Mycamine, Astellas Pharma US Inc., Deerfield, Illinois) intravenously for pulmonary aspergillosis accompanied by [DOSAGE ERROR CORRECTED] pulmonary Mycobacterium avium complex (MAC) infection. Pulmonary aspergillosis was noninvasively diagnosed by a fungus lump in a cavity in the right upper lung field with a high value of 1,3-beta-D-glucan and a positive result for aspergillosis antigen. The patient had a medical history of gastrectomy due to gastric cancer and idiopathic thrombocytopenic purpura (ITP). He had been prescribed 800 mg/d of clarithromycin, 400 mg/dL of rifampicin, and 750 mg/d of ethambutol hydrochloride for pulmonary MAC infection for 2 years and 5 mg/d of prednisolone for ITP for 7 years. No traditional or homeopathic medicine had been received/administered. Laboratory tests at the onset of abdominal pain revealed a white blood cell count of 4300/microL with 51% neutrophils. There was no eosinophilia. Platelet count was 15,100/muL, with normal coagulation. Immunoglobulin G and immunoglobulin M were 1720 and 154 mg/dL, respectively. The patient had no history of allergy, biliary tract disease, hyperlipidemia, or hypercalcemia. He did not report alcohol use. The laboratory findings, magnetic resonance imaging, and upper abdominal tenderness were consistent with acute pancreatitis. After cessation of all drugs, his symptoms improved with bowel rest and parenteral nutrition. His laboratory measurements normalized thereafter. All drugs, except micafungin, were readministered for pulmonary MAC infection and ITP, and itraconazole was administered for pulmonary aspergillosis after the recovery from pancreatitis. During 16 months of follow-up, the pancreatitis did not recur. DISCUSSION: We performed a literature search of all available English-language articles published on MEDLINE between January 1966 and January 2007 using the key terms micafungin (text and indexed terms) and pancreatitis (text and indexed terms). Based on the search of MEDLINE, there have been no reports of acute pancreatitis associated with micafungin. The Naranjo adverse drug reaction (ADR) probability scale was used to assess the probability of micafungin-associated acute pancreatitis. A score of 6 was obtained, indicating a probable ADR from micafungin treatment. CONCLUSION: We report a case of acute pancreatitis probably associated with micafungin use in an elderly patient.