Variations in morphology of cystic artery: systematic review and meta-analysis.

Background: Variations in cystic artery anatomy are not unusual in occurrence, hence considerably crucial during hepatobiliary surgical planning and execution. This systematic review and meta-analysis of the anatomical variations of cystic artery (CA) was undertaken to emphasize their significance in surgical practice. Methods: The PICO model was adopted, both MeSH term and free keywords were utilized for the search strategy. The risk of bias in each study was calculated by the anatomy quality assurance (AQUA) tool. Result: The search strategy identified 8204 records, extracted 5529 studies, and evaluated 117 abstracts. Out of these 117 studies, 53 met the eligibility criteria. The CA was absent in 2% of instances (95% CI: 0.01-0.04), indicating that 98% of cases had the CA. In 10071 participants from 29 investigations, double cystic arteries were found in 13% (95% CI: 11-16%), with significant heterogeneity (I2 = 91%). In 46 studies with a total of 9928 participants, 89% of the individuals had CA originating from RHA (95% CI: 85%-92%) with significant heterogeneity (I2=94.3%) and a predictive range of 43%-99%. Conclusion: The cystic artery is primarily derived from the right hepatic artery, followed by aberrant, proper, and left hepatic arteries. It is located anterior to common hepatic ducts and cystic ducts. The mean length and diameter of CA were 20.77 mm and 1.91 mm Short cystic arteries are common (20%) Congenital anomalies like absent and double cystic arteries have low prevalence but must be conside-red during surgery.

A Prospective Randomized Controlled Trial Comparing the Psychological Impact of Traditional Cold Steel Adenoidectomy and Endoscopic-Assisted Cold Steel Adenoidectomy.

Traditional Cold Steel Adenoidectomy (TCSA) and Endoscopic-Assisted Cold Steel Adenoidectomy (EACSA) frequently employ surgical adenoid removal methods. While these techniques effectively treat adenoid- related conditions, their influence on patients' psychological well-being still needs to be more adequately explored. With the increasing focus on the significance of mental well-being in surgical results, this study sought to explore and differentiate the psychological impacts of TCSA and EACSA. The primary objective was to examine and compare anxiety levels between TCSA and EACSA groups. Secondary objectives included evaluating surgical apprehension, post- surgery psychological well-being, procedural satisfaction, postoperative pain, duration until return to daily activities, and occurrence of postoperative complications. In a prospective, randomized controlled trial, 100 patients undergoing adenoidectomy were randomly allocated to the TCSA or EACSA group. The Hospital Anxiety and Depression Scale (HADS) was employed to evaluate anxiety levels at one week, one month, and three months following the surgery. Additional outcomes included surgical apprehension, post-surgery psychological well-being, procedural satisfaction, postoperative pain, time until return to daily activities, and postoperative complications. The EACSA group exhibited significantly lower HADS scores, surgical apprehension scores, and postoperative pain, alongside higher post-surgery psychological well-being scores and procedural satisfaction compared to the TCSA group (p < 0.05). Moreover, the EACSA group had a significantly shorter duration until the return to daily activities (p < 0.05). There were no significant variations found between the groups in terms of either the amount of bleeding during the procedure or the length of the operation. However, the EACSA group demonstrated a lower occurrence of postoperative complications, such as bleeding and infection. The results indicate that EACSA may provide benefits over TCSA in terms of reduced anxiety levels, surgical apprehension, postoperative pain, time until return to daily activities, and enhanced post-surgery psychological well-being and patient satisfaction. These findings could support clinicians in making informed decisions and offering patient counselling when choosing the most appropriate surgical technique based on patients' psychological health. Nevertheless, additional research is required to assess the enduring psychological consequences of these methods.

Anatomical variations and developmental insights of tendons in the first extensor compartment of the hand: Cadaveric study with surgical implications.

Background: Anatomical variations in first extensor compartment play a role in the development of de Quervain's disease. This study delves into the detailed examination of these anatomical variations. Methods: 50 upper limbs (28 male and 22 female) from 25 for-malin-embalmed adult human cadavers were dissected to investigate variations in tendons of first extensor compartment. Results: Accessory tendons to main tendon of abductor pollicis longus (APL) were reported in 49 (98%) cases, with 34% having two accessory tendons, 52% having three, and 12% having four. Terminal ends of these accessory tendons were generally consistent, except in one case where it split into two tendinous bands at insertion site, which was most commonly at base of first metacarpal. Extensor pollicis brevis (EPB) was found as a single tendon in 48 cases, with one case each of duplication and absence. In 19 cases (38%), muscle belly of EPB was fused with that of APL to some extent and it typically inserted at base of the proximal phalanx of the thumb. Average length of muscle belly, tendon, and muscle tendon ratio (MTR) of APL was 15.99±0.62 cm, 5.91±0.76 cm and 2.71 and of EPB was 6.39±0.29 cm, 9.15±0.74 cm and 0.70 respectively. Conclusion: APL variations range from accessory tendons, splitting of tendons to various insertion points. Additionally, length and insertions points of these accessory tendons are key factors in deciding their usability as graft sources for tendon reconstruction and in surgical treatments of conditions like de Quervain's tenosynovitis.

Negligible radiological impact of Indian nuclear power plants on the environment and the public: Findings from a 20-year study.

Nuclear power plants, recognized for their extended operational life, minimal greenhouse gas emissions, and high-power density, are deemed as reliable energy sources. Nonetheless, concerns persist regarding the radioactive discharges from these plants and their potential impact on health and the environment. To comprehend the radiological implications of such releases, this study presents, for the first time, an analysis of radiological data from 7 Indian nuclear power plants (NPPs), collected by Indian environmental survey laboratories (ESL) over the past two decades (2000-2020). This dataset encompasses radioactivity concentrations in the atmospheric, aquatic, and terrestrial environments within a 30 km radius of each NPP, as well as the annual cumulative external gamma doses recorded by environmental thermoluminescence dosimeters (TLDs). The analysis yielded several key findings: (i) Radioactivity concentrations around the NPPs were low and comparable to values measured at other nuclear power plant sites worldwide; (ii) Tritium concentrations in receiving water bodies were <1 % of the internationally recommended limit of 10,000 Bq/l; (iii) The estimated total radiation doses to the public were at most 10 % of the stipulated regulatory dose limit of 1000 µSv and consistently decreased over the study period and (iv) Variations in doses among the NPP sites were primarily attributed to legacy technology used in specific reactors. These results indicate efficient and secure reactor operations and the minimal contribution of Indian nuclear power plants to anthropogenic doses in the country. The findings hold potential significance for reinforcing India's commitment to advancing its nuclear power program.