AIM: This study aims to investigate the effects of two medication regimens—labetalol combined with magnesium sulfate versus labetalol alone—on intraoperative blood pressure variability (BPV) and maternal-neonatal outcomes in patients with hypertensive disorders of pregnancy (HDP) undergoing cesarean delivery.METHODS: This retrospective cohort study enrolled 170 HDP patients who underwent cesarean delivery at TongXiang Maternity and Child Health Care Hospital between January 2023 and June 2025. Based on perioperative medication regimens, patients were divided into a combination group (labetalol plus magnesium sulfate, n = 86) and a monotherapy group (labetalol alone, n = 84). After propensity score matching (PSM), a cohort of 54 patients was included in each group for analysis. All patients received oral labetalol for preoperative blood pressure control and postoperative management. Patients in the combination group additionally received intravenous magnesium sulfate. The primary outcome measure was the standard deviation of intraoperative systolic blood pressure (SD of systolic blood pressure (SBP)). Secondary outcomes included intraoperative blood pressure target attainment rate, incidence of severe hypertensive events, and maternal-neonatal complications.RESULTS: After PSM, baseline characteristics were balanced between the two groups. The combination group exhibited a significantly lower intraoperative SD of SBP compared to the monotherapy group (p < 0.001), along with a higher intraoperative blood pressure target attainment rate (p < 0.001) and a lower incidence of severe hypertensive events (p = 0.030). Regarding maternal-neonatal outcomes, the combination group had significantly higher 1‑minute and 5‑minute Apgar scores (p = 0.035 and p = 0.036, respectively) and a lower rate of admission to the neonatal intensive care unit (NICU) (p = 0.002). There were no significant differences between the groups in the incidence of adverse drug events such as hypotension or bradycardia.CONCLUSIONS: For HDP patients undergoing cesarean delivery, the perioperative application of a combined regimen of labetalol and magnesium sulfate, compared with labetalol alone, was associated with more stable intraoperative blood pressure, reduced variability under surgical stress, and improved early neonatal outcomes. This combined regimen provides valuable clinical reference for optimizing perioperative blood pressure management during cesarean delivery.
AIM:Recurrence after haemorrhoid surgery is a clinical concern, but the factors associated with recurrence have not yet been fully elucidated. In particular, the effects of external haemorrhoids and postoperative complications on long-term outcomes have not been clearly defined. This study aimed to identify the factors associated with haemorrhoid recurrence and recurrence-free survival following haemorrhoid surgery. METHODS:This retrospective cohort study included patients who underwent elective haemorrhoid surgery between January 2021 and December 2023 at Dr. Soliman Fakeeh Hospital. We grouped the participants according to their recurrence status. Continuous variables were compared using the Mann-Whitney U test, while categorical variables were analysed using chi-square or Fisher's exact tests, as appropriate. We assessed recurrence-free survival using Kaplan-Meier analysis with log-rank tests. Independent predictors of recurrence were identified using Cox proportional hazards regression analysis. RESULTS:A total of 529 patients were included, with a cumulative recurrence incidence of 4.3% (n = 23). Patients who developed recurrence were younger than those who did not (median age: 33 vs. 37 years, p = 0.025). There were also higher incidences of external haemorrhoids (30.4% vs. 14.0%, p = 0.030) and postoperative complications in the recurrence group (43.5% vs. 11.9%, p < 0.001). Kaplan-Meier analysis demonstrated significantly lower recurrence-free survival among patients who developed postoperative complications (log-rank p = 0.005). Patients with external haemorrhoids showed a trend towards lower recurrence-free survival, but the difference did not reach statistical significance (log-rank p = 0.151). In our multivariable Cox regression analysis, postoperative complications remained independently associated with recurrence risk (hazard ratio [HR] 4.63, 95% confidence interval [CI]: 1.68-12.80, p = 0.003). The association between external haemorrhoids and recurrence risk demonstrated borderline significance (HR 2.55, 95% CI: 0.99-6.60, p = 0.053). CONCLUSIONS:Postoperative complications were independently associated with earlier recurrence and poorer recurrence-free survival following haemorrhoid surgery. There was a trend towards increased recurrence risk in patients with external haemorrhoids, but the association did not remain statistically significant after adjustment. These findings may help identify patients at higher risk of recurrence and support more individualised postoperative follow-up strategies.
AIM: Thyroid dysfunction is common in pregnancy, but its effects on perioperative outcomes in cesarean section remain unclear. This study aimed to investigate the effects of thyroid dysfunction in the third trimester on perioperative hemodynamic stability and early postoperative recovery in women undergoing cesarean section.METHODS: Clinical data from women undergoing elective cesarean section at Yuhuan Second People’s Hospital between January 2023 and December 2025 were retrospectively collected. Propensity score matching (1:2 nearest neighbor matching, caliper 0.1) was used to balance baseline covariates between groups. After matching, 81 cases were included in the thyroid dysfunction group and 162 cases were categorized in the euthyroid group. Intraoperative hemodynamic parameters (hypotension, hypertension, tachycardia, bradycardia, vasopressor use, and maximum decrease in mean arterial pressure (MAP)), postoperative recovery indicators (pain scores, time to bowel function recovery, onset of lactation, higher Edinburgh Postnatal Depression Scale (EPDS) scores, length of hospital stay, and complications), and neonatal outcomes were compared between the two groups.RESULTS: After matching, baseline data were well-balanced between the two groups (all standardized differences <0.1). Compared to the euthyroid group, the thyroid dysfunction group had significantly higher rates of intraoperative hypotension, tachycardia, bradycardia, and vasopressor use (all p < 0.01), along with a greater maximum decrease in MAP (p < 0.001). Postoperative pain scores, time to first flatus and defecation, time to onset of lactation, EPDS scores, and length of hospital stay were significantly increased in the thyroid dysfunction group compared with the euthyroid group (all p < 0.001). No significant difference was found between groups in intraoperative hypertension (p > 0.05). Subgroup analysis showed that the hypothyroidism subgroup had higher rates of intraoperative hypotension (p = 0.042), and longer time to first flatus (p = 0.004); the hyperthyroidism subgroup had a higher rate of tachycardia (p = 0.017). Regarding neonatal outcomes, the 5-minute Apgar score was slightly lower in the thyroid dysfunction group (p < 0.05), but all scores were within the normal range. Neonatal hyperthyroidism occurred in one infant born to a mother with hyperthyroidism.CONCLUSIONS: Thyroid dysfunction was associated with intraoperative hemodynamic instability and delayed early postoperative recovery in cesarean section, with distinct clinical characteristics between hypothyroidism and hyperthyroidism. Perioperative monitoring and management should be enhanced for these patients.
AIM: High-grade gliomas (HGGs) are among the most aggressive brain tumors, including gliosarcoma. This report aims to present a case of gliosarcoma managed in a general non-tertiary hospital and to highlight the systemic barriers that delayed diagnosis and treatment.CASE PRESENTATION: A 53-year-old female was diagnosed with two intra-axial brain lesions and was managed in a general non-tertiary hospital. One lesion was excised and identified as gliosarcoma. Pathological analysis concluded that the excised lesion was World Health Organization (WHO) grade 4 gliosarcoma, isocitrate dehydrogenase (IDH)-wild type, with glial and spindle sarcomatous components, P53 mutation, C228T (c.-124C>T) variant of the telomerase reverse transcriptase (TERT) promoter, and hypermethylated O-6-methylguanine-DNA methyltransferase (MGMT) promoter status. The final diagnosis was concluded as gliosarcoma, WHO grade 4, IDH-wild type.RESULTS: Despite the detailed histopathological and molecular findings, there were delays in radiological imaging, surgical treatment, and possible adjuvant therapy because of several systemic barriers, including initial family opposition and resource-limited conditions. The case also shows the challenges of managing high-grade gliomas in non-tertiary settings and the impact of delayed referral and treatment.CONCLUSIONS: This report highlights the limitations of care in resource-limited settings and the need for stronger referral systems and better access to timely imaging, surgery, and adjuvant treatment to improve outcomes for patients with HGGs. It also suggests that future WHO guidelines for central nervous system tumors may consider adding diagnostic and prognostic parameters relevant to resource-limited settings, rather than relying only on histological entities or using the term “Not Otherwise Specified” when molecular classification is not achievable.
AIM: To evaluate the impact of prophylactic low-dose glucocorticoids on the incidence of postoperative pulmonary complications (PPCs) and perioperative recovery parameters in patients undergoing surgery for type B aortic dissection.METHODS: This retrospective cohort study analyzed 240 patients who underwent type B aortic dissection (TBAD) surgery at Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University from January 2023 to December 2025. Patients were divided into an intervention group (n = 118) receiving a single dose of dexamethasone (5 mg intravenously) after anesthesia induction and a control group (n = 122) receiving standard care. To minimize selection bias, propensity score matching (PSM) was performed using 1:1 nearest neighbor matching with a caliper of 0.2 times the standard deviation of the propensity score. Covariates included age, sex, body mass index, diabetes, smoking history, preoperative C-reactive protein, preoperative PaO2/FiO2 ratio, operative time, intraoperative blood transfusion volume, and surgical procedure (thoracic endovascular aortic repair [TEVAR] vs. open surgery). After matching, 93 well-balanced pairs were obtained. The primary outcome was the incidence of PPCs within 30 days postoperatively. Secondary outcomes included the duration of mechanical ventilation, intensive care unit (ICU) and hospital length of stay, as well as postoperative inflammatory markers (C-reactive protein [CRP], white blood cell [WBC]) and oxygenation (PaO2/FiO2 ratio) at 24 hours.RESULTS: After PSM, baseline characteristics were well balanced between groups, with all standardized mean differences <0.1. The intervention group showed a significantly lower incidence of PPCs compared to the control group (20.43% vs. 34.41%, p = 0.033). The intervention was also associated with significantly shorter mechanical ventilation duration (p = 0.008), ICU stay (p = 0.003), and total hospital stay (p = 0.009). Additionally, the intervention group demonstrated significantly lower postoperative CRP and WBC levels and a higher PaO2/FiO2 ratio at 24 hours (all p < 0.001). No significant differences were observed in safety outcomes including new-onset infection, wound healing impairment, or hyperglycemia.CONCLUSIONS: Prophylactic low-dose glucocorticoids were associated with a lower incidence of PPCs and improved perioperative recovery in patients undergoing TBAD surgery, including shorter ventilation time and the length of hospital stay, attenuated inflammatory response, and better oxygenation. These findings suggest potential clinical benefits with a favorable safety profile, but causality cannot be inferred due to the retrospective design. Therefore, prospective multicenter studies are warranted to validate these results.
AIM: Scenario-based teaching has demonstrated potential in medical education, but its application to comprehensive gynecological laparoscopic training remains limited. This study aimed to evaluate the impact of scenario-based teaching centered on the complete gynecological laparoscopic surgical procedure on resident physicians’ clinical decision-making ability, operative standardization, and training satisfaction.METHODS: This single-center retrospective cohort study included 47 resident physicians who underwent laparoscopic training in the Department of Obstetrics and Gynecology at Zhoukou Central Hospital between April 2021 and April 2025. Based on the training methods implemented during the teaching phase, participants were assigned to a routine training group (n = 23) or a scenario-based training group (n = 24). The routine training group received conventional theoretical instructions and basic laparoscopic simulation training, whereas the scenario-based teaching group additionally participated in scenario-based simulation teaching modules designed around the complete surgical workflow. Following completion of the training program, participants underwent a comprehensive assessment using a closed-book theoretical examination, the Global Assessment of Laparoscopic Skills (GOALS), structured case-based clinical decision-making scoring, and a teaching satisfaction questionnaire. Differences in theoretical knowledge, operative skills, clinical decision-making ability, and satisfaction were compared between the two groups.RESULTS: After training, the theoretical examination scores of the scenario-based teaching group were significantly higher than those of the routine training group (p = 0.047). In the assessment of laparoscopic operative performance, the scenario-based teaching group significantly outperformed the routine training group across all GOALS dimensions (depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy), and total score (all p < 0.05). In terms of clinical decision-making ability, the scenario-based training group achieved higher scores than the routine training group in diagnostic accuracy, surgical plan rationality, and identification of key risk points (p < 0.05), with particularly marked differences observed in surgical plan rationality and key risk point identification (both p < 0.001). Regarding training satisfaction, the scenario-based training group reported significantly higher scores across all six dimensions, including content arrangement rationality, applicability of teaching format, participation in practical activities, perceived improvement in decision-making ability, perceived enhancement in operative skills, and overall satisfaction (all p < 0.05).CONCLUSIONS: Under the conditions of this study, scenario-based teaching centered on the complete gynecological laparoscopic surgical procedure was associated with significant improvements in residents’ acquisition of theoretical knowledge, laparoscopic operative standardization, and clinical decision-making competence. Moreover, trainees reported higher levels of satisfaction with the teaching process. These findings suggest that this teaching model may represent an effective strategy for optimizing standardized training in gynecological laparoscopic residency programs.
AIM: The purpose of this study was to evaluate and analyze the influence of isokinetic muscle strength training combined with early functional exercise on joint function after knee cruciate ligament reconstruction.METHODS: A total of 294 patients undergoing knee cruciate ligament reconstruction from January 2023 to June 2025 were retrospectively selected. Based on different exercise methods, 155 patients who received early functional exercise for 24 weeks were included in a control group (CG), and the other 139 patients receiving isokinetic muscle strength training (starting from the 4th week after surgery) combined with early functional exercise were enrolled as an experimental group (EG). After propensity score matching (PSM), 252 patients were retained for analysis, including 126 cases in the EG and 126 cases in the CG. The primary clinical outcomes encompassed International Knee Documentation Committee Subjective Knee Form (IKDCSKF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) before training (T0) and at 8 weeks (T1), 12 weeks (T2) and 24 weeks (T3) after surgery, and the secondary outcomes included joint range of motion (ROM) and isokinetic muscle strength test results involving extensor peak torque (EPT), flexor peak torque (FPT) and hamstrings/quadriceps (H/Q).RESULTS: Repeated measures analysis of variance (ANOVA) revealed significant group × time interaction effects for both IKDCSKF and KOOS scores (both p < 0.001), indicating different improvement trajectories between the two groups. Significant time effects and group effects were also observed for both outcomes (both p < 0.001). Post hoc analysis with Bonferroni correction demonstrated that the EG group had significantly higher IKDCSKF and KOOS scores than the CG group at T1, T2, and T3 (p < 0.05 or p < 0.001), with more pronounced differences observed at T2 and T3 (all p < 0.001). At T3, EG had higher ROM, EPT, FPT and H/Q than CG (p < 0.001, p < 0.001, p < 0.001, p = 0.001). No significant difference was found in the proportion of patients with normal H/Q between the two groups (χ2 = 0.06, p = 0.798). The β (95% CI) for EG on IKDCSKF score was 4.35 (2.82~5.87), and the β (95% CI) on KOOS score was 5.22 (3.91~6.53).CONCLUSIONS: Isokinetic muscle strength training combined with early functional exercise was associated with greater improvement in joint function and knee flexor and extensor muscle strength in patients undergoing knee cruciate ligament reconstruction. In addition, the intervention protocol may be independently associated with the patient’s joint function.
AIM:To investigate the combined predictive value of systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) for postoperative flap-related complications in patients with stage Ⅲ and Ⅳ pressure injuries undergoing flap repair. METHODS:A single-center retrospective cohort study was conducted. A total of 242 patients with stage Ⅲ and Ⅳ pressure injuries who underwent flap repair between January 2020 and December 2024 were enrolled. Based on postoperative flap-related complications, patients were divided into a non-complication group (n = 181) and a complication group (n = 61). Preoperative clinical data and laboratory parameters were collected, and SII and PNI were calculated. Independent risk factors were identified using univariate and multivariate logistic regression analyses, and a nomogram prediction model was subsequently developed. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive performance of the model. RESULTS:Multivariate analysis demonstrated that PNI (odds ratio (OR) = 0.851, 95% CI: 0.793-0.913), SII (OR = 1.307, 95% CI: 1.143-1.494), and intraoperative blood loss (OR = 2.150, 95% CI: 1.141-4.052) were independent predictors of postoperative flap-related complications. The area under the curve (AUC) of the prediction model based on these three variables was 0.88 (95% CI: 0.83-0.93). The calibration curve demonstrated good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, p = 0.335). CONCLUSIONS:Elevated preoperative SII, reduced preoperative PNI, and increased intraoperative blood loss are independent risk factors for flap-related complications following flap repair in patients with stage Ⅲ and Ⅳ pressure injuries. The prediction model based on these three factors demonstrates good discrimination and calibration, which may facilitate perioperative risk assessment and provide a basis for individualized clinical interventions.
AIM:Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) are established treatments for abdominal aortic aneurysm (AAA). This meta-analysis evaluated 30-day readmission, patient characteristics, postoperative complications, and length of stay after EVAR and OAR, and explored whether 30-day readmission may serve as a surrogate marker of healthcare quality. METHODS:Following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature search of Embase, PubMed, Web of Science, and Cochrane databases was conducted from 1 January 2010 through 31 December 2024. Observational studies reporting 30-day readmission after elective EVAR and OAR were included. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled proportions and comparative effect estimates were calculated using random-effect models. Heterogeneity was assessed using the I2 statistic. Meta-analyses and meta-regression models evaluated associations between patient comorbidities, length of stay (LOS), postoperative complications, and 30-day readmission. RESULTS:Forty-nine studies reported outcomes after EVAR (578,744 patients) and OAR (228,683 patients). In procedure-specific pooled analyses, 30-day readmission rates were 8% after EVAR and 13% after OAR. LOS was shorter after EVAR than after OAR (mean 4.2 vs. 7.4 days; p < 0.001). No significant association was observed between length of stay and 30-day readmission for either OAR (effect estimate 0.0004, 95% CI [-0.0256-0.0265]; p = 0.973) or EVAR (effect estimate 0.0113, 95% CI [-0.0036-0.0262]; p = 0.136). Comorbidities including arterial hypertension, congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease were significant predictors of readmission after both procedures. Study-level meta-regression suggested that postoperative stroke (EVAR), graft-related and cardiac complications, including myocardial infarction (EVAR and OAR), were significantly associated with higher 30-day readmission rates. Sensitivity analyses confirmed the stability of the pooled estimates, and no significant publication bias was detected. Data on 90-day readmission were too heterogeneous for pooled analysis. In direct comparative studies, random-effects meta-analysis showed no significant difference in 30-day readmission between EVAR and OAR (Odds Ratio [OR] 0.91, 95% CI [0.82-1.01]; I2 = 93.8%). CONCLUSIONS:EVAR was associated with lower pooled 30-day readmission rates and shorter hospital stays than OAR. However, direct comparative meta-analysis indicated no significant difference in 30-day readmission rates between procedures. At the study level, readmission was linked to patient comorbidity and postoperative complications, whereas no significant association was observed between length of stay and readmission. Given the observational design, substantial heterogeneity, and potential residual confounding, these findings should be interpreted with caution. Long-term outcomes were not assessed.
AIM: To compare the clinical efficacy and safety of gasless endoscopic radical thyroidectomy via the transaxillary approach versus the subclavicular approach for unilateral cN0 thyroid cancer.METHODS: A total of 415 patients with unilateral cN0 thyroid cancer admitted between January 2022 and May 2025 were retrospectively included. After propensity score matching (PSM), patients were divided into Group A (gasless endoscopic radical thyroidectomy via the transaxillary approach, n = 57) and Group B (gasless endoscopic radical thyroidectomy via the subclavicular approach, n = 57). The clinical outcomes of these two approaches were compared.RESULTS: Group B had significantly shorter operative time, lower postoperative drainage volume, and a higher rate of complete central compartment exposure than Group A (p < 0.05). Repeated-measures analysis of variance (ANOVA) showed significant main effects of time, group, and time-by-group interaction for interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), incision pain scores, parathyroid hormone (PTH), and Quality of Life Questionnaire-Core 30 (QLQ-C30) scores (p < 0.05). Group B had a lower total complication rate and higher aesthetic satisfaction scores at 1 and 3 months postoperatively than Group A (p < 0.001).CONCLUSIONS: Gasless endoscopic radical thyroidectomy via the subclavicular approach demonstrated potential short-term advantages over the transaxillary approach, including shorter operative time, improved central compartment exposure, attenuated inflammatory response, milder early postoperative pain, and more favorable trends in PTH levels and early quality-of-life recovery. However, given the limited 3-month follow-up period, the absence of significant differences in clinical hypocalcemia rates, and the lack of long-term oncological outcomes, these findings should be interpreted with caution.
AIM: Gastroesophageal reflux disease (GERD) is prevalent in the Middle East, with hiatal hernia (HH) reported in nearly 30% of patients with GERD in Saudi Arabia. Management primarily involves lifestyle modifications and proton pump inhibitor therapy; however, patients with persistent symptoms may require surgical intervention. This study sought to establish expert-driven, best-practice recommendations to improve clinical outcomes in the management of HH through a Saudi-led structured expert consensus that also incorporated perspectives from the wider Middle East region.METHODS: A structured expert consensus approach was conducted. A steering group of four experts collaboratively developed and ratified 32 Likert-scale statements encompassing five clinical domains: referral criteria, mesh utilization, risk mitigation, best practices, and guideline requirements. The ratified statements were subsequently distributed through a single-round online survey to surgeons performing HH repair across the Middle East, with a predefined consensus threshold of ≥75% agreement for each statement.RESULTS: A total of 61 responses were analyzed, including 54 (88.5%) from Saudi Arabia and 7 (11.5%) from other Middle Eastern countries (Jordan, Qatar, Kuwait, Egypt, and the United Arab Emirates). Respondents comprised general surgeons (n = 42), thoracic surgeons (n = 8), upper gastrointestinal/bariatric surgeons (n = 8), and other specialists (n = 3). Nearly 40% of respondents had more than 10 years of specialty experience. Of the 32 statements, 31 (96.9%) achieved consensus (≥75%), with only one statement—regarding mesh use for hernias 4–6 cm—not reaching consensus (67%). Based on these findings, nine recommendations were developed addressing referral pathways, diagnostic evaluation, surgical indications, and mesh utilization.CONCLUSIONS: Strong agreement across 31 of 32 statements among predominantly Saudi surgical experts reflects a shared recognition of challenges and areas for improvement in GERD and HH management. These findings provide a foundation for the future development of standardized care pathways for the diagnosis, referral, and surgical management of symptomatic HH, primarily within Saudi Arabia while also informing broader clinical practice across the Middle East.
AIM:Idiopathic macular epiretinal membrane (iERM) induces traction and deformation of the macular retina, significantly impairing function and quality of life. This study aimed to evaluate the predictive value of early postoperative optical coherence tomography (OCT) microstructural changes for visual prognosis in patients undergoing vitrectomy with membrane peeling for iERM. METHODS:A total of 110 patients diagnosed with iERM at Huzhou Aier Eye Hospital between January 2021 and July 2024 were retrospectively enrolled. According to OCT findings, patients were divided into stage I (n = 38), stage II (n = 52), and stage III (n = 20). All patients underwent 23-gauge minimally invasive vitrectomy combined with indocyanine green staining and peeling of the epiretinal membrane and internal limiting membrane. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), choroidal thickness at 1000 μm from the nasal side of the macular fovea (NFCT), and choroidal thickness at 1000 μm from the temporal side of the macular fovea (TFCT) were assessed before surgery and at 1 and 3 months postoperatively. Repeated-measures analysis of variance was used to compare intergroup differences over time, and multivariate logistic regression was performed to identify indicators associated with a favorable visual prognosis. RESULTS:Significant gradient differences were observed among the three groups in CMT, SFCT, NFCT, TFCT, and BCVA, with stage I patients exhibiting significantly lower values than those in stage II and stage III (all p < 0.05). During postoperative follow-up, OCT parameters and visual acuity improved in all groups, with significantly greater improvement in stage I patients compared with stage II or stage III (all p < 0.05). Repeated-measures analysis demonstrated a significant time × group interaction effect for CMT (F = 2.334, p = 0.032), with a greater rate of CMT reduction in stage I patients. At 6 months postoperatively, 71 patients (64.55%) achieved a favorable visual prognosis. Multivariate logistic regression analysis indicated that lower CMT at 1 month postoperatively (OR = 0.98, 95% CI: 0.97-0.99, p < 0.05) was significantly associated with favorable visual outcomes at 6 months. CONCLUSIONS:Postoperative anatomical and functional recovery in iERM patients is stage-dependent. Lower CMT at 1 month after surgery is significantly associated with favorable visual outcomes at 6 months, suggesting its potential value as an early postoperative prognostic indicator. These findings underscore the importance of incorporating early postoperative OCT assessment into clinical follow-up to facilitate individualized prognosis and patient counseling.
AIM:To assess the changes in biochemical indicators of nutritional deficiencies before and after bariatric surgery. METHODS:This retrospective cohort study included 480 adult patients who underwent bariatric surgery between June 2016 and June 2019 at a tertiary care center in Saudi Arabia. Demographic data, comorbidities, and pre- and postoperative biochemical parameters, including hemoglobin, iron profile, Vitamin D, Vitamin B12, albumin, calcium, and parathyroid hormone levels, were extracted from the medical records. These biochemical parameters were used to assess micronutrient status and identify clinically relevant nutritional deficiencies based on established laboratory thresholds. Paired t- and McNemar tests were used to compare the pre- and postoperative values. Statistical significance was set at p < 0.05. RESULTS:We found a high prevalence of pre- and postoperative nutritional deficiencies among patients. The mean hemoglobin decreased from 13.09 to 12.34 g/dL (mean difference -0.75 g/dL; 95% CI -0.89 to -0.61; p < 0.001). We observed a significant association between ferritin and gender pre- and postoperatively, which was lower in women than in men preoperatively and decreased in both sexes postoperatively. The prevalence of 25-hydroxyvitamin D deficiency was 88.0% preoperatively and 72.7% postoperatively in patients with available laboratory data. CONCLUSIONS:A high prevalence of pre- and postoperative nutritional deficiencies was observed among patients undergoing bariatric surgery in Saudi Arabia. Although certain parameters improved after surgery, others remained prevalent or worsened postoperatively. These findings highlight the importance of structured nutritional assessments and regular biochemical monitoring before and after bariatric surgery.
AIM:Postoperative complications following hepatectomy remain common and are closely associated with patient prognosis. Conventional preoperative assessment may not adequately capture perioperative coagulation disturbances, systemic inflammation, and endothelial injury. This study aimed to develop and internally validate a multidimensional preoperative prediction model integrating thromboelastography (TEG)-related parameters with inflammatory and endothelial biomarkers. METHODS:This single-center retrospective cohort study included 195 consecutive patients who underwent elective hepatectomy between March 2022 and May 2025. The cohort was randomly divided into a training set (n = 136) and a validation set (n = 59) at an approximate 7:3 ratio. The primary outcome was the occurrence of Clavien-Dindo grade ≥II complications within 30 days postoperatively. All clinically relevant candidate variables were entered into a least absolute shrinkage and selection operator (LASSO) regression model for feature selection. Variables retained by LASSO were further evaluated before inclusion in the multivariable model. Two multivariable logistic regression models were subsequently constructed: a baseline clinical model (Model 1) and an extended biomarker model (Model 2), which additionally incorporated C-reactive protein (CRP), thrombomodulin (TM), and thromboelastography maximum amplitude (MA). Model discrimination, reclassification, calibration, and potential clinical utility were assessed, and Shapley Additive exPlanations (SHAP) were applied as a supplementary interpretability analysis. RESULTS:A total of 195 patients were included, of whom 56 (28.72%) developed postoperative complications. The final model retained seven predictors: albumin, prothrombin time, portal hypertension, surgical approach, CRP, TM, and MA. Model 2 demonstrated superior discriminative performance compared with Model 1 in the training cohort (area under the curve (AUC) 0.88 vs. 0.74, p = 0.006); a similar advantage was observed in the validation cohort (AUC 0.84 vs. 0.67, p = 0.001). Model 2 also achieved higher net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values in both cohorts. Incremental value analysis indicated that the performance gain of Model 2 was primarily attributable to MA, while CRP and TM provided only limited additional predictive value. Calibration and decision curve analyses further supported the overall performance and potential clinical utility of Model 2. CONCLUSIONS:The extended preoperative prediction model demonstrated superior overall predictive performance compared with the model based solely on conventional clinical indicators. This improvement was driven primarily by MA, while CRP and TM, included as exploratory biomarkers within the extended framework, contributed only modest incremental value. These findings should be considered preliminary and require confirmation in larger multicenter studies with external validation before broader clinical implementation.
AIM:To systematically compare the perioperative safety, early recovery, and mid-term clinical outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in very elderly patients (≥80 years). METHODS:This single-center retrospective study enrolled 62 very elderly patients (≥80 years) undergoing isolated CABG from 2012 to 2022, assigned to on-pump (n = 22) or off-pump (n = 40) groups. Baseline characteristics, intraoperative data, and one-year follow-up outcomes were collected and compared. The primary endpoint was 30-day major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause death, stroke, and myocardial infarction. Secondary endpoints included the individual components of MACCE and key recovery metrics (duration of mechanical ventilation, intensive care unit (ICU) length of stay, and total hospital length of stay). RESULTS:No statistically significant differences were observed between the two groups in perioperative mortality, incidence of major adverse cardiac and cerebrovascular events (including stroke and myocardial infarction), or one-year survival rates (p > 0.05). The off-pump group had significantly shorter median durations of postoperative mechanical ventilation (15 hours vs. 20.5 hours, p = 0.014) and ICU stay (3 days vs. 5 days, p = 0.007) compared to the on-pump group. However, there were no statistically significant differences in median total postoperative hospitalization (14 days vs. 15 days, p = 0.525) or in the time from ICU transfer to discharge (10 days vs. 9.5 days, p = 0.318). Analysis of postoperative complications revealed a high incidence of severe pulmonary inflammation, with no statistically significant difference between the groups. New-onset postoperative stroke was identified as a leading cause of early and mid-term mortality in this population. CONCLUSIONS:In this exploratory retrospective analysis of selected very elderly patients, both on-pump and off-pump CABG demonstrated comparable survival and major adverse event outcomes. Although the off-pump group exhibited a statistically significant signal toward faster early physiological recovery (shorter ventilation and ICU stay), this observation warrants cautious interpretation due to baseline imbalances and should be considered hypothesis-generating rather than definitive. These preliminary findings highlight the need for future risk stratification tools and integrated care pathways, rather than prescribing a specific surgical technique based on recovery speed alone.
AIM:Protecting both bifurcation branches with a single device is challenging when the neck of an intracranial aneurysm is centered at a bifurcation and forms an acute angle. This study aimed to evaluate the efficacy of the bulging technique using a single Neuroform Atlas stent to protect two branches in complex, acute-angled, wide-necked bifurcation aneurysms (WNBAs). METHODS:We retrospectively reviewed patients with complex, acute-angled WNBAs who underwent single stent-assisted coiling using the bulging technique with a Neuroform Atlas stent between August 2020 and July 2024. Technical feasibility, procedure-related complications, and angiographic and functional outcomes were evaluated. RESULTS:A total of 52 eligible patients were enrolled, including 22 (42.3%) with acutely ruptured aneurysms. The bulging technique was successfully implemented in all cases. Initial angiographic assessment demonstrated complete occlusion in 33 (63.5%) cases, neck remnants in 14 (26.9%) cases, and residual aneurysms in 5 (9.6%) cases. Angiographic follow-up was available for 48 (92.3%) patients, with a median follow-up duration of 6.4 months. Follow-up angiography demonstrated complete occlusion in 42 (87.5%) patients and neck remnants in 6 (12.5%) patients. Procedure-related complications occurred in 2 (3.8%) patients and consisted of ischemic events. Favorable functional outcomes (modified Rankin Scale score, 0-2) were achieved in 48 (92.3%) patients during follow-up. No cases of permanent procedure-related morbidity or mortality were observed. CONCLUSIONS:The bulging technique using a single Neuroform Atlas stent appears to be a feasible and safe treatment for complex, acute-angled WNBAs, with satisfactory short-term angiographic and clinical outcomes. However, further studies with longer follow-up durations are warranted to establish its long-term efficacy.
AIM:This study comparatively evaluates the efficacy and safety of contouring-assisted resection versus traditional fistula tract excision in the crus of helix cartilage region for the treatment of congenital preauricular fistula (CPF). METHODS:This retrospective cohort study recruited 198 CPF patients who underwent surgical treatment at Ruijin Hospital between January 2018 and June 2024. Based on surgical technique, patients were divided into a contouring group (n = 98), who underwent contouring-assisted resection involving systematic dissection along the anterior and deep surfaces of the crus of helix cartilage while preserving the cartilage framework, and a traditional surgery group (n = 100), who underwent conventional fistula tract identification and excision. Baseline characteristics, recurrence rate, operative time, postoperative complications, and patient satisfaction were statistically compared between the two groups. RESULTS:The recurrence rate was significantly lower in the contouring group than in the traditional group (2.0% vs. 18.0%, p < 0.001). Patients in the contouring group experienced significantly longer operative time (p < 0.001), while intraoperative blood loss did not differ significantly between groups. The overall complication rate was significantly lower in the contouring group (4.1% vs. 20.0%, p < 0.001), with a particularly reduced rate of incision-related infection in this group (1.0% vs. 8.0%, p = 0.044). Patient satisfaction scores were significantly higher in the contouring group (p < 0.001). CONCLUSIONS:The contouring-assisted resection approach was associated with a significantly lower recurrence rate and higher patient satisfaction compared with traditional fistula tract excision, without an increase in specific complications such as chondritis, hematoma requiring intervention, or persistent sensory abnormality. These observations suggest this method is an effective and safe surgical option for patients with CPF in the crus of the helix region.
