Anemia and postoperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms

Objective

Anemia is associated with increased cardiac adverse events during the early postoperative period because of high physiologic stress and increased cardiac demand. The aim of this study was to assess the surgical outcomes and prognostic implications of anemia in patients undergoing repair of intact abdominal aortic aneurysms (AAAs).

Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry

BackgroundAdherence to follow-up visits is often unsatisfactory after bariatric surgery.ObjectivesTo identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015–2018).MethodsPatients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45–60, and >60 years).ResultsPatients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m². More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non–insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (P_s < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (P_s < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45–60 years, respectively.ConclusionAlthough challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.     

TikTok browsing for anxiety relief in the preoperative period: A randomized clinical trial

ObjectiveThe purpose of this study was to determine the effect of browsing TikTok for 20 min on patients’ preoperative anxiety.MethodA randomized controlled trial was conducted at the Department of Anesthesiology of The First Affiliated Hospital, Zhejiang University School of Medicine from January 2021 to March 2021. The 80 patients were randomly divided into two groups. The experimental group browsed TikTok for 20 min, but the control group did not. Preoperative anxiety was measured with the help of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and anxiety visual analog test (AVAT). Preoperative anxiety, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were checked before and after 20 min of TikTok browsing. Patient satisfaction with anesthesia was evaluated as the patient entered and exited the operating room.ResultsThe pretest APAIS scores, AVAT scores, vital signs and patient satisfaction were similar in both groups (p > 0.05). Compared with the control group, patient anxiety levels and systolic blood pressure decreased significantly after 20 min of TikTok browsing (p < 0.05), and patient satisfaction with anesthesia was significantly higher (p < 0.05). In the experimental group, after patients browsed TikTok for 20 min, all of the physiological and behavioral variables of anxiety were significantly reduced (p < 0.05).ConclusionsTikTok is a popular, simple, effective, noninvasive and inexpensive method for decreasing preoperative anxiety, and browsing TikTok can lower a patient's blood pressure and heart rate to some extent.     

皮肤高频超声和皮肤镜在基底细胞癌术前精确评估中的应用

【摘要】 目的 探讨超声和皮肤镜在基底细胞癌（BCC）术前精确评估中的价值及其与组织病理复发风险的相关性。方法 收集2016年4月至2018年12月于北京协和医院皮肤科确诊的33例BCC患者的临床数据，分析36处BCC皮损的高频超声及皮肤镜检查结果。根据病理类型将病灶分为高危型和低危型。采用Fisher′s精确检验比较两组间超声和皮肤镜特征是否存在统计学差异，超声和皮肤镜下特征的对应关系通过简单匹配系数进行分析。结果 高危型BCC皮损4处，低危型皮损32处。二组间的超声表现重叠大，形态、边界、内部回声、点状强回声和后方回声两组间差异均无统计学意义（P > 0.05）。但是，24处（75%）低危BCC病灶局限于真皮层内，4处高危病灶均累及皮下组织，二组差异有统计学意义（P = 0.008）。5例BCC皮损，除了临床易于发现的皮损外，超声可发现临床易被忽略的微小病灶或深度不可见的病灶。高危组和低危组BCC的皮肤镜特征差异均无统计学意义。但是，4处高危型BCC均未见轮幅样区域、乳红色无结构区、粟粒样囊肿、粉刺样开口或彩虹模式。超声下皮损内点状强回声与皮肤镜下粟粒样囊肿的简单匹配系数为36.1%，表皮层强回声不连续与皮肤镜下溃疡或糜烂的简单匹配系数为75.0%。结论 皮肤高频超声和皮肤镜可以为术前判定BCC病灶的风险性提供重要信息。皮肤高频超声可显示临床易被忽略的潜在病灶。     

Peritoneal MRI in patients undergoing cytoreductive surgery and HIPEC: History,clinical applications,and implementation

MR imaging provides considerable advantages in the evaluation of patients with peritoneal metastases. A standardized peritoneal MRI protocol, including diffusion-weighted and gadolinium-enhanced sequences, allows an efficient exploration of small peritoneal tumors that are often missed on other imaging tests. In experienced hands, a dedicated reading allows producing a quantitative and qualitative evaluation of lesional localization to better assist surgeons in the selection of candidates for curative surgery by evaluating the possibility of complete resection, and to plan the surgical procedure. Based on a close collaboration between oncologic surgeon and radiologist, MRI provides a powerful tool for accurate preoperative imaging in patients being considered for curative surgery but also in their surveillance to detect an early recurrence.