Learning Curve in Left Ventricular Assist Device Implantation: Low Volumes Do Not Equate Bad Outcomes

ABSTRACT Introduction: Most implantations of left ventricular assist devices (LVAD) are performed in low-volume centers. This study aimed to evaluate the procedural learning curve of HeartMate II (HM2) implantations by comparing outcomes between two time periods in a low-volume center. Methods: All 51 consecutive patients undergoing HM2 implantation between January 2009 and December 2017 were reviewed and allocated into 2 groups: early-era group (from 2009 to 2014; n=25) and late-era group (from 2015 to 2017; n=26). The primary outcome was the 90-day mortality rate, and the secondary outcome was a composite of mortality, neurological event, reoperation for bleeding, need for temporary right ventricular assist device, and pump thrombosis at 90 days. Median follow-up time was 51 months (0-136). A cumulative sum (CUSUM) control analysis was used to establish a threshold of implantations that optimizes outcomes. Results: Patients in the early era had a higher rate of diabetes, previous stroke, and inotrope support before HM2 implantation. The 90-day mortality rate was not significantly higher in the early era (24% vs. 15%, P=0.43), but the composite endpoint was significantly higher (76% vs. 42%, P=0.01). The CUSUM analysis found a threshold of 23 operations after which the composite endpoint was optimized. Conclusion: Patients undergoing HM2 implantation in a low-volume center have improving outcomes with number of cases and optimized results after a threshold of 23 cases. Significant changes in patient selection, surgical techniques, and patient management might lead to improved outcomes after LVAD implantation.

Knock-down the expression of TaH2B-7D using virus-induced gene silencing reduces wheat drought tolerance

BACKGROUND: Drought is a major abiotic stress affecting global wheat (Triticum aestivum L.) production. Exploration of drought-tolerant genes is essential for the genetic improvement of drought tolerance in wheat. Previous studies have shown that some histone encoding genes are involved in plant drought tolerance. However, whether the H2B family genes are involved in drought stress response remains unclear. METHODS: Here, we identified a wheat histone H2B family gene, TaH2B-7D, which was significantly up-regulated under drought stress conditions. Virus-induced gene silencing (VIGS) technology was used to further verify the function of TaH2B-7D in wheat drought tolerance. The phenotypic and physiological changes were examined in the TaH2B-7D knock-down plants. RESULTS: In the TaH2B-7D knock-down plants, relative electrolyte leakage rate and malonaldehyde (MDA) content significantly increased, while relative water content (RWC) and proline content significantly decreased compared with those in the non-knocked-down plants under drought stress conditions. TaH2B-7D knock-down plants exhibited severe sagging, wilting and dwarf phenotypes under drought stress conditions, but not in the non-knocked-down plants, suggesting that the former were more sensitive to drought stress. CONCLUSION: These results indicate that TaH2B-7D potentially plays a vital role in conferring drought tolerance in wheat.

To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy

Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. P. Divya Daniel, D. Anupama. To determine effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy. IAIM, 2017; 4(10): 77-86. Page 78 Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.

Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy.

This case control study was conducted in the department of Gynae & Obstetrics, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH), Dhaka, during the period of January 2008 to December 2008 to compare the length of operation, blood loss, length of hospital stay, drug requirements for pain and post-operative pain and activity levels between Laparoscopically Assisted Vaginal Hysterectomy (LAVH) & Total Abdominal Hysterectomy (TAH). A total of 50 patients who met some eligibility criteria were consecutively included in the study and matched in a case control manner for age, weight, diagnosis & uterine size. The procedures were performed by the same surgeon. On average, LAVH operations took significantly longer than TAH operations (P<0.001). Equal number of patients of both groups (40%) needed blood transfusion. No significant difference about haemoglobin level compared to TAH group on 3rd POD (P=0.246). However total amount of analgesics needed was much higher in the TAH group than that of the LAVH group (243.7 ± 40.3VS 182.1 ± 69.6 mg; P= 0.005) and the total cost of operation was significantly less in the TAH group (4500 ± 500 takas) than in the LAVH group (6500 ± 500 taka) (P<0.001). It was observed that LAVH group produced earlier relief from pain in terms of pain VAS on 3rd POD, (P<0.001). LAVH is less painful, has a shorter length of hospital stay and quicker return to work than TAH. Moreover LAVH does not increase intra or postoperative complications.

Effect of Minimally Invasive Operation on Early Endometrial Carcinoma and Level of Patients' Satisfaction / 中国康复理论与实践

@#Objective To study laparoscopic pelvic lymphyectomy combined with vaginal hystectomy in the treatment of patients with stage Ⅰ endometrial carcinoma.Methods The data of 77 patients with stage Ⅰ endometrial carcinoma were reviewed retrospectively. These patients divided into the laparoscopic group and abdominal group according to the operation style. The operation time, blood loss, postoperation complication, rehabilition of the digestion tract, satisfaction degree to the operation of two groups were compared.Results There was no serious complications in the both groups. In the laparoscopic group, the operation time was longer than the abdominal group ( P<0.01), but so far as to the blood loss, the time of rehabilition of the digestion tract, the number of lymphyectomy, the postoperation pain alleviation and the degree of postoperation depression were superior to the abdominal group ( P<0.01).Conclusion Though the Laparoscopic operation takes longer time than the abdominal operation, it has much more advantage: mimimal blood loss, minimal abdominal scar, rapid postoperation rehabilition, much better pain alleviate, less urine retention.

Comparison of Total Laparoscopic Hysterectomy with Laparoscopic-Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy / 대한산부인과학회지

The objective of this study is to evaluate short-term results of total laparoscopic hysterectomy with those of total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy in a retrospective study. We compared patient's age, mean uterine weight, total operating time, length of hospital stay and perioperative hemoglobin concentration change between total laparoscopic hysterectomy (300 patients) and total abdominal hysterectomy (100 patients) and laparoscopically assisted vaginal hysterectomy (52 patients). There were no differences in terms of patient's age, parity between the three groups. There were 7 minor complications in the laparoscopically assisted vaginal hysterectomy group compared with 9 minor complications in the abdominal hysterectomy group and 14 minor complications in the total laparoscopic hysterectomy group (P not significant). The length of hospital stay was significantly shorter for total laparoscopic hysterectomy than laparoscopically assisted vaginal hysterectomy and total abdominal hysterectomy (p<.001). This study demonstrates that laparoscopic-assisted vaginal hysterectomy and total laparoscopic hysterectomy appears to be as safe as laparotomy and may replace abdominal hysterectomy in most patients and generally has the advantage of shorter hospital stay and earlier return to normal activities.

A Comparative Study of Total Lapaproscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between total laparoscopic Hysterectomy (TLH) and total abdominal hysterectomy (TAH). METHODS: 100 cases of TLH and 95 cases of TAH, which were performed at Pocheon CHA university from January 2001 to September 2004. We analyzed the results with regard to patient's characteristics (age, parity), uterine weight, operative time, blood loss, hospital stay and complications. RESULTS: There were no differences in terms of patient's age, parity, main operative indication and total operating time between the 2 groups. The mean uterine weight of TAH group was larger than TLH (291 +/- 239 gm for TLH, 404 +/- 174 gm for TAH, p<.05) group. The estimated blood loss was significantly lower for TLH (239.00 +/- 155.63 mL) than for TAH (333.68 +/- 228.4 mL) (p<.05). The length of hospital day was significantly shorter for TLH (6.78 +/- 1.70 day) than for TAH (7.39 +/- 1.49 day) (p<.05). Post-operative complications in the TLH group were dysuria in 2 cases, major hemorrhage requiring transfusion in 4 cases, trocar site hematoma in 1 case and bowel injury in 1 case. Post-operative complications In the TAH group were major hemorrhage requiring transfusion in 7 cases, wound infection in 3 cases and bowel injury in one case. CONCLUSION: The present study demonstrates that, given adequate training in laparoscopic surgery, TLH may replace TAH in most patients who require a hysterectomy, showing clear advantages of shorter hospitalization and the acceptable complication rate.

Clinical Comparisons of Laparoscopic Assisted Vaginal Hysterectomy and Total Abdominal Hysterectomy in the Huge Uterine Myoma / 대한산부인과학회잡지

OBJECTIVE: This study is to evaluate the effectiveness and the value of laparoscopic assisted vaginal hysterectomy (LAVH) and the possibility of replacing total abdominal hysterectomy (TAH) to LAVH. METHODS: Retrospective study of 25 cases of LAVH and 157 cases of TAH for huge uterine myoma (uterus weight 500 gram) in Dept. of OB/GYN, Kyungpook National University Hospital from Jan. 1998 to May. 2000 was carried out and postoperative results were compared between 2 methods. Statistical analysis was performed using x2 test and Student t-test as appropriate. Statistical significance was defined as p0.05). The mean operating time was 126+/-53 (range 53-240) min vs 109+/-29 (range 60-250) min (p>0.05). The mean weight of uterus was 719+/-389 (range 500-2414) gram vs 791+/-541 (range 500- 4700) gram (p>0.05). The mean of hospital stay was 4.3+/-1.1 (range 3-8) days vs 6.9+/-3.4 (range 4-25) days (p0.05). Postoperative hospital stay was significantly shorter in LAVH than TAH. CONCLUSION: Even though fewer cases have been done, there was no episode of changing the surgery from LAVH to TAH in huge uterine myoma operation. For the more, neither was increase of morbidity compared to TAH. In huge uterine myoma operation, LAVH may replace the role of TAH in limited number of cases we have experienced. The advantages of LAVH are cosmetic superiority and early hospital discharge. In hands of experienced laparoscopic operator, huge uterine myoma is not an absolute contraindication of LAVH.

Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Abdominal Hysterectomy (TAH) / 대한산부인과학회잡지

OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). METHOD: 60 of LAVH cases and 60 of TAH cases, which were performed at Dankook university hospital from April 1998 to December 2000. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, weight of uterus, operation time, blood loss, hospital stay and complications. RESULTS: Total 120 of hysterectomy cases (60 LAVH, 60 TAH) were enrolled in this study. All operations, LAVH and TAH, were performed by same surgeon. There were no significant differences in patient's characteristics (age, height, weight, parity) between the two groups. The main preoperative indication was myoma uteri, followed by adenomyosis, CIN III, for both LAVH and TAH. The mean uterine weight of TAH cases was larger than LAVH (214.8+/-88.1 gm for LAVH, 377.1+/-269.0 gm for TAH, p0.05). The hospital stay of LAVH was significantly shorter than TAH (4.9+/-0.6day for LAVH, 7.5+/-1.9day for TAH, p<0.05). CONCLUSION: In the comparison of LAVH and TAH operation, we conclude that LAVH can be considered as the first choice when determining hysterectomy method, unless contraindication prevents it. LAVH has advantages of shorter hospitalization and the acceptable complication rate.

The clinical efficacy of pelviscopic classic intrafascial supracervical hysterectomy / 대한산부인과학회잡지

OBJECTIVES: Our purpose was to evaluate the efficacy of pelviscopic classic intrafascial supracervical hysterectomy (CISH) & compare it with total abdominal hysterectomy (TAH). METHODS: We analyzed retrospectively, the clinical data of 1126 patients admitted from January 1993 to December 1998, at 11 university or general hospitals in Korea, for CISH group and 363 patients admitted from January 1993 to December 1998, at Chung-Ang university hospitals, Seoul, Korea, for TAH group. These patients were operated on with the indication of benign uterine disease without cervical malignant lesion. The patients with malignant cervical lesion were excluded in this study. RESULTS: (1) The average age of CISH group was 42.2 (range 24-63) years old and TAH group was 46 (range 31-54) years old. (2) The mean operative time was 150.7+/-49.9 (mean+/-SD, range 55-395) minutes in CISH group and 133.8+/-35 (mean+/-SD, range 65-350) minutes in TAH group. The mean estimated blood loss was 206+/-183.6 (mean+/-SD, range 20-2000) ml in CISH group and 596+/-452.3 (mean+/-SD, range 100-6500) ml in TAH group. The mean hemoglobin change was 1.52+/-0.98 (mean+/-SD, range 0-7) g/dL in CISH group and 3.03+/-1.47 (mean+/-SD, range 0.2-8.4) g/dL in TAH group. The mean time in hospital was 6.3+/-1.43 (mean+/-SD, range 3-18) days in CISH group and 11.0+/-4.08 (mean+/-SD, range 7-37) days in TAH group. (3) Overall complications occured at 5.3% in CISH group and 9.1% in TAH group. (4) Pathologic findings of cervix were benign in 1121 patients (99.6%) and severe dysplasia or carcinoma in situ in 5 patients (0.4%) among CISH groups. In TAH groups, 351 patients (96.7%) had benign cervical lesion and 12 patients (3.3%) had more than oderate dysplasia or carcinoma in situ. In both groups, no invasive cervical cancer was found and the transformation zone of the cervix was included within the resection margin of the cervix in all cases. CONCLUSION: The pelviscopic CISH group has less operative blood loss, less postoperative hemoglobin change, shorter hospital stay and less operative complication than TAH group. Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery and coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we believe that pelviscopic CISH is preferred in cases of benign uterine diseases, because it lowers operative complications and it may have several benefits compared with total hysterectomy, especially, in women with no pathologic lesion of the cervix.