Assessing Adipocyte Viability and Surgeons' Work Efficiency by Comparing Different Liposuction Methods.

Background: Autologous fat grafting is widely used in plastic and reconstructive surgery. Liposuction methods play a key role in surgeons' work efficiency, adipocyte viability, graft survival, and outcomes. We investigated the effect of four liposuction methods on adipocyte viability, debris, and surgeons' work efficiency by measuring the active energy expenditure and changes in heart rate. Methods: Human lipoaspirate was harvested from patients' removed abdominal flaps using four different liposuction methods, and we counted calories per aspirated volume and surgeons' heart rate. Adipocytes were separated from the lipoaspirate immediately by digestion with 0.1% type I collagenase. After digestion, parts of the cells and debris were measured. Adipocytes were plated in an adipocyte maintenance medium containing Alamar blue reagent. The adipocyte metabolic activity was measured using a spectrophotometer. Results: After evaluating the active energy expenditure and changes in surgeons' heart rate, the ultrasonic-assisted liposuction (UAL) method was determined to be the most ergonomic liposuction device for surgeons. In addition, adipocyte viability was higher in the UAL group than in the other groups, and debris was the lowest in the power-assisted liposuction 1 group (PAL1). Conclusions: Adipocyte viability is crucial for improving fat grafting outcomes. This study revealed that the viability of adipocytes is best preserved using the UAL and PAL1 liposuction methods. The UAL and PAL1 methods caused the least damage to the cells. The UAL method yielded the best results for surgeons' work efficiency.

Split-thickness skin grafting: early outcomes of a clinical trial using different graft thickness.

OBJECTIVE: In clinical practice, split-thickness skin graft (STSG) transplantation remains the gold standard for covering large skin defects. Currently, there is no consensus on the optimal thickness of skin grafts. The purpose of our study was to compare the early healing processes of recipient and donor wounds after STSG transplantation using grafts of different thickness. METHOD: This prospective, randomised clinical trial included 84 patients that underwent STSG transplantation surgery for post-burn, post-traumatic or postoperative skin defects. Patients were randomised to receive a skin graft of either 0.2mm, 0.3mm or 0.4mm thickness. After skin transplantation, the wound healing parameters of both the recipient and donor wounds were evaluated after three days, one week, two weeks and one month. RESULTS: The greatest mean epithelialisation scores and highest rate of complete wound epithelialisation were identified in the recipient and donor wounds of the 0.2mm transplant group, at all time points. When the recipient wound pain scores were evaluated, the greatest visual analogue scale (VAS) values were found in the 0.2mm transplant group. The opposite result was found for the donor wound, where the highest VAS scores were identified in the 0.4mm transplant group. There were no significant differences, at any follow-up period, when wound secretion, erythema, swelling, localised warmth and fluctuation were compared. CONCLUSION: The early healing of recipient wounds after STSG transplantation with grafts of various thickness differed considerably, especially regarding wound epithelialisation and pain.

Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery.

OBJECTIVE: Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. To prevent this complication, routine pharmacological prophylactic drugs could be administered. Our study aimed to analyze the various perioperative factors associated with the development of POAF after coronary artery bypass graft (CABG) surgery. METHODS: This prospective study included 617 patients, who received CABG surgery in the year 2014. RESULTS: There were 429 (69.5%) male and 188 (30.5%) female patients. Mean patient age was 67.2 (9.4) years, and 365 patients (59.2%) were more than 65 years. Incidence of POAF was 24.1% (N = 149). Multivariable analysis showed that independent predictors of POAF after CABG surgery were: age >65 (P  = 0.008; OR 2.089; 95% CI 1.208-3.613), AF in the past (P < 0.001; OR 10.838; 95% CI 5.28-22.247), preoperative hypertrophy or dilation of left atrium (P = 0.002; OR 4.996; 95% CI 1.823-13.691), CABG surgery using 4 or more bypass grafts (P = 0.042; OR 1.669; 95% CI 0.972-2.866), preoperative hypokalemia (P = 0.001; OR 3.317; 95% CI 1.678-6.559), >trivial mitral (P = 0.024; OR 7.556; 95% CI 0.964-20.376), and aortic (P = 0.009; OR 1.937; 95% CI 1.178-3.187) valve regurgitation. CONCLUSIONS: The profile of patients affected by POAF was considerably different with regard to the demographics, preoperative heart condition, history of previous heart rhythm disorders, and operative data. The most important independent factors that predicted POAF after CABG surgery were associated with structural heart defects, advanced age, history of previous AF, and preoperative hypokalemia.

Percutaneous Transhepatic Biliary Stenting with Uncovered Self-Expandable Metallic Stents in Patients with Malignant Biliary Obstruction - Efficacy and Survival Analysis.

BACKGROUND: The aim of this study was to assess short- and long-term outcomes of malignant biliary obstruction (MBO) treatment by percutaneous transhepatic biliary stenting (PTBS) with uncovered selfexpandable metallic stents (SEMS), and to identify predictors of survival. MATERIAL/METHODS: A nine-year, single-centre study from a prospectively collected database included 222 patients with inoperable MBO treated by PTBS with uncovered nitinol SEMS. RESULTS: Technical and clinical success rates were 95.9% and 82.4%, respectively. The total rate of postprocedural complications was 14.4%. The mean durations of the primary and secondary stent patency were 114.7±15.1 and 146.4±21.2 days, respectively. The 30-day mortality rate was 15.3% with no procedure-related deaths. The mean estimated length of survival was 143.3±20.6 days. Independent predictors increasing the risk of death included higher than 115 µmol/L serum bilirubin 2-5 days after biliary stenting (HR 3.274, P=0.019), distal (non-hilar) obstruction of the bile ducts (HR 3.711, P=0.008), Bismuth-Corlette type IV stricture (HR 2.082, P=0.008), obstruction due to gallbladder cancer (HR 31.029, P=0.012) and only partial drainage of liver parenchyma (HR 4.158, P=0.040). CONCLUSIONS: PTBS with uncovered SEMS is an effective and safe method for palliative treatment of MBO. Serum bilirubin higher than 115 µmol/L 2-5 days after the procedure has a significant negative impact on patients' survival. Lower survival is also determined by distal bile duct obstruction, Bismuth- Corlette type IV stricture, biliary obstruction caused by gallbladder cancer and when only partial liver drainage is applied.