Unseen Threefold Mortality After the First Ten Days in Hemodialysis Patients Following Joint Arthroplasty: A Nationwide Retrospective Cohort Study of 1,287 Arthroplasty Patients on Hemodialysis.

BACKGROUND: The study addresses the growing number of hemodialysis (HD) patients undergoing joint arthroplasty, who are at higher risk of complications and mortality. Previous research has often overlooked deaths after discharge. This study aimed to examine early outcomes in a large nationwide cohort of patients who underwent arthroplasty for elective and fracture-related reasons. METHODS: Between 2016 and 2022, a study was conducted using the e-Nabiz database of the Türkiye Ministry of Health, focusing on patients aged 18 years and above who underwent elective or fracture-related arthroplasty. This study included 1,287 patients reliant on dialysis who underwent total hip arthroplasty, total knee arthroplasty, or hemiarthroplasty (HA), with 7.7% of them receiving dialysis for the first time. Propensity score matching was used to create an equally sized group of non-dialysis-dependent patients, ensuring demographic balance in terms of age, sex, a comorbidity index, and surgery type. The primary objective was to compare mortality rates 10, 30, and 90 days after arthroplasty. RESULTS: The first-time dialysis patients who underwent HA had significantly higher 30- and 90-day mortality rates compared to the chronic dialysis group (P = .040 and P < .001, respectively). Also, the HD patients consistently exhibited higher 90-day mortality rates across all surgery types. With total knee arthroplasty, HD patients had a mortality rate of 8.7%, in stark contrast to 0% among non-HD patients (P < .001). Similarly, with total hip arthroplasty, HD patients had a 12% mortality rate, while non-HD patients had a markedly lower rate of 2.7% (P = .008). In the case of HA, HD patients had a significantly elevated 90-day mortality rate of 31.9%, in contrast to 17.1% among non-HD patients (P < .001). CONCLUSIONS: Joint arthroplasty has higher rates of mortality and complications among HD patients. Surgical decisions must be based on patients' overall health, necessitating collaboration among specialists. These patients should be closely monitored.

A review of the Mutillidae (Hymenoptera) of Azerbaijan.

Fifty-eight species in 19 genera are recorded from Azerbaijan. A new synonymy is proposed for Mutilla sinuata Olivier, 1811 (=M. binotata Radoszkowski, 1879, syn. nov.; M. araratica Radoszkowski, 1890, syn. nov.) and Smicromyrme atrithorax (Andr, 1902) (=S. kurdus Skorikov, 1935, syn. nov.). The lectotypes of seven species: Agama caucasica Radoszkowski, 1885, ; Ephutomma radoszkovskii Skorikov, 1935, ; Mutilla armeniaca Kolenati, 1846, ; M. elongata Radoszkowski, 1885, ; M. binotata Radoszkowski 1879, ; M. araratica Radoszkowski 1890, ; and M. villosa Klug 1829, are designated. Fourteen species are recorded for the first time from Azerbaijan: Dasylabris (Inbaltilla) regalis (Fabricius, 1793); D. (I.) popovi Skorikov, 1935; D. (I.) shelkovnikovi Lelej, 1985; Dentilla erronea (Andr, 1900); Myrmilla (M.) calva (Villers, 1789); M. (Pseudomutilla) glabrata (Fabricius, 1775); M. (P.) vutshetitshi Skorikov, 1927; Physetopoda daghestanica (Radoszkowski, 1885); Pseudophotopsis armeniaca (Skorikov, 1935); Smicromyrme (Astomyrme) ausonius Invrea 1950; S. (Eremotilla) novaki Invrea, 1954; S. (Smicromyrme) ruficollis ruficollis (Fabricius, 1793); S. (S.) rufipes (Fabricius, 1787); and S. (S.) tristis Lelej, 1984. Four species are excluded from the list of Azerbaijan fauna. An updated key to three Palaearctic species of Macromyrme Lelej, 1984 is given and new combination and resurrected status are proposed for Macromyrme villosa (Klug, 1829). A cluster analysis of faunal similarities among Azerbaijan, Armenia, Georgia, Turkey and three regions of Russia (Crimea, North Caucasus, south of European part) for Mutillidae produce two major clusters (index similarity 0.4): Azerbaijan, Armenia, Turkey and Georgia (bootstrap probability 45 %), and three regions of Russia (bootstrap probability 87 %). This demonstrates the important boundary between two large biogeographical subregions of Palaearctic: Mediterranean and Euro-Siberian. The Azerbaijan fauna, especially Nakhchivan Autonomous Republic, is most closely related with the Armenian fauna.

New records of solitary vespid wasps (Hymenoptera: Vespidae: Masarinae and Eumeninae s. l.) from the Nakhchivan Autonomous Republic of Azerbaijan.

An account on 35 species in the family Vespidae (subfamilies Masarinae, Eumeninae s. str., and Raphiglossinae) is presented. Genera Jugurtia de Saussure, 1854, Quartinia Andr, 1884, Brachypipona Gusenleitner, 1967, and Cyrtolabulus van der Vecht, 1969, as well as 17 species and one subspecies are new to Azerbaijan. Three additional species are new to the Nakhchivan Autonomous Republic; the records of nine species confirm previous doubtful reports from the territory of the autonomy. One species is excluded from the fauna of Azerbaijan. New synonymies are proposed: Antepipona orbitalis (Herrich-Schffer, 1839) = A. orbitalis ballioni (Morawitz, 1867), syn. nov.; A. varentzowi (Morawitz, 1895) = A. laevigata (Blthgen, 1951), syn. nov.; Euodynerus disconotatus (Lichtenstein, 1884) = E. disconotatus sulfuripes (Morawitz, 1885), syn. nov. = E. disconotatus laniensis Giordani Soika, 1979, syn. nov.; E. semisaecularis (von Dalla Torre, 1889) = E. semisaecularis macedonicus (Blthgen, 1951), syn. nov.; Gymnomerus laevipes (Shuckard, 1837) = G. laevipes scandinavus (de Saussure, 1856), syn. nov.; Odynerus albopictus de Saussure, 1856 = O. albopictus calcaratus (Morawitz, 1885), syn. nov. = O. albopictus kazakhstanicus Kurzenko, 1977, syn. nov. Hitherto unknown males of Brachyodynerus kusdasi Gusenleitner, 1967 and Brachypipona orientalis Gusenleitner, 2004 are described. The number of species of solitary Vespidae known from the Nakhchivan Autonomous Republic of Azerbaijan is increased to 91, with one additional subspecies which requires a revision. A preliminary list of these wasps of the whole Azerbaijan is presented; it contains 107 identified species and one additional subspecies.

The first modified Delphi consensus statement on sleeve gastrectomy.

INTRODUCTION: Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. METHODS: We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. RESULTS: The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1 cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5 years after surgery to screen for BE. CONCLUSION: A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

The First Modified Delphi Consensus Statement for Resuming Bariatric and Metabolic Surgery in the COVID-19 Times.

The purpose of this study was to achieve consensus amongst a global panel of expert bariatric surgeons on various aspects of resuming Bariatric and Metabolic Surgery (BMS) during the Coronavirus Disease-2019 (COVID-19) pandemic. A modified Delphi consensus-building protocol was used to build consensus amongst 44 globally recognised bariatric surgeons. The experts were asked to either agree or disagree with 111 statements they collectively proposed over two separate rounds. An agreement amongst ≥ 70.0% of experts was construed as consensus as per the predetermined methodology. We present here 38 of our key recommendations. This first global consensus statement on the resumption of BMS can provide a framework for multidisciplinary BMS teams planning to resume local services as well as guide future research in this area.

25-OH-Vitamin D and procalcitonin levels after correction of acute hyperglycemia.

BACKGROUND: Hyperglycemia is a common complication of diabetes melitis (DM) and in the absence of metabolic decompensation is a common finding in the Emergency Department (ED). We aimed to evaluate the 25 OH Vit D [25(OH)D] and procalcitonin (PCT) levels during hyperglycemia and after normalization of blood glucose. MATERIAL AND METHODS: The study included 88 patients over the age of 18 years who presented with acute hyperglycemia at the Hacettepe University Department of Emergency Medicine. Euglycemia was obtained within 6-12 hours and serum samples were taken from patients on admission and 6 hours after normalization of blood glucose. Along with plasma glucose, plasma 25(OH)D and PCT levels were measured using ELISA. RESULTS: There were 88 (45 males) patients, with a median age of 60.0±13.9 years. Serum 25(OH)D levels increased in all patients after normalization of blood glucose, and serum PCT levels decreased in the whole group. This decrease was independent of type of diabetes or presence of infection. CONCLUSIONS: We demonstrated an increase in 25(OH)D after normalization of blood glucose, and a decrease in PCT in patients with hyperglycemia. This effect was independent of the type of diabetes and presence of infection. Further studies are needed to evaluate the faster link between metabolic abnormalities, vitamin D, PCT, and inflammation.

Effect of increased abdominal pressure on cytokines (IL1 beta, IL6, TNFalpha), C-reactive protein (CRP), free radicals (NO, MDA), and histology.

BACKGROUND: It is generally accepted that proinflammatory mediators, including cytokines, are responsible for the metabolic changes associated with injury. Recent clinical and experimental studies have also shown that the laparoscopic procedures actually produce ischemia-reperfusion injury in the organs by oxygen-derived free radicals. This study aimed to assess the effect of different insufflation pressures and laparotomy on tissue response by comparing the proinflammatory cytokines, C-reactive protein, and serum and tissue levels of oxygen-derived free radicals. METHODS: Forty mature New Zealand white rabbits were assigned to 4 groups of 10 animals. In groups 1 to 3, CO2 pneumoperitoneum was created using an automatic insufflator to the designated pressure of 10, 15, and 20 mm Hg, respectively. The remaining 10 animals underwent laparotomy using 10 cm midline incision (group 4). Blood samples were collected before (0 min) and at the end of the procedure (60 min). After the collection of last blood samples, all animals were killed and samples from liver and gut were obtained for measurements of tissue malondialdehyde levels and histology. RESULTS: The proinflammatory cytokine levels were increased significantly in groups 1 to 3, but did not change in the laparotomy group. Serum C-reactive protein levels were elevated in all groups. The comparison of the results between the laparotomy and laparoscopy groups showed that serum interleukin 6 and nitric oxide levels were significantly elevated in relation the intra-abdominal pressure, and serum interleukin 6 and nitric oxide levels peaked in group 3. Tissue malondialdehyde levels were significantly higher in groups 1 and 2 than in groups 3 and 4. CONCLUSIONS: The findings of our experiment suggest that the elevated intra-abdominal pressure is responsible for ischemia, free radical production, and proinflammatory cytokine response-mediated cell damage during laparoscopic surgery.

Ergonomic problems encountered by the surgical team during video endoscopic surgery.

BACKGROUND: The aim of this study is to analyze the problems related to the ergonomic conditions faced by video endoscopic surgical teams during video endoscopic surgery by means of a questionnaire. METHODS: A questionnaire was distributed to 100 medical personnel, from 8 different disciplines, who performed video endoscopic surgeries. Participants were asked to answer 13 questions related to physical, perceptive, and cognitive problems. RESULTS: Eighty-two questionnaires were returned. Although there were differences among the disciplines, participants assessment of various problems ranged from 32% to 72% owing to poor ergonomic conditions. CONCLUSIONS: As the problems encountered by the staff during video endoscopic surgery and the poor ergonomic conditions of the operating room affect the productivity of the surgical team and the safety and efficiency of the surgery, redesigning of the instruments and the operating room is required.

Treatment of idiopathic pulmonary fibrosis: is there anything new?

Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic fibrosing interstitial pneumonia of unknown aetiology and is associated with the histological picture of usual interstitial pneumonia. Treatment in most cases is unsatisfactory and the prognosis remains poor. There is insufficient evidence to suggest that any treatment, apart from lung transplantation, improves survival or halts disease progression for IPF patients. Data on treatment response are limited by the paucity of clinical trails, the lack of homogenous clinical features, the small number of patients, and the absence of histological and radiological documentation in many cases. Anti-inflammatory medications such as corticosteroids, azathioprine and cyclophosphamide remain the commonly used medications. More recently, it has been proposed that IPF is a primary fibrotic disease rather than an inflammatory condition. Antifibrotic agents such as colchicine, pirfenidone and interferon-gamma (IFN-gamma) have been tried. However, a recent placebo-controlled trial has failed to demonstrate a significant effect of IFN-gamma on disease progression, lung function or quality of life in IPF patients, though a clinically significant survival benefit of the drug could not be ruled out.

Fate of the patient with chronic leg ischaemia. A review article.

Much has been published on the surgical treatment of leg ischaemia but relatively little is known about the incidence of claudication and the fate of the majority of patients presenting with chronic leg ischaemia who never come to surgery. A review of the available literature suggests the following conclusions: (1) about 1.5% of men under 49 and 5% of men over 50 will develop symptoms of intermittent claudication. The incidence of asymptomatic arterial disease is much higher; (2) the incidence of claudication in women is only slightly less, but the local disease follows a more benign course; (3) compared to the general population of comparable age the mortality of men presenting with chronic leg ischaemia is two to three times higher after 5 years; (4) about 50% of deaths will be due to myocardial ischaemia, 15% to stroke and 10% to vascular disease in the abdomen. In only 25% will the principal cause of death be unconnected with the circulation; (5) there is virtually no reliable information available at the moment on the incidence of non-fatal myocardial infarction or stroke in these patients.

Effect of defibrinogenation on the early patency rate of experimental small calibre arterial grafts.

The effect of defibrinogenation with Arvin was studied in a new animal model of early thrombosis of a 3 mm diameter polytetrafluoroethylene (PTFE) graft with a poor run-off. Fifteen control animals were compared with fourteen animals treated with subcutaneous Arvin 20 units kg-1 body weight day-1, starting 2 days before surgery and continuing for 2 days postoperatively. The peroperative fibrinogen level in the controls was 2.8 +/- 0.9 gl-1 compared with 0.4 +/- 0.3 gl-1 in the treated group. There was no significant difference in the peroperative or postoperative platelet count or haematocrit value between the two groups. Plasma viscosity and whole blood viscosity (at a low shear rate of 0.7s-1) were significantly less during and after surgery in the defibrinogenated group. The degree of defibrinogenation in these animals produced no problems with haemostasis during surgery or in the postoperative period. The cumulative patency rates of the controls at 24 h, 48 h, and 4 days were 43 per cent, 28 per cent and 28 per cent compared with 86 per cent (P less than 0.05), 73 per cent (P less than 0.05) and 73 per cent (P less than 0.05) respectively in the defibrinogenated group. In this model of a narrow PTFE graft with a poor run-off, defibrinogenation was a safe and effective method of improving early patency of small calibre arterial grafts.

The effect of normovolaemic haemodilution on the early patency rate of small calibre vascular prostheses studied in a new animal model.

A new animal model has been developed to study early thrombosis in small calibre vascular prostheses. It consists of an ePTFE graft 2 cm long and of 3mm internal diameter inserted into a rabbit abdominal aorta in which the distal run-off is reduced by narrowing both common iliac arteries using clips with a standard gap. Scanning electron microscopy and in vivo gamma imaging of the graft using labelled autologous platelets showed that, as in the human, platelets played a primary role in the model graft thrombosis. This model was used to study the effect of haemodilution on early graft patency. Moderate normovolaemic haemodilution dramatically improved the early patency rate.