Postoperative Recovery Time in Inguinal Herniotomy Under Ilioinguinal/Iliohypogastric Block and Sedation Versus General Anesthesia: A Retrospective Propensity-Score Matched Study.

Background Associated advantages of ilioinguinal/iliohypogastric block and sedation versus general anesthesia (GA) for inguinal hernia repair have not been reported. The use of regional anesthesia (RA) is advantageous during the COVID-19 pandemic as it eliminates the need for airway manipulation.This study aimed to determine the association between postoperative recovery time when ilioinguinal/iliohypogastric block and sedation were utilized for inguinal hernia versus GA. Method This single-center retrospective study used multivariable logistic regression to model the anesthetic modality as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, major comorbidities to generate a propensity score for each patient for matching. Results After screening 295 patients, 80 patients each in the general and regional anesthesia groups were matched.RA was associated with a 35.6 minutes (95% CI: -46.6 to -25.0) shorter total postoperative recovery time when compared to GA without the increased preoperative time and adverse outcomes. Conclusions Inguinal hernia repair, when performed under ilioinguinal/iliohypogastric block and sedation, was associated with reduced postoperative recovery time. This can be advantageous during the time of the COVID-19 pandemic to reduce the risk of aerosol generation and shorten hospital stay. Future research can focus on establishing a causal relationship.

An examination of difficulties accessing surgical care in Canada from 2005-2014: Results from the Canadian Community Health Survey.

BACKGROUND: Difficulties accessing surgical care (e.g., related to wait times, cancellations, cost, receiving a diagnosis) are understudied in Canada. Using population-based data, we studied difficulty accessing non-emergency surgical care, including (1) the incidence and annual changes in incidence, (2) types of difficulties, and (3) associated factors (e.g., sociodemographics, surgery characteristics). METHODS: Cross-sectional data from the Canadian Community Health Survey annual components were analyzed from 2005-2014. Weighted frequencies established the annual incidence of difficulty accessing surgical care, and total incidence of types of difficulties. Chi-square analyses, independent samples t-tests, and a multivariable logistic regression examined sociodemographic and surgery-related characteristics associated with difficulty accessing surgical care. RESULTS: Among individuals who required past-year non-emergency surgery between 2005-2014 (weighted n = 3,052,072), 15.6% experienced difficulty accessing surgical care. The most common difficulty was "waited too long for surgery" (58.5%). There were significant differences in the incidence of difficulty according to year (Χ2 = 83.50, p < .001) from 2005-2014. The incidence of difficulty accessing surgery varied according to sex (Χ2 = 4.02, p < .05), surgery type (Χ2 = 96.09, p < .001), party responsible for cancellation/postponement (Χ2 range: 4.36-19.01, p < .05), and waiting time (t = 10.59, p < .001). In particular, males, orthopedic surgery, and surgery cancelled by the surgeon or hospital had the highest rates of difficulty. CONCLUSION: Results provide insight into the difficulties experienced by patients accessing elective surgery, and the associated factors. These results may inform targeted healthcare interventions and resource reallocation to reduce these occurrences.

Phosphatidylinositol-3,4-Bisphosphate and Its Binding Protein Lamellipodin Regulate Chemotaxis of Malignant B Lymphocytes.

Cell migration is controlled by PI3Ks, which generate lipid messengers phosphatidylinositol-3,4,5-trisphosphate and phosphatidylinositol-3,4-bisphosphate [PI(3,4)P2] and consequently recruit pleckstrin homology (PH) domain-containing signaling proteins. PI3K inhibition impairs migration of normal and transformed B cells, an effect thought to partly underlie the therapeutic efficacy of PI3K inhibitors in treatment of B cell malignancies such as chronic lymphocytic leukemia. Although a number of studies have implicated phosphatidylinositol-3,4,5-trisphosphate in cell migration, it remains unknown whether PI(3,4)P2 plays a distinct role. Using the PI(3,4)P2-specific phosphatase inositol polyphosphate 4-phosphatase, we investigate the impact of depleting PI(3,4)P2 on migration behavior of malignant B cells. We find that cells expressing wild-type, but not phosphatase dead, inositol polyphosphate 4-phosphatase show impaired SDF-induced PI(3,4)P2 responses and reduced migration in Transwell chamber assays. Moreover, PI(3,4)P2 depletion in primary chronic lymphocytic leukemia cells significantly impaired their migration capacity. PI(3,4)P2 depletion reduced both overall motility and migration directionality in the presence of a stable chemokine gradient. Within chemotaxing B cells, the PI(3,4)P2-binding cytoskeletal regulator lamellipodin (Lpd) was found to colocalize with PI(3,4)P2 on the plasma membrane via its PH domain. Overexpression and knockdown studies indicated that Lpd levels significantly impact migration capacity. Moreover, the ability of Lpd to promote directional migration of B cells in an SDF-1 gradient was dependent on its PI(3,4)P2-binding PH domain. These results demonstrate that PI(3,4)P2 plays a significant role in cell migration via binding to specific cytoskeletal regulators such as Lpd, and they suggest that impairment of PI(3,4)P2-dependent processes may contribute to the therapeutic efficacy of PI3K inhibitors in B cell malignancies.