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176, p = 0.043, and OR 3.243, p = 0.001, respectively). After PSM, there were no differences in intraoperative blood transfusion or postoperative complication rates between the IPM and no IPM groups. Neither did we observe any differences in the subgroup analysis for cirrhotic patients. Postoperative serum liver function tests were not affected by the use of IPM.

Based on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis.

Based on our findings, we conclude that the use of IPM in minimally invasive liver resection is safe and feasible for patients with HCC, including those with compensated liver cirrhosis.

Gastric leaks constitute some of the most severe complications after obesity surgery. Resulting peritonitis can lead to inflammatory changes of the stomach wall and might necessitate drainage. The inflammatory changes make gastric leak treatment difficult. A common endoscopic approach of using stents causes the problem of inadequate leak sealing and the need for an external drainage. Based on promising results using endoscopic vacuum therapy (EVT) for esophageal leaks, we implemented this concept for gastric leak treatment after bariatric surgery (Ahrens et al., Endoscopy 42(9)693-698, 2010; Schniewind et al., Surg Endosc 27(10)3883-3890, 2013).

We retrospectively analyzed data of 31 gastric leaks after bariatric surgery. selleck chemicals llc For leak therapy management, we used revisional laparoscopy with suturing and drainage. EVT was added for persistent leaks in sixteen cases and was used in four cases as standalone therapy.

Twenty-one gastric leaks occurred in 521 sleeve gastrectomies (leakage rate 4.0%), 9 in 441 Rouxon, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage.

EVT is highly beneficial in cases of gastric leaks in obesity surgery where local peritonitis is present. Revisional surgery was unsuccessful later than 2 days after primary surgery (16 of 16 cases). EVT shows a similar healing rate to stent therapy (80-100%) but a shorter duration of treatment. The advantages of EVT are endoscopic access, internal drainage, rapid granulation, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage.The Sheba Blue Dye Test Protocol (SBDTP) is a swallowing bedside evaluation for tracheotomized patients (TP). It is based on the Modified Evans' Blue Dye Test (MEBDT), but includes several modifications that aim to overcome previously described caveats of the traditional MEBDT. These modifications include evaluating the patient three times, with increasing quantities of bolus. The purpose of this study was to examine the rates of positive and negative results of TP undergoing the SBDTP, in comparison to the MEBDT, which, generally, consists of a single evaluation. The study included a cohort of 39 TP admitted to the Sheba general hospital with various background diseases. Findings indicated that the percentage of positive results increased significantly from the first (18%) to the last stage (46.2%) of the SBDTP. This result demonstrated the advantage of the SBDTP as a more reliable evaluation for tracing aspiration among TP, especially in cases where access to instrumental examination is limited.Globally, marine animal distributions are shifting in response to a changing climate. These shifts are usually considered at the species level, but individuals are likely to differ in how they respond to the changing conditions. Here, we investigate how movement behaviour and, therefore, redistribution, would differ by sex and maturation class in a wide-ranging marine predator. We tracked 115 tiger sharks (Galeocerdo cuvier) from 2002 to 2020 and forecast class-specific distributions through to 2030, including environmental factors and predicted occurrence of potential prey. Generalised Linear and Additive Models revealed that water temperature change, particularly at higher latitudes, was the factor most associated with shark movements. Females dispersed southwards during periods of warming temperatures, and while juvenile females preferred a narrow thermal range between 22 and 23 °C, adult female and juvenile male presence was correlated with either lower ( 23 °C) temperatures. During La Niña, sharks moved towards higher latitudes and used shallower isobaths. Inclusion of predicted distribution of their putative prey significantly improved projections of suitable habitats for all shark classes, compared to simpler models using temperature alone. Tiger shark range off the east coast of Australia is predicted to extend ~ 3.5° south towards the east coast of Tasmania, particularly for juvenile males. Our framework highlights the importance of combining long-term movement data with multi-factor habitat projections to identify heterogeneity within species when predicting consequences of climate change. Recognising intraspecific variability will improve conservation and management strategies and help anticipate broader ecosystem consequences of species redistribution due to ocean warming.

To investigate the impact of virtual reality (VR) technologies on urological surgeries, specifically in the management of prostate cancer and renal cancer.

A non-systematic review of the literature was performed. Medline, Pubmed, and the Cochrane Database were screened for studies regarding the use of VR technologies in the management of prostate and renal cancer.

In the management of prostate cancer, VR technologies have been increasingly applied for diagnosis with magnetic resonance imaging/ultrasound fusion biopsy, surgical training using a simulator, surgical navigation in robot-assisted radical prostatectomy, and targeted focal therapy. In partial nephrectomy, surgical simulation and intra-surgical guidance with three-dimensional VR have been used for better understanding of thehilar vascular information, tumor location,and positional relationships of the tumor-feeding vessel and pyelocaliceal system.

VR contributes to the education, training, and simulation of surgical procedures as well as helping the surgeonsto tailor surgical planning oneach patient. Further prospective studies are needed to assess the beneficial impacts of this technology for both the physician and patient by objective parameters.

VR contributes to the education, training, and simulation of surgical procedures as well as helping the surgeons to tailor surgical planning on each patient. Further prospective studies are needed to assess the beneficial impacts of this technology for both the physician and patient by objective parameters.

To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis.

Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life.

Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups.

Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.

Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.

Aging is the most significant determinant for brain iron accumulation in the deep grey matter. Data on brain iron evolution during brain maturation in early childhood are limited. The purpose of this study was to investigate age-related iron deposition in the deep grey matter in children using quantitative susceptibility (QSM) and R2* mapping.

We evaluated brain MRI scans of 74 children (age 6-154months, mean 40months). A multi-echo gradient-echo sequence obtained at 3 Tesla was used for the QSM and R2* calculation. Susceptibility of the pallidum, head of caudate nucleus, and putamen was correlated with age and compared between sexes.

Susceptibility changes in all three nuclei correlated with age (correlation coefficients for QSM/R2* globus pallidus 0.955/0.882, caudate nucleus 0.76/0.65, and putamen 0.643/0.611). During the first 2years, the R2* values increased more rapidly than the QSM values, indicating a combined effect of iron deposition and myelination, followed by a likely dominating effect of iron deposition. There was no significant gender difference.

QSM and R2* can monitor myelin maturation processes and iron accumulation in the deep grey nuclei of the brain in early life and may be a promising tool for the detection of deviations of this normal process. Susceptibility in the deep nuclei is almost similar early after birth and increases more quickly in the pallidum. The combined use of QSM and R2* analysis is beneficial.

QSM and R2* can monitor myelin maturation processes and iron accumulation in the deep grey nuclei of the brain in early life and may be a promising tool for the detection of deviations of this normal process. Susceptibility in the deep nuclei is almost similar early after birth and increases more quickly in the pallidum. The combined use of QSM and R2* analysis is beneficial.Anthracycline (AC) therapy is associated with left ventricular (LV) dysfunction. Left atrial (LA) size and function are used to assess LV diastolic function in heart failure in adults. Data on LA size and function following AC therapy in children is limited. We hypothesized that LA size and function will be abnormal in children following AC chemotherapy. This retrospective review included patients who received AC for pediatric cancers. Controls had normal echocardiograms performed for evaluation of chest pain, murmur, or syncope. Real-time three-dimensional echocardiography was performed to evaluate LA reservoir, conduit, and booster pump function parameters. In addition to LA volume data, LV shortening fraction, spectral and tissue Doppler variables assessing diastolic function as well as myocardial performance index was obtained. Groups with and without AC therapy were compared by student t-test and chi-square test. We evaluated 136 patients, 55 (40.4%) had received AC. There was no significant difference between the groups in LV shortening fraction, diastolic as well as global function indices.