Notes

Restriction of the natriuretic peptide clearance receptor attenuates proteinuria in a computer mouse button style of central segmental glomerulosclerosis.
There is scanty evidence on the impact of bariatric surgery on urinary incontinence (UI) in the Asian population.

Patients who underwent bariatric surgery from June 2018 to June 2019 were screened using the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaire. Patients having UI were identified and followed until 1year of surgery using the ICIQ-UI-SF. These were classified as having stress, urge, or mixed type of UI. The prevalence, change in scores, and the number of pads used were compared at baseline and at follow-up.

A total of 148 patients underwent bariatric surgery of whom, 41 patients (M = 2, F = 39) had UI. Stress incontinence was seen in 70.7%, 19.5% had urge incontinence, and rest had the mixed type. Using logistic regression, it was found that female gender was the most important predictor of having UI (OR 8.33). The prevalence of UI decreased from 27.7% at baseline to 8.1% at 6months and 3.4% at 12months. The mean ICIQ-UI-SF score improved from 8.76 (SD = 3.2) at baseline to 0.66 (SD = 2.1) at 12months of follow-up. The proportion of patients with UI using any number of pads decreased from 92.7% at baseline to 9.8% at 12months. There was a decrease in the number of patients having moderate to very severe UI from 35 (85.4%) at baseline to 2 (4.9%) at 12months. Proportion of patients showing resolution was highest among the stress incontinence group at 96.5%. Presence or absence of comorbidities did not significantly influence the ICIQ-UI-SF scores.

Bariatric surgery leads to profound improvement in UI in obese individuals which is well sustained until 1year of follow-up. Resolution rates might be higher in Asian population.
Bariatric surgery leads to profound improvement in UI in obese individuals which is well sustained until 1 year of follow-up. Resolution rates might be higher in Asian population.
This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method.

START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed.

Among the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range 13-58years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7kg/m
(range 15.9-37.0kg/m
). CI-1040 All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method.

START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency.
START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency.
This experimental study assesses the influence of different gases and insufflation pressures on the portal, central-venous and peripheral-arterial pH during experimental laparoscopy.

Firstly, 36 male WAG/Rij rats were randomized into six groups (n = 6) spontaneously breathing during anaesthesia laparoscopy using carbon dioxide or helium at 6 and 12mmHg, gasless laparoscopy and laparotomy. 45 and 90min after setup, blood was sampled from the portal vein, vena cava and the common femoral artery with immediate blood gas analysis. Secondly, 12 animals were mechanically ventilated at physiological arterial pH during 90min of laparotomy (n = 6) or carbon dioxide laparoscopy at 12mmHg (n = 6) with respective blood gas analyses.

Over time, in spontaneously breathing rats, carbon dioxide laparoscopy caused significant insufflation pressure-dependent portal acidosis (pH at 6mmHg, 6.99 [6.95-7.04] at 45min and 6.95 [6.94-6.96] at 90min, pH at 12mmHg, 6.89 [6.82-6.90] at 45min and 6.84 [6.81-6.87] at 90min; p < 0.05) compared to laparotomy (portal pH 7.29 [7.23-7.30] at 45min and 7.29 [7.20-7.30] at 90min; p > 0.05). Central-venous and peripheral-arterial acidosis was significant but less severely reduced during carbon dioxide laparoscopy. Laparotomy, helium laparoscopy and gasless laparoscopy showed no comparable acidosis in all vessels. Portal and central-venous acidosis during carbon dioxide laparoscopy at 12mmHg was not reversible by mechanical hyperventilation maintaining a physiological arterial pH (pH portal 6.85 [6.84-6.90] (p = 0.004), central-venous 6.93 [6.90-6.99] (p = 0.004), peripheral-arterial 7.29 [7.29-7.31] (p = 0.220) at 90min; Wilcoxon-Mann-Whitney test).

Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.
Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.
Screening colonoscopy effectiveness depends on procedure quality; however, knowledge about colonoscopy quality in rural and underserved areas is limited. This study aimed to describe the characteristics and quality of colonoscopy and to examine predictors of colonoscopy quality at rural and underserved hospitals.

Adults undergoing colonoscopy from April 2017 to March 2019 at rural or underserved hospitals across the Illinois Surgical Quality Improvement Collaborative were prospectively identified. The primary outcome was colorectal adenoma detection, and secondary outcomes included bowel preparation adequacy, cecum photodocumentation, and withdrawal time. Performance was benchmarked against multisociety guidelines, and multivariable logistic regression was used to examine patient, physician, and procedure characteristics associated with adenoma detection.

In total, 4217 colonoscopy procedures were performed at 8 hospitals, including 1865 screening examinations performed by 19 surgeons, 9 gastroenterologreas, individualized interventions to improve colonoscopy quality are needed.
The transoral vestibular approach for thyroid and parathyroid surgery is being adopted rapidly world-wide. Currently there is a paucity of information on this approach for primary hyperparathyroidism (PHPTH). If this approach is safe and efficacious it would provide patients a completely scarless option for parathyroidectomy.

To determine whether parathyroidectomy via the transoral vestibular approach can be successfully done in a safe and efficient manner.

Consecutive case series of 101 transoral parathyroidectomies performed over a two-year period.

Multi-institutional, academic, high-volume transoral thyroidectomy centers from the USA, Israel, and Thailand.

A consecutive series of adult patients with a biochemical diagnosis of classic PHPTH and who met criteria for parathyroidectomy based on established international consensus for surgery for PHPTH. All patients also had well-localized single adenomas on at least two preoperative imaging studies.

Transoral endoscopic parathyroidectomy vestibulars with PHPTH.
Transoral endoscopic parathyroidectomy via the vestibular approach is a scarless method of removing parathyroids that is clinically feasible, safe, and efficacious and is a reasonable option for focused minimally invasive parathyroidectomy that can be offered to select patients with PHPTH.
Laparoscopic endoscopic cooperative colorectal surgery (LECS-CR) is a promising technique to achieve full-thickness resection of colorectal tumors. This approach has shown good rates of complete resection and low local recurrence, especially for large laterally spreading tumors, which are difficult to remove via endoscopy alone. However, it is often difficult to prevent peritoneal leakage of intestinal content, causing infections and risks of cancer spreading. It was hypothesized that a robotic assistance could make the procedure easier and decrease intestinal fluid leakage. This preclinical trial aims to assess the feasibility of robotic and endoscopic cooperative colorectal surgery (RECS-CR).

LECS-CR was performed in five female pigs and RECS-CR was also performed in five female pigs. With the animal under general anesthesia, pseudotumors were created on the colonic mucosa at a distance comprised between 20 and 25cm from the anal verge. Desired resection margins were marked endoscopically and two stay sinal content leakage, potentially preventing postoperative infections.Human noroviruses (HuNoVs), especially GII.4 strains, are a major cause of gastroenteritis epidemics in both children and adults. Stool samples were collected from 113 Tunisian children with acute gastroenteritis in 2001 and 2002 and were retrospectively tested for HuNoVs. Fifteen (13.2%) of the 113 samples were positive for HuNoVs, all of which were genogroup II strains, and the GII.4-2004/Hunter variant was predominant (67%). We reconstituted the temporal circulation of HuNoV strains in central Tunisia between 2003 and 2012 using HuNoV isolates reported in our previous studies. A comparative analysis showed a dynamic change in the molecular profile of the HuNoV strains over a 12-year period. We found that GII.4-2004/Hunter strains were circulating as early as June 2002 and that GIX.1[GII.P15] HuNoVs were already circulating four years before this genotype was first reported in Japan in 2006. Our data suggest that epidemic strains of HuNoV circulate for several years in the pediatric population before becoming predominant. This study suggests that children from low-income countries with poor sanitation may play a significant role in the molecular evolution of noroviruses and the global emergence of new epidemic strains.Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions.
The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model.

Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis.
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