On the Existence of an Optimum End-to-side Junctional Geometry in Peripheral Bypass Surgery—A Computer Generated Study

AbstractBackground. To investigate hemodynamic flow changes associated with vein cuffs and patches that may be responsible for improved patency of prosthetic infrainguinal grafts.Methods. The role of the graft–artery junction angle was examined by computational fluid dynamics to assess the influence of anastomotic geometry on wall shear stress (WSS) distributions. Three geometrically different junction configurations were studied and the WSS and WSS gradient (WSSG) values were compared.Results. The inclusion of a patch or a cuff moves the bed stagnation point (BSP) distally, increasing the area on the bed of the junction which experiences a BSP and reducing the strength of the recirculation region opposite the heel of the junction by 54.8 and 50.8%, respectively. The patched geometry promotes earlier recovery of the flow in the distal outflow segment (DOS) than for the unpatched model. Also, the helical flow patterns in the DOS associated with the cuffed geometry are stronger. The net effect of these changes are that peak WSSG values for the patched and cuffed geometries are three times lower than those for the uncuffed geometry.Conclusion. This study provides some additional insights into the hemodynamics of graft–artery junction geometry which may influence future clinical practice

Local Anaesthetic Flush Reduces Postoperative Pain and Haematoma Formation After Great Saphenous Vein Stripping—A Randomised Controlled Trial

AbstractObjectivesTo observe the effect of local anaesthetic flush through the great saphenous vein (GSV) tunnel on postoperative pain and haematoma formation following saphenous vein stripping operations.DesignProspective, double-blind, randomised, control trial.MethodsOne hundred patients were randomized to receive 20ml of local anaesthetic (bupivacaine 0.25%+adrenaline) or saline control flush through the GSV tunnel after stripping in a double-blind study. Visual analogue pain scores were used to measure postoperative pain daily for the 1st week, then at 3 weeks and 6 weeks. Patients were examined during the 1st, 3rd and 6th week for haematoma formation.ResultsIn the control group the median postoperative pain score was 4 (range 0–7) in the immediate postoperative period compared to a median of 1 (range 0–4) in the LA group (p<0.001). The median pain score on day-4 was 4 (range 1–6) (control) vs. 1 (range 0–3) (LA group) (p<0.001, Mann–Whitney Utest) and on day-6 it was 1 (range 0–5) (control) vs. 0 (range 0–5) (LA group) (p<0.001, Mann–Whitney). Twelve patients (24%) developed a haematoma in the GSV tunnel in the control group compared to three patients (6%) in the LA group (p=0.007).ConclusionFlushing of the GSV tunnel with bupivacaine plus adrenaline significantly reduces postoperative pain and haematoma formation in patients undergoing GSV stripping for varicose veins

Age at first birth in women is genetically associated with increased risk of schizophrenia

Prof. Paunio on PGC:n jäsenPrevious studies have shown an increased risk for mental health problems in children born to both younger and older parents compared to children of average-aged parents. We previously used a novel design to reveal a latent mechanism of genetic association between schizophrenia and age at first birth in women (AFB). Here, we use independent data from the UK Biobank (N = 38,892) to replicate the finding of an association between predicted genetic risk of schizophrenia and AFB in women, and to estimate the genetic correlation between schizophrenia and AFB in women stratified into younger and older groups. We find evidence for an association between predicted genetic risk of schizophrenia and AFB in women (P-value = 1.12E-05), and we show genetic heterogeneity between younger and older AFB groups (P-value = 3.45E-03). The genetic correlation between schizophrenia and AFB in the younger AFB group is -0.16 (SE = 0.04) while that between schizophrenia and AFB in the older AFB group is 0.14 (SE = 0.08). Our results suggest that early, and perhaps also late, age at first birth in women is associated with increased genetic risk for schizophrenia in the UK Biobank sample. These findings contribute new insights into factors contributing to the complex bio-social risk architecture underpinning the association between parental age and offspring mental health.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries