Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Chirurgie vitréorétinienne robot-assistée :présent et perspectives futures

info:eu-repo/semantics/nonPublishe

PortFolio des ophtalmologues

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Secondary IOL selection and implantation from a posterior segment surgeon’s point of view: strategies for different scenarios

Tips and tricks on how to manage a capsular rupture or a dislocated lens, perform an anterior vitrectomy and select the right secondary IOL to implant depending of the scenario.info:eu-repo/semantics/nonPublishe

La DMLA, un fléau qui frappe de plus en plus tôt

https://www.levif.be/societe/sante/la-dmla-un-fleau-qui-frappe-de-plus-en-plus-tot/info:eu-repo/semantics/publishe

Un nouveau traitement à l'étude contre la dégénérescence maculaire liée à l'âge

https://www.lesoir.be/470747/article/2022-10-12/un-nouveau-traitement-letude-contre-la-degenerescence-maculaire-liee-lageinfo:eu-repo/semantics/publishe

Autosomal recessive spastic ataxia of Charlevoix-Saguenay with prominent nervous fibers of the optic nerve head: A case report

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Time Independence, Optimized Surgical Steps - The Promise of Robotics

OBJECTIVE Demonstrate the advantages of high precision robotics in retinal delivery over manual techniquePURPOSE Robotics provides high positional stability as well as micrometer precision and accuracy in XYZ. This removes any time constraint on drug delivery within the retinal space, whether intracannular or subretinal. It also allows for a detailed analysis of each phase of a surgical procedure and its optimization.METHODS The following exemplifies our approach to procedure optimizations. To optimize subretinal delivery, first in vitro models are used such as freshly harvested porcine eyes, in which a standard pars plana vitrectomy with IOP control under microscopic visualization through a Rescan 700 Zeiss device was performed. Subsequently, subretinal injection using a 41G Teflon needle, was executed with or without the Preceyes Surgical System (PSS). The following parameters were recorded: absence of a Bruch’s membrane breech, initiation success and duration to subretinal bleb creation. Surgical iOCT and microscopic recording where analyzed and categorized after completion of the surgery .Surgical success was defined as a creation of a subretinal bleb confirmed by intraoperative oct, while avoiding reflux. These were followed by studies in live anesthetized animals using similar parameters.RESULTS No breech of Bruch’s membrane was observed using either manual or robotic assistance. While static positioning was possible manually in the subretinal space, repeated contact with Bruch’s was observed due to physiologic hand tremor. There was no motion while using the PSS. Surgical success was achieved in 80% of PSS assisted surgeries (blebs creation in 100%, with leakage in 20% at the time of retraction). With manual surgery, leakage was observed in all cases, in only 40% of cases could a bleb be successfully created. Leakage was observed at all stages of bleb initiation, injection and retraction of the needle. Time involved in belb generation was longer while using the PSS which may have bearing on the success.CONCLUSION Removing any time constraint on delivery, providing high precision positioning allows for controlled delivery of substances to the appropriate targeted space. Given the stability of the robotic system, it is possible to carefully analyze the surgical procedure using existing iOCT technology. In fact, combining the robot with an iOCT appears to be the ideal optimal use of both technologies and requires further exploration.HUMAN RESEARCH No: Study does not involve human researchinfo:eu-repo/semantics/publishe

Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1

Objective: To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs).Design: Nonrandomized, multicenter retrospective study.Participants: One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs.Methods: Reported data included specific clinical findings, the method of repair, and the outcome after intervention.Main outcome measures: Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate).Results: Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10(-8)). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034).Conclusions: In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful.Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.0info:eu-repo/semantics/publishe

Subretinal Therapy: Technological Solutions to Surgical and Immunological Challenges

Recent advances in ocular gene and cellular therapy rely on precisely controlled subretinal delivery. Due to its inherent limitations, manual delivery can lead to iatrogenic damage to the retina, the retinal pigment epithelium, favor reflux into the vitreous cavity. In addition, it suffers from lack of standardization, variability in delivery and the need to maintain proficiency. With or without surgical damage, an eye challenged with an exogenous viral vector or transplanted cells will illicit an immune response. Understanding how such a response manifests itself and to what extent immune privilege protects the eye from a reaction can help in anticipating short- and long-term consequences. Avoidance of spillover from areas of immune privilege to areas which either lack or have less protection should be part of any mitigation strategy. In that regard, robotic technology can provide reproducible, standardized delivery which is not dependent on speed of injection. The advantages of microprecision medical robotic technology for precise targeted deliveries are discussed.Keywords: cell therapy; gene therapy; immune response; ocular robotics; retina; subretinal delivery.info:eu-repo/semantics/publishe