Comparison of Cognitive Function after Carotid Artery Stenting versus Carotid Endarterectomy

The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitative review of the literature was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement for studies evaluating the changes in cognitive function after CAS compared with CEA. Thirteen studies (403 CEAs; 368 CAS procedures) comparing the changes in cognitive function after CEA versus CAS were identified. Most studies did not show significant differences in overall cognitive function or only showed a difference in a single cognitive test between the two procedures. A definitive conclusion regarding the effect of CAS versus CEA on cognitive function was not possible owing to heterogeneity in definition, method, timing of assessment, and type of cognitive tests. For the same reasons, performing a meta-analysis was not feasible. The lack of standardization of specific cognitive tests and timing of assessment of cognitive function after CAS and CEA do not allow for definite conclusions to be drawn. Larger, adequately-powered and appropriately designed studies are required to accurately evaluate the effect of CAS versus CEA on postprocedural cognitive function

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

Collateral Vessel Formation Causes Clinical Recovery from Limb Ischemia in a Mouse Model

Experimental models of recovery from limb ischemia are required for evaluating novel means of treating ischemia. We describe a mouse model to assess gait after inducing limb ischemia. Gait analysis was performed using a Plexiglass tube, the floor of which contained load cells. Gait was measured in 20 mice; 10 underwent ligation of the right hind limb artery and the other 10 underwent a sham operation. The gait of the animals was measured at 1, 2, and 4 weeks following the procedure. In sham-operated animals, the gait showed no measurable change. In the ligated animals, the ratio of the right fore-to-hind limb changed from 1.07 at baseline to 1.4 at day 0 (P =.001), 1.16 (P =.012 compared with control), and 1.04 (P =.37 compared with control) at weeks 2 and 4, respectively. Gait returned to normal within 4 weeks of induction of ischemia. This model may be helpful in testing potential novel therapies