Fu Wai Hospital

The management of finger flexor spasticity (FFS) remains challenging. Traditional surgical approaches like peripheral neurotomies (PNs) and C8 cervical nerve root transection often achieve initial success in relieving FFS but are prone to rebound and recurrence. To address this limitation, we propose T1 nerve root neurectomy as a novel intervention. Among 19 patients with finger and thumb flexion spastic paralysis treated with T1 neurectomy, two also underwent contralateral C7 (CC7) or phrenic nerve (PhN) transfer for T1 repair. Patients were divided by preoperative finger extension strength into Group A (complete paralysis, n=10) and Group B (preserved function, n=9). Changes in extrinsic finger flexor muscle tone (EFFMT) and flexor pollicis longus muscle tone (FPLMT), as well as hand function, were assessed using the Modified Ashworth Scale (MAS) and the House Functional Classification (HFC), respectively. The median follow-up duration was 24.0 months (IQR 20.0-44.0). Both EFFMT and FPLMT showed a significant decrease in MAS grades, from 4 (IQR 3-4) to 2 (IQR 1-3) (P < 0.001) and from 4 (IQR 4-4) to 1 (IQR 1-3) (P < 0.001), respectively. The HFC grade for hand function improved by a median of 1 grade in Group A (IQR 0.8-2.0; P = 0.01) and 3 grades in Group B (IQR 2.5-3.5; P = 0.01). Group B demonstrated significantly greater improvement compared to Group A (β = 1.83, P = 0.012). T1 neurectomy demonstrated durable efficacy in relieving FFS and significantly improved hand function, particularly in patients with preserved finger extension function.

To compare perioperative outcomes between resuscitative endovascular balloon occlusion of the aorta (REBOA) and non-REBOA management in ruptured abdominal aortic aneurysm (rAAA) repair, and to perform an exploratory comparison of REBOA outcomes between open surgical repair (OSR) and endovascular aortic repair (EVAR). A retrospective analysis was conducted of 107 consecutive rAAA patients (2013-2022), stratified by surgical approach (OSR vs EVAR) and REBOA utilization. Propensity score matching (1:2) was performed based on preoperative shock, comorbidities, and aneurysm morphology, yielding 22 REBOA and 44 non-REBOA patients. Outcomes were compared statistically. Resuscitative endovascular balloon occlusion of the aorta was utilized in 22 patients (10/45 [22.2%] OSR and 12/62 [19.4%] EVAR), with a 100% technical success rate. One Clavien-Dindo grade I access site hematoma occurred (4.5%). No instances of aortic injury, distal embolization, limb ischemia, or balloon failure were observed. After matching, 30-day mortality did not differ significantly (13.6% vs 22.7%, p=0.555). Resuscitative endovascular balloon occlusion of the aorta was associated with a significantly reduced rate of major adverse cardiovascular event (MACE) (4.5% vs 20.5%, p=0.043) and a higher intraoperative diastolic blood pressure (BP) (mean difference+6.7 mm Hg, p=0.031). Blood loss, intensive care unit stay length, and costs were comparable between groups. Long-term survival was similar (log-rank p=0.375). In an exploratory analysis, outcomes between REBOA-OSR (n=10) and REBOA-EVAR (n=12) subgroups showed no significant differences in mortality or MACE, although this analysis was underpowered. Resuscitative endovascular balloon occlusion of the aorta demonstrated high technical success and an excellent safety profile in rAAA repair. Its use was associated with improved intraoperative hemodynamic stability (higher diastolic BP) and a reduced rate of MACE, although it did not significantly impact mortality or survival. Larger, prospective trials are warranted to confirm the observed reduction in MACE. The comparative outcomes of REBOA in OSR versus EVAR settings remain inconclusive due to the limited sample size.Clinical ImpactThis study demonstrates that resuscitative endovascular balloon occlusion of the aorta (REBOA) in ruptured abdominal aortic aneurysm (rAAA) repair is safe and feasible, and is associated with improved intraoperative hemodynamics and reduced major adverse cardiovascular events. For clinicians, these findings support its use for unstable rAAA patients, particularly those with refractory shock or challenging anatomy. Resuscitative endovascular balloon occlusion of the aorta may serve as both a resuscitative and a cardioprotective strategy by augmenting coronary perfusion. The innovation lies in validating its contemporary safety and proposing a mechanism for cardiac benefits, potentially changing risk-benefit assessments in emergency aortic surgery.

Ground-level ozone pollution poses significant public health risks globally, necessitating spatially-resolved governance strategies. Utilizing real-time monitoring data from China's National Environmental Monitoring Network (2017–2021), this study establishes localized exposure-response relationships for Shenzhen through meta-analytic synthesis and BenMAP-CE modeling, quantifying spatial-temporal health burdens. The results found that: (1) the ozone concentration in Shenzhen exhibited fluctuating patterns between seasons and years, indicating an overarching decline between 2017 and 2021 and a peak annual average was observed in 2019; (2) the disease- risk hierarchy was found that cardiovascular mortality with the highest susceptibility (RR=1.0092), followed by respiratory diseases (RR=1.0063), and all-cause non-accidental mortality (RR=1.0046); and (3) severe health burdens were mainly concentrated in western industrial zones in Shenzhen. The study provides insights into the spatial-temporal distribution of ozone pollution and its health impacts in Shenzhen, and the results confirm that ozone control must prioritize megacity emission hotspots and seasonal peaks. Future research should integrate microenvironmental exposure assessment, toxicological mechanisms, and demographic stratification to advance spatially-precise governance in megacities.

Study objective: This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing colorectal surgery. Design: Systematic review and network meta-analysis of randomized controlled trials. Patients: Patients undergoing colorectal surgery. Interventions: Coffee consumption and gum chewing for postoperative bowel function recovery. Measurements: The primary outcomes included the time to first defecation and flatus postoperatively. Secondary outcomes comprised the time to first toleration of food, length of hospital stay, time to first feeling of hunger, postoperative opioid analgesic use, incidence of complications, postoperative ileus, anastomotic leakage, nausea, vomiting, and in-hospital mortality. Main results: Twenty-one studies involving 1536 patients were included. Six studies compared coffee consumption to a control group, while 15 studies compared gum chewing to a control group. Compared with control groups, coffee consumption significantly reduced the time to first defecation [mean difference (95% CI): −10.91 (−16.17, −5.65); I 2 = 43%; P &lt; 0.0001] and flatus [mean difference (95% CI): −6.38 (−11.89, −0.87); I 2 = 0%; P = 0.02]. Similarly, gum chewing demonstrated significant reductions in time to first defecation [mean difference (95% CI): −17.83 (−22.60, −13.07); I 2 = 83%; P &lt; 0.00001] and flatus [mean difference (95% CI): −13.71 (−17.88, −9.54); I 2 = 88%; P &lt; 0.00001]. Network meta-analysis revealed a non-significant trend favoring gum chewing over coffee for these outcomes. Notably, gum chewing provided additional clinical benefits including reduced incidence of postoperative ileus and shorter hospitalization. In contrast, coffee showed superior effects in facilitating earlier oral intake and reducing postoperative opioid requirements. Both interventions exhibited comparable safety profiles with no significant differences in complication rates. Conclusions: This study demonstrates that both chewing gum and coffee consumption can promote postoperative bowel function recovery in patients undergoing colorectal surgery, with chewing gum appearing to yield superior outcomes. Both interventions were significantly more effective than standard care in reducing the time to first flatus and first defecation. Trial registration: PROSPERO identifier: CRD420251114493. The protocol can be accessed at PROSPERO.

Abstract Background Cardiac surgery significantly improves clinical endpoints but imposes challenges in postoperative recovery. Assessing patient-reported outcome is crucial for optimal care. However, no cardiac surgery-specific tools currently exist to adequately capture postoperative recovery experience. Objectives To develop and validate a recovery scale after cardiac surgery (Fuwai-CRS). Methods This study was conducted from May 2023 to December 2024, comprising: (1) a qualitative study (Cohort 1) enrolling postoperative patients of cardiac surgery and medical staffs to develop the draft scale through literature review, semi-structured interview and Delphi consensus; and (2) a single-center prospective validation study (Cohort 2) to finalize the scale and evaluate psychometric properties. Results In Cohort 1, a 17-item draft Fuwai-CRS was generated based on literature review, semi-structured interview (40 patients and medical staffs) and a Delphi study (15 experts). In Cohort 2 (n=500), a 9-item Fuwai-CRS was finalized by data distribution assessment, hierarchical cluster and factor analysis, and its understandability, reliability, validity and responsiveness were found acceptable. Conclusions The Fuwai-CRS is a concise and valid tool for recovery assessment after cardiac surgery.