Clarificative evaluation of elementary level grammar program of a tertiary level preparatory class in Turkey

Short-term and long-term outcomes in living donors for liver transplantation: Cohort study

Efforts to improve surgical safety and outcomes have traditionally placed little emphasis on intraoperative performance, partly due to difficulties in measurement. Video-based assessment (VBA) provides an opportunity for blinded and unbiased appraisal of surgeon performance. Therefore, we aimed to systematically review the existing literature on the association between intraoperative technical performance, measured using VBA, and patient outcomes. Major databases (Medline, Embase, Cochrane Database, and Web of Science) were systematically searched for studies assessing the association of intraoperative technical performance measured by tools supported by validity evidence with short-term (≤ 30days) and/or long-term postoperative outcomes. Study quality was assessed using the Newcastle-Ottawa Scale. Results were appraised descriptively as study heterogeneity precluded meta-analysis. A total of 11 observational studies were identified involving 8 different procedures in foregut/bariatric (n = 4), colorectal (n = 4), urologic (n = 2), and hepatobiliary surgery (n = 1). The number of surgeons assessed ranged from 1 to 34; patient sample size ranged from 47 to 10,242. High risk of bias was present in 5 of 8 studies assessing short-term outcomes and 2 of 6 studies assessing long-term outcomes. Short-term outcomes were reported in 8 studies (i.e., morbidity, mortality, and readmission), while 6 reported long-term outcomes (i.e., cancer outcomes, weight loss, and urinary continence). Better intraoperative performance was associated with fewer postoperative complications (6 of 7 studies), reoperations (3 of 4 studies), and readmissions (1 of 4 studies). Long-term outcomes were less commonly investigated, with mixed results. Current evidence supports an association between superior intraoperative technical performance measured using surgical videos and improved short-term postoperative outcomes. Intraoperative performance analysis using video-based assessment represents a promising approach to surgical quality-improvement.

The neutrophil-to-lymphocyte ratio (NLR) predicts short-term and long-term outcomes in gastric cancer patients

Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high-sensitivity cardiac troponin I (hs-cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome. We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs-cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs-cTnI levels and their Δ with short-term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long-term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs-cTnI levels were 27 (interquartile range [IQR], 13-62) ng/L initially and 28 (IQR, 14-68) ng/L subsequently, with a Δ of 0 [IQR, -2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short-term outcomes (odds ratio, 1.14 per 2-fold higher [95% CI, 1.02-1.28]). Both individual measurements and the Δ were associated with long-term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year. Repeat measurements of hs-cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short- and long-term outcomes.

The article aims to study scientific and methodological features of the ways to enhance students’ learning activities in the context of higher education. The study's theoretical significance is derived from the in-depth analysis of the development of students' learning activity. The study offers the framework of characteristics for the concept of “students' learning (cognitive) activity". The main used methods were: analysis, peer-assessment, self-assessment. The interview method was used to make a cognitive profile of the participants, taking into account their psychological characteristics. The authors developed and scientifically tested educational model based on module curricula and interactive teaching methods to enhance students' learning activity. The authors also reflected the dynamic of the learning activity of the students with disabilities participating in the experiment. The results proved the effectiveness of the developed model of enhancing students' learning activity by using interactive teaching methods. It was concluded that the module curricular and active teaching methods help enhance students with disabilities' learning activity and make them more responsible in respect to the results of their study.

Purpose: The purpose of this study was to explore whether liver cirrhosis (LC) influences short-term and long-term outcomes in gastric neoplasm patients who undergo endoscopic submucosal dissection (ESD). Materials and Methods: Eligible studies were identified in three databases, including PubMed, Embase, and the Cochrane Library on December 18, 2022. Clinical characteristics, short-term outcomes, and long-term outcomes were compared between an LC group and a no liver cirrhosis (NLC) group. For continuous variables, the mean difference (MD) and standard deviation (SD) were pooled. For discontinuous variables, raw data from the 2 × 2 tables or odds ratio (OR) and 95% confidence intervals (CIs) were pooled. Forest plots were used to show the results, and a funnel plot was used to evaluate publication bias. Data analyses were performed by STATA SE 16.0 software. Results: Six retrospective studies involving 1616 gastric neoplasm patients were included in the study. Clinical characteristics, including age, gender, location, macroscopic type, invasion depth, differentiation, and ulceration, were found to be not significantly different between the LC group and the NLC group (P > .05). Moreover, LC was not a risk factor for short-term outcomes, including operative time (MD = 0.15, 95% CI = -0.02 to 0.32, I2 = 0.00%, P = .09), en bloc resection (OR = 0.87, 95% CI = 0.43-1.75, I2 = 0.00%, P = .69), R0 resection (OR = 0.77, 95% CI = 0.42-1.43, I2 = 8.97%, P = .41), bleeding (OR = 1.10, 95% CI = 0.62-1.93, I2 = 0.00%, P = .75), and perforation (OR = 1.62, 95% CI = 0.45-5.84, I2 = 0.00%, P = .46). However, gastric cancer patients with LC exhibited a higher recurrence rate (OR = 3.40, 95% CI = 1.09-10.61, I2 = 0.00%, P = .04) after ESD. Conclusion: Surgeons performing ESD in gastric neoplasm patients should pay more attention to long-term effects.

Hypertensive disorders during pregnancy remain a leading cause of maternal and perinatal morbidity and mortality worldwide and represent a significant challenge in contemporary obstetrics. Despite advances in diagnostics, treatment, and screening programs, their prevalence continues to rise, driven by sociodemographic and medical factors such as higher maternal age and increasing rates of comorbidities. Aim: to analyze current scientific literature on the prevalence short-term and long-term outcomes of hypertensive disorders during pregnancy, with a particular focus on preeclampsia, and to identify promising strategies for prevention and postpartum follow-up in women affected by these complications. Materials and methods. A literature search was conducted in PubMed, Scopus, Web of Science, Medline, and UpToDate using the keywords: hypertensive disorders in pregnancy, gestational hypertension, preeclampsia, eclampsia, long-term outcomes, short-term outcomes, maternal cardiovascular risk, offspring, neurodevelopment, postpartum follow-up, cardiovascular prevention. Publications from 2020–2025 were prioritized. The review included systematic reviews, meta-analyses, cohort studies, and clinical guidelines. After exclusions, 70 publications meeting the criteria for relevance, evidence level, and clinical significance were analysed. Results. The review summarizes the main clinical forms of hypertensive disorders during pregnancy – gestational hypertension, preeclampsia, and eclampsia – and highlights an upward trend in prevalence, particularly for gestational hypertension. The impact of the COVID-19 pandemic on incidence patterns is noted. Reported long-term maternal consequences – including cardiovascular, metabolic, and neurological disorders – as well as for their children, who may experience neurodevelopmental and psycho-emotional disturbances. Conclusions. Hypertensive disorders during pregnancy carry substantial short- and long-term health risks for both mother and child. Women with a history of these conditions require structured postpartum follow-up and targeted preventive measures. Children born from such pregnancies may face elevated cardiovascular and neurodevelopmental risks, warranting ongoing monitoring. Implementation of early risk identification, patient education, and a multidisciplinary preventive approach is essential for reducing adverse outcomes.

To examine the influence of massive perioperative transfusion on both short-term and long-term outcomes in children undergoing brain tumor resection. This retrospective cohort study analyzed pediatric patients who underwent brain tumor surgeries at the Women and Children's Medical Center, Guangzhou Medical University, between October 2014 and March 2022. Massive transfusion was characterized as the transfusion of red blood cells equivalent to or exceeding the estimated preoperative blood volume within 48 h after surgery. To evaluate the relationship between massive transfusion and patient outcomes, logistic regression models were utilized. Survival curves were constructed to compare the long-term outcomes of patients who received massive transfusion with those who did not. The primary outcomes assessed were 30-day all-cause mortality (short-term outcomes) and 1-year survival rates (short-term outcomes). Among the 306 patients included in the analysis, 78 were categorized as part of the massive transfusion group, while 228 were in the non-massive transfusion group. Multivariable regression analysis indicated that perioperative massive transfusion was significantly linked to an increased risk of 30-day mortality (odds ratio (OR): 0.137, 95% confidence interval (CI) [0.036-0.528], p = 0.004). Additionally, patients in the massive transfusion group exhibited higher incidences of postoperative intracranial hypertension (OR: 4.788, 95% CI [1.547-14.824], p = 0.007), extended mechanical ventilation duration (OR: 0.247, 95% CI [58.739-147.895], p < 0.001), and prolonged intensive care unit (ICU) stays (ß = 0.184, 95% CI [3.874-15.077], p = 0.001). Massive transfusion has a pronounced impact on short-term outcomes, particularly increasing perioperative mortality and complication risks in children undergoing brain tumor surgery. Careful consideration of the risks and benefits of transfusion is crucial in managing these cases.

Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.

Background Although studies have indicated that the small posterior fossa plays a role in hemifacial spasm (HFS), few studies have denoted the correlations between local measurements of the cerebellopontine angle and the incidence of HFS and surgical outcomes. Methods We retrospectively analyzed the demographic and clinical data of HSF patients who underwent microvascular decompression at our institution. Healthy controls were recruited. The divergent prognosis of HFS was defined as an ordinal variable. A multivariable ordinal regression model was generated to estimate the relationship between the variables and outcomes of HFS. Results Between 2013 and 2018, 180 patients who were enrolled in our study met the inclusion criteria. Compared with the control group (n = 94), HFS patients had a smaller internal acousticmeatus-brainstem distance (P < 0.001) on the unaffected side and a larger facial nerve-brainstem angle (P < 0.001). The regression analysis demonstrated that subgroups with more severe facial nerve compression (mild vs severe, OR = 0.269, P = 0.018; moderate vs severe, OR = 0.215, P < 0.001) and a thinner brainstem (OR = 2.368, P = 0.014) were more likely to experience better short-term outcomes, while subgroups with a thinner brainstem (OR = 5.583, P = 0.007) were more likely to experience better long-term outcomes. Discussion Structural changes occurring in patients are risk factors for HFS. The patient’s local neurovascular structure and brainstem volume are factors that significantly influence short-term and long-term surgical outcomes.

In this article, we will review the outcomes of patients with intestinal transplant (ITx) with a focus on factors affecting long-term graft and patient survival. The most recent International Intestinal Transplant Registry reports a 1-, 5-, and 10-year graft survival of 71%, 50%, and 41% respectively, for ITx grafts transplanted since 2000. Over the past decades, significant improvements have been achieved in short-term graft and patient outcomes for ITx recipients. The improvement in short-term outcomes may be related to the focused treatment of antihuman leukocyte antigen antibodies, the use of induction immunotherapy protocols, refinements in surgical techniques, establishment of dedicated ITx units, and improved postoperative management.However, long-term graft and patient outcomes for ITx recipients remain stagnant. Issues impairing long-term outcomes of ITx include the challenges in the diagnosis and treatment of chronic rejection and antibody-mediated rejection, progressive decline in renal function, and long-term infectious and malignancy risks especially related to cytomegalovirus, Epstein-Barr virus and posttransplant lymphoproliferative disorder after ITx. Addressing and preventing early and late complications is the key to improving short-term and long-term outcomes after ITx.

Background: Laparoscopic posterior exenteration (total and supralevator) is a complex and rarely done procedure. In this study we describe the surgical technique and short-term perioperative outcomes in 7 female patients of locally advanced carcinoma rectum operated with laparoscopic pelvic exenteration. Materials and Methods: We report 7 cases of carcinoma rectum involving either posterior wall of the uterus or vagina, which were operated with a laparoscopic procedure. All perioperative and intraoperative data were collected retrospectively from prospectively maintained electronic data. Results: Nine female patients with the diagnosis of nonmetastatic locally advanced lower rectal adenocarcinoma were selected. In MRI 4 patients had uterus-cervix involvement and 3 patients had a posterior vaginal wall and anal sphincter involvement. Four patients were operated with laparoscopic supralevator posterior exenteration and 3 patients were operated with laparoscopic complete posterior exenteration. Three patients underwent vaginal reconstruction, which was done with bilateral V-Y plasty. All 7 patients received neoadjuvant chemoradiotherapy (NACTRT), 3 patients also received additional chemotherapy (CAPOX regimen) due to poor response to NACTRT. Mean body mass index (BMI) was 23.85 (range 19-27.20). Mean duration for complete posterior exenteration was 9.63 hours (range 7-12 hours). Mean duration for supralevator posterior exenteration was 6.81 hours (range 6.25-7.5 hours). The mean postoperative stay was 10.71 days (range 7-16 days). Mean blood loss was 700 mL (range 200-1800 mL). On postoperative histopathology, all margins were free of tumor in all cases. Conclusion: Laparoscopic approach for locally advanced carcinoma rectum in female patients is feasible with less morbidity and safe short-term oncological outcomes. Careful selection of patients based on MRI is a must before undertaking the minimally invasive surgery approach. Long-term outcomes are still unknown and will require long-term follow-up.

This study evaluated the results of laparoscopic surgery (LAP) compared to open surgery (OP) for locally advanced mid-to-lower rectal cancer. From February 2008 to December 2014, we collected patient data with clinical stage II/III mid-to-lower rectal cancer who underwent resection with LAP or OP at 13 institutions associated with the Yokohama Clinical Oncology Group (YCOG). The short-term outcomes and long-term prognoses associated with LAP and OP were analyzed after adjusting for the patients' backgrounds using propensity score matching. Among 1091 eligible cases, a propensity score matching with six covariates-age, sex, body mass index, American Society of Anesthesiologists physical status category, tumor location, and clinical stage-extracted 237 cases each for the LAP and OP groups, respectively. After matching, there were no differences in background factors between the two groups except for the presence or absence of preoperative treatment. Operative time was significantly longer in the LAP group than that in the OP group (p < 0.001), while the amount of bleeding and the length of postoperative hospital stay were significantly lower in the LAP group than that in the OP group (p < 0.001 and p = 0.001, respectively). There were no significant differences between groups in the incidence of postoperative complications. The 3-year overall survival and relapse-free survival rates were 90.5% and 88.6% and 78.3% and 71.6% in the LAP and OP groups, respectively, which did not differ significantly. The short-term outcomes and long-term prognoses of LAP in this cohort study indicated that LAP could be a therapeutic option for locally advanced rectal cancer. UMIN000040406.

Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes

Lung cancer remains the leading cause of cancer-related death globally. While lobectomy is the standard treatment for early-stage disease, trials have shown that segmentectomy offers comparable survival outcomes for small (≤2 cm) peripheral tumours. Robotic-assisted thoracic surgery (RATS) has gained popularity due to enhanced precision compared with video-assisted thoracic surgery (VATS). However, comparative outcomes of RATS vs VATS segmentectomy remain unclear. This study, therefore, aimed to compare short-term and long-term outcomes in patients undergoing VATS and RATS segmentectomy for non-small cell lung cancer (NSCLC). We retrospectively reviewed consecutive patients undergoing RATS or VATS segmentectomy for NSCLC between July 2015 and December 2021. Primary outcomes were overall survival (OS), disease-free survival (DFS), and recurrence. Secondary outcomes included complications, length of stay, length of drainage, and lymph-node stations harvested. A total of 144 patients were included (RATS n = 86; VATS n = 58). Baseline characteristics were comparable across groups. RATS was associated with a significantly greater number of lymph-node stations harvested and wider tumour-free margins. Short-term outcomes, including complications, length of stay, drainage duration, conversion rates, and operative time, were similar. Long-term outcomes favoured the robotic approach, with significantly improved OS, DFS, and lower recurrence rates, although multivariable analysis showed no significant difference in hazard ratios between approaches. RATS segmentectomy demonstrated improved survival metrics and reduced recurrence compared with VATS while maintaining comparable perioperative outcomes. The robotic platform facilitated more extensive lymphadenectomy and wider resection margins, which may underlie the observed oncologic advantages.