Articles: cations.
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To explore high-stakes surgical decision making from the perspective of seniors and surgeons. ⋯ Seniors and surgeons highly value quality of life, but this notion is difficult to incorporate in acute surgical decisions. Some seniors use these values to consider a choice between surgery and palliative care, whereas others view this as a simple choice between life and death. Surgeons acknowledge challenges framing decisions and describe a clinical momentum that promotes surgical intervention.
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Comparative Study
Comparison of Clinical Outcomes of Posterior C1-2 Temporary Fixation Without Fusion and C1-2 Fusion for Fresh Odontoid Fractures.
Posterior C1-C2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. However, few studies analyze the difference in clinical outcome between this technique and posterior C1-C2 fusion technique for new odontoid fracture. ⋯ Functional outcomes were significantly better after posterior C1-C2 temporary fixation than after fusion. Temporary fixation can be used as a salvage treatment for an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation.
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Review Meta Analysis
Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy.
The effectiveness of perioperative antibiotics in reducing surgical-site infection (SSI) and overall nosocomial infections in patients undergoing laparoscopic cholecystectomy for biliary colic and low- and moderate-risk cholecystitis (Tokyo classification) is unclear. A systematic review and meta-analysis was performed to assess this. ⋯ Antibiotics should not be administered before laparoscopic cholecystectomy in patients with biliary colic and/or low- and moderate-risk cholecystitis.
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The lipopolysaccharide (LPS) molecule is composed of a hydrophobic lipid region (Lipid A), an oligosaccharide core, and an O-Antigen chain. Lipid A has been described as the molecular region responsible for inducing activation of immune cells. We hypothesize that the O-Antigen plays a critical role in the activation and responsiveness of mononuclear cell immune function. ⋯ Structural variants of LPS activate monocytes differentially. The complete O-Antigen is important for maximal activation of MAPK, cytokine synthesis, and cytokine secretion. LPS with attenuated O-Antigen and Lipid A activate only certain components of these pathways. LPS with a complete O-Antigen stimulates cytokine secretion that is partially independent of CD14, but shortening or removal of the O-Antigen inhibits this secretion.
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The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions. ⋯ Hospitalization due to EGS adheres to a consistent cyclical pattern, with more admissions occurring during the Summer months. Although the reasons for this variability are unknown, this information may be useful for hospital resource reallocation and staffing.