Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

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Background The double stitch everting (DSE) technique, in which time is won by leaving the needle inside the vessel wall in-between stitching, is a modification of the end-to-side (ETS) anastomosis in the interest of reducing anastomosis time. This ensures proper wall eversion, intima-to-intima contact, and improved suture symmetry. Materials and Methods We designed an N-of-1 randomized trial with each microsurgeon as their own control. We included 10 microsurgeons of different levels of experience who were then asked to perform classic and DSE ETS anastomoses on the chicken leg and rat femoral models. Every anastomosis was cut and evaluated using blinded assessment. Two-way analysis of variance (ANOVA) and multivariable logistic regression were used to analyze the results and for confounder adjustment. Results A total of 210 anastomoses were performed, of which 177 on the chicken leg and 43 on the rat femoral artery and vein. From the 210 anastomoses, 111 were performed using the classic technique and 99 using the DSE technique. The mean anastomosis time was 28.8 ± 11.3 minutes in the classic group and 24.6 ± 12 minutes in the DSE group (p < 0.001, t-test). There was a significant reduction (p < 0.001, two-way ANOVA) in the number of mistakes when using the DSE technique (mean 5.5 ± 2.6) compared with those using the classic technique (mean 7.7 ± 3.4). Conclusion The DSE technique for ETS anastomoses improves anastomoses times in experienced and moderately experienced microsurgeons while also improving or maintaining suture symmetry and lowering the number of mistakes.

SummaryVarious rodent models have been developed for examining either focal or global cerebral ischemia so far, but the most used model is the rat middle cerebral artery occlusion by intraluminal filaments, followed by reperfusion, and 2,3,5-triphenyltetrazoliumchloride or Cresyl Violet/Nissl staining for evaluation of the region of interest. Like other surgical procedures, this one is prone to various complications (excessive bleeding, vascular or nerve lesions) and failure related to the surgical technique. We focused on detailed surgical techniques, along with data from literature, in order to reduce the complications and increase the chance of experiment success. Magnetic Resonance Imaging evaluation with 3D reconstruction of the ischemic area opens new perspectives on investigations into the ischemic brain, having the advantage of being noninvasive as an alternative to gold histological standard for measuring the infarct size, being the only one accesible in surviving subjects.Keywords: stroke, middle cerebral artery occlusion, cerebral ischemia Streszczenie Dotychczas opracowano różne modele badania gryzoni z ogniskowowym lub całkowitym niedokrwienim mózgu. Jednakże najczęściej ostatnio stosowany to ten, który opiera się na zwężeniu tętnicy środkowej szczurów, a następnie reperfuzji i barwieniu mózgu chlorekiem 2,3,5-trifenylotetrazolium lub Cresyl Violet / Nissl w celu oceny badanego obszaru. Podobnie jak w przypadku innych zabiegów chirurgicznych, z zabiegiem tym wiążą się różne powikłania (nadmierne krwawienie, zmiany naczyniowe lub nerwowe) oraz ryzyko niepowodzenia związane ze stosowaniem danej techniki. Praca koncentruje się na szczegółowych technikach chirurgicznych przy uwzględnieniu danych z literatury i ma na celu opisać możliwość zmniejszenia komplikacji i zwiększenia szans na sukces w eksperymencie. Zastosowanie rezonansu magnetycznego i przetworzenie informacji metodą rekonstrukcji trójwymiarowej (3D) obszaru niedokrwiennego otwiera nowe perspektywy w badaniach nad niedokrwionym mózgiem. Ma też tę zaletę, że jest metodą nieinwazyjną i stanowi alternatywę dla złotego standardu diagnostycznego (badania histologicznego) przy ocenie wielkości zawału, jako jedynej dostępnej metodzie u osobników, które go przeżyły.Słowa kluczowe: udar mózgu, okluzja tętnicy środkowej mózgu, niedokrwienie mózgu Address for correspondence / Adres korespondencyjny: Adina Huțanu, University of Medicine and Pharmacy of Târgu-Mureș, Gheorghe Marinescu 38; 540139 Târgu-Mureș, Romania, e-mail: adina.hutanu@umftgm.ro; phone: +40 744 300 508Orădan A, Huțanu A, Horváth E, Chiriac L, Dobreanu M. Improved rat stroke model by intraluminal middle cerebral artery occlusion: a special emphasis on surgical