Purpose:Ureteroscopy is a commonly performed procedure, with postoperative pain that can lead to revisits and opioid prescribing. Perioperative gabapentinoids have shown promise in decreasing pain and opioid use. We hypothesized that single-dose perioperative pregabalin would be safe and efficacious for decreasing pain after ureteroscopy.Materials and Methods:This was an Institutional Review Board–approved and registered blinded, placebo-controlled trial conducted at a single institution. Patients undergoing ureteroscopy without histories that would limit use of opioids, gabapentinoids, and nonsteroidal medications were enrolled. Either 300 mg pregabalin or placebo was administered 1 hour before ureteroscopy. Pain was assessed using a visual analogue scale before administration and 1 hour after surgery. Clinical factors, pain scores, a proxy for cognition, patient satisfaction, and opioid prescribing were assessed in the first 30 postoperative days.Results:A total of 118 patients were enrolled over a 2-year period. Patients who received pregabalin were younger than those who received placebo (median of 44 years vs 57). Postoperative pain scores were higher in those who received pregabalin (3.7 vs 2.0, P = .004), a finding that remained statistically significant when accounting for patient age and preoperative pain scores. There was no difference in the measure of cognition or in reports of adverse events.Conclusions:In this trial evaluating the efficacy of single-dose perioperative pregabalin in ureteroscopy, pregabalin did not decrease postoperative pain when compared to placebo. Urologists should not routinely use this adjunctive medication in ureteroscopy, as it is unlikely to provide benefit.
Aim: 3D printing is a growing technology with promising applications in orthopedic surgery. However, the utilization of 3D-printed surgical implants has not been fully explored. Materials & methods: One-third tubular plates and cortical screws were printed via fused deposition modeling using four materials: acrylonitrile butadiene styrene, carbon fiber-reinforced polylactic acid, polycarbonate and polyether ether ketone. Plates were analyzed with three-point bending and torque testing, and screws underwent torque, shear and pullout testing. Results: Two-factor Analysis of Variance (ANOVA) demonstrated several significant differences between mechanical profiles for different materials and between designs. Conclusion: The results demonstrate that desktop 3D printers can print biocompatible materials to replicate surgical implant designs at a low cost. However, current materials and structures do not approximate the properties of stainless-steel implants.
Objectives: Three-dimensional (3D) printing has emerged as a promising technology in the field of orthopaedic surgery. The purpose of this study was to evaluate the mechanical properties of 3D printed 1/3 tubular plates and cortical screws compared to standard-of-care stainless steel 1/3 tubular plates and cortical screws. Methods: Replication and modification designs were developed for both plates and screws using open-source computer-assisted design (CAD) software. Models were printed in four materials: acrylonitrile butadiene styrene (ABS), carbon fiber reinforced polylactic acid (PLA), polycarbonate (PC), and polyether ether ketone (PEEK). The implants (Figure 1) were tested and compared to surgical steel plates and screws. Plates were tested with three-point bend and torsional loading using an Instron® material testing machine. Screws were analyzed on pull-out strength in a Sawbones® bone model, shear strength, and torsional loading. Each combination of design and material was placed in its own test group with a sample size (n = 5) and compared to a steel control group (n = 5) for each mechanical test. Results: Significant interaction effects between material type and design type were observed for screw shear (p = 0.003), screw torque (p = 0.023), plate 3-point bend (p = 0.002), and plate torque (p = 0.001). A significant interaction effect was not observed for screw pull-out (p = 0.407), however, a statistically significant difference in mean force between material types (p <0.0005) was observed.Screw Shear: The highest mean force when both material and design were considered was for the CFPLA modified flat design with a mean force of 105.83 N (95% CI 88.51 to 123.14).Screw Torque: The highest mean force when both material and design were considered was for the PEEK modified tilt design with a mean force of 49.51 Ncm (95% CI 43.40 to 55.63).Plate 3-Point Bend: The highest mean force when both material and design were considered was for the PEEK modification design with a mean force of 31.93 N (95% CI 30.53 to 33.33).Plate Torque: The highest mean force when both material and design were considered was for the CFPLA modified flat design with a mean force of 46.88 Ncm (95% CI 42.95 to 50.80).Screw Pull-Out: Mean force produced was highest for PC across all test groups (Figure 2) with a total mean force of 211.86 N (95% CI 186.81 to 236.90). Conclusion: This study demonstrates that desktop 3D printers are capable of printing biocompatible materials that can replicate surgical implants. Although the current materials have significant mechanical variability, they do not approximate the properties of stainless steel. The utility of 3D printed surgical implants for internal fracture fixation provides a potential clinical application in locations where equipment is not as readily available, such as developing countries, forward operating military units, or long duration space flight missions. Furthermore, the cost for 3D printers and 3D printable materials has significantly decreased over recent years. This increase in technology and associated decrease in costs, along with numerous open-source 3D modeling software programs, could provide a low-cost alternative to more expensive and less accessible standard-of-care stainless-steel implants. [Figure: see text]
INTRODUCTION AND OBJECTIVE: Our current study aims to determine the correlation between controlling nutritional status (CONUT) and prognostic nutritional index (PNI) and long term outcomes in bladder cancer patients.METHODS: A total of 302 bladder cancer patients who received a cystectomy from University Hospitals Cleveland Medical Center between 2007-2019 were evaluated. CONUT score was obtained based on total cholesterol, albumin, and lymphocyte count. PNI was calculated by utilizing the following formula: 10 Â the serum albumin value (g/dl) þ 0.005 Â the total lymphocyte count in peripheral blood (per mm3). Using inclusion/exclusion criteria, a total of 179 patients were included. We utilized Kaplan-Meier survival analyses to determine the correlation between CONUT and PNI and survival. PNI and CONUT association with upstaging was performed via multivariable regression analysis after adjusting for age, gender, chemotherapy status (y/n), smoking, Charlson Comorbidity Index.RESULTS: Patients with a PNI >50 (no evidence of malnourishment) had an Odds-Ratio (OR) of 0.416 (95% CI: 0.196-0.884, p[0.023) for upstaging of disease compared to patients with PNI <50, suggesting a protective effect against upstaging. When adjusted for age (OR[ 1.026.95%
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