Abstract Background: Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). Methods: Patients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). Conclusion: In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register Number: NCT05199922.

Abstract Objective: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG). Methods: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE). Results: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001). Conclusion: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.

Fundamentos: O reparo cirúrgico convencional de dissecção da aorta torácica é um desafio devido aos riscos de mortalidade e morbidade. Objetivos: Analisamos nossa experiência no reparo híbrido do arco aórtico em dissecções complexas do arco aórtico. Métodos: Entre os anos de 2009 e 2013, 18 pacientes (idade média de 67 ± 8 anos de idade) foram submetidos ao reparo híbrido do arco aórtico. A estratégia de procedimento foi determinada individualmente para cada paciente. Resultados: Treze pacientes fizeram o reparo tipo I utilizando enxerto trifurcado; outro paciente utilizou um enxerto bifurcado. Dois pacientes fizeram o reparo tipo II com substituição da aorta ascendente. Dois pacientes receberam desvios extra-anatômicos de enxertia pela artéria carótida esquerda, permitindo a cobertura da zona 1. A taxa de implantação do stent foi de 100%. Nenhum paciente apresentou acidente vascular cerebral. Um paciente com desramificação total do arco aórtico após dissecção aguda do arco proximal faleceu 3 meses depois de realizar o reparo endovascular da aorta torácica (TEVAR), por insuficiência cardíaca. Não houve endoleak precoce ou a médio prazo. A média de acompanhamento foi de 20 ± 8 meses, com taxa de patência de 100%. Conclusão: Diversas soluções de desramificação, utilizadas em diferentes cenários complexos do arco aórtico, são procedimentos menos invasivos que a cirurgia aberta convencional e permitem o tratamento seguro e eficaz deste subgrupo, altamente selecionado de pacientes com patologias complexas da aorta.

Background: Conventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks. Objectives: We analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch. Methods: Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient. Results: Thirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%. Conclusion: Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

The purpose of this study was to investigate the predictors contributing to be in the first three places with right and left arm in armwrestling. Seventy-three male senior armwrestlers competed in Turkish National Championship voluntarily participated in this study. Some participants competed with both arms. Two samples were composed of according to the participant competition category, for right (69 participants) and left arm (65 participants). The data were collected from eight different weight classes. Handgrip strength, auditory reaction time, forearm length, and forearm circumference were determined as the predictors. All the measurements were taken after weigh-ins had been done and before the first day of national championship competition. Logistic regression analysis was conducted to predict whether a competitor in armwrestling would be in the first three places either with right or left arm, to be a winner or non-winner. Relative handgrip strength was found a significant predictor for both right and left arm ranking (p < 0.05). Auditory reaction time was found a significant predictor only for right arm ranking (p < 0.05) and forearm circumference was found a significant predictor only for left arm ranking (p < 0.05). These results suggest that strength can be viewed as the main predictor in left arm ranking; however, auditory reaction time is also an important factor to be in the first three places in right arm ranking. Thus, competitors should also focus to improve this perceptual skill.

El objetivo de este estudio fue investigar los predictores que contribuyen a clasificar en los tres primeros lugares en la lucha de fuerza de brazos (vencidas o pulsadas) con el brazo derecho e izquierdo. Setenta y tres hombres luchadores senior compitieron en el Campeonato Nacional de Turquía y participaron voluntariamente en este estudio. Algunos participantes compitieron con ambos brazos. Dos muestras fueron conformadas de acuerdo con la categoría de competencia del participante, para el brazo derecho (69 participantes) y el brazo izquierdo (65 participantes). Los datos se obtuvieron para 8 categorías de peso. La fuerza de prensión, tiempo de reacción auditiva, largo del brazo y circunferencia del antebrazo se determinaron como predictores. Todas las medidas fueron tomadas después de pesaje clasificatorio y antes del primer día de competición. Un análisis de regresión logística se realizó para predecir si un competidor en lucha de fuerza estaría en los tres primeros lugares ya sea con el brazo derecho o izquierdo, para ser un ganador o no ganador. La fuerza de prensión relativa resultó un predictor significativo para la clasificación tanto en el brazo derecho e izquierdo (p <0,05). El tiempo de reacción auditiva se encontró un predictor significativo sólo para la clasificación del brazo derecho (p <0,05) y la circunferencia del antebrazo un predictor significativo sólo para el brazo izquierdo (p <0,05). Estos resultados sugieren que la fuerza puede ser vista como el principal predictor en la clasificación para el brazo izquierdo, sin embargo, el tiempo de reacción auditiva es también un factor importante para estar en los tres primeros lugares de la clasificación para el brazo derecho. Por lo tanto, los competidores también deben centrarse en mejorar esta habilidad perceptual.