Background
The COVID‐19 pandemic was associated with significant disruptions to healthcare provision globally and in Aotearoa New Zealand. It remains unclear how this disruption affected the surgical ...management of acute cholecystitis and whether there are ongoing impacts.
Methods
We conducted a secondary analysis of two multicentre cohort studies (CHOLECOVID and CHOLENZ) on patients who underwent cholecystectomy for acute cholecystitis. Participants were categorized into pre‐pandemic (September–November 2019), pandemic (March–May 2020), and late‐pandemic (August–October 2021) phases. Baseline demographics, clinical management, and 30‐day postoperative complications were assessed between phases. Multivariable logistic regression was used to explore the impact of timing of operation on rates of hospital readmission and postoperative complications.
Results
517 participants were included, of whom 85 (16%) were in the pre‐pandemic‐phase, 52 (10%) were in the pandemic phase, and 380 (73%) were in the late‐pandemic phase. Pandemic and late‐pandemic phase participants were more comorbid and had higher rates of obesity and deranged blood results than pre‐pandemic. After multivariable adjustment, there were no differences in rates of hospital readmission or postoperative complications at 30‐day follow‐up across phases.
Conclusion
The COVID‐19 pandemic had minimal impacts on the provision of cholecystectomy for acute cholecystitis in Aotearoa New Zealand. However, patients managed during the COVID‐19 pandemic were more comorbid and had higher rates of obesity and elevated inflammatory markers.
We found that the surgical management of acute cholecystitis through cholecystectomy had minimal disruptions over pre‐pandemic, pandemic, and late‐pandemic phases, but identify key differences in rates of comorbidity and disease severity. We also report novel sub‐analyses exploring the impact of ethnicity.
Folding of the cerebral cortex is a critical phase of brain development in higher mammals but the biomechanics of folding remain incompletely understood. During folding, the growth of the cortical ...surface is heterogeneous and anisotropic. We developed and applied a new technique to measure spatial and directional variations in surface growth from longitudinal magnetic resonance imaging (MRI) studies of a single animal or human subject. MRI provides high resolution 3D image volumes of the brain at different stages of development. Surface representations of the cerebral cortex are obtained by segmentation of these volumes. Estimation of local surface growth between two times requires establishment of a point-to-point correspondence ("registration") between surfaces measured at those times. Here we present a novel approach for the registration of two surfaces in which an energy function is minimized by solving a partial differential equation on a spherical surface. The energy function includes a strain-energy term due to distortion and an "error energy" term due to mismatch between surface features. This algorithm, implemented with the finite element method, brings surface features into approximate alignment while minimizing deformation in regions without explicit matching criteria. The method was validated by application to three simulated test cases and applied to characterize growth of the ferret cortex during folding. Cortical surfaces were created from MRI data acquired in vivo at 14 days, 21 days, and 28 days of life. Deformation gradient and Lagrangian strain tensors describe the kinematics of growth over this interval. These quantitative results illuminate the spatial, temporal, and directional patterns of growth during cortical folding.
This is the first of two articles designed to provide user-friendly schematics of the adult dural vascular anatomy. It describes the intrinsic meningeal arteries and veins of the skull base/cranial ...vault and the dural partitions (the tentorium, falx cerebelli, and falx cerebri). The discussion of this anatomy is supplemented by illustrative pathologic insights. The second article focuses on the dural sinuses and their remaining tributaries from the brain, diploë, and emissary veins from the extracranial soft tissues. This information will assist in interpreting neuroimaging studies, communications with clinicians, and teaching of this difficult subject.
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