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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cable-driven mechanism models are, usually, included in actuated systems; however, recently, their use for sensitive systems has been explored. In this paper, two cable-driven multi-body mechanism models are compared, underlining advantages and constraints in using sensitive cable-driven mechanisms for minimally invasive robotic instruments. The proposed approach could be useful in bypassing sterilization problems for surgical robotic instruments because our system allows for the separation of the robotic sterilizable part from the sensitive-actuated part of the surgical instrument. The real implementation of the proposed mechanism models, presented partially in other works, are validated in this paper, performing a simulation using a multi-body environment. Results confirm the feasibility of the proposed sensitive-actuated approach, defining new bases for the next challenges of the future. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative robots, designed to work alongside humans for manipulating end-effectors, greatly benefit from the implementation of active constraints. This process comprises the definition of a boundary, followed by the enforcement of some control algorithm when the robot tooltip interacts with the generated boundary. Contact with the constraint boundary is communicated to the human operator through various potential forms of feedback. In fields like surgical robotics, where patient safety is paramount, implementing active constraints can prevent the robot from interacting with portions of the patient anatomy that shouldn't be operated on. Despite improvements in orthopaedic surgical robots, however, there exists a gap between bulky systems with haptic feedback capabilities and miniaturised systems that only allow for boundary control, where interaction with the active constraint boundary interrupts robot functions. Generally, active constraint generation relies on optical tracking systems and preoperative imaging techniques. Methods: This paper presents a refined version of the Signature Robot, a three degrees-of-freedom, hands-on collaborative system for orthopaedic surgery. Additionally, it presents a method for generating and enforcing active constraints "on-the-fly" using our previously introduced monocular, RGB, camera-based network, SimPS-Net. The network was deployed in real-time for the purpose of boundary definition. This boundary was subsequently used for constraint enforcement testing. The robot was utilised to test two different active constraints: a safe region and a restricted region. Results: The network success rate, defined as the ratio of correct over total object localisation results, was calculated to be 54.7% ± 5.2%. In the safe region case, haptic feedback resisted tooltip manipulation beyond the active constraint boundary, with a mean distance from the boundary of 2.70 mm ± 0.37 mm and a mean exit duration of 0.76 s ± 0.11 s. For the restricted-zone constraint, the operator was successfully prevented from penetrating the boundary in 100% of attempts. Discussion: This paper showcases the viability of the proposed robotic platform and presents promising results of a versatile constraint generation and enforcement pipeline. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Microsoft HoloLens is a mixed reality device with the capability to provide a real-time 3D platform using multiple sensors and holographic processing to display information, and even to simulate a virtual world. With rapidly evolving technology and virtual learning on the increase, the HoloLens can be used as a vital tool for education and surgical planning. The aim of this pilot study was to ascertain its benefit in dental education and in the surgical planning of complex oral surgery procedures. METHODS: A cohort of postgraduate dentists working at the Eastman Dental Hospital in London were shown two holographic videos. Participation was voluntary and an email invitation was sent to all non-consultant grade dental staff across multiple dental specialties. The cases demonstrated were a mandibular third molar in close association with the inferior alveolar nerve and an impacted tooth. Each video had a narration and explanation by a consultant oral surgeon. After having watched the videos, participants were asked to rate seven statements using a Likert scale. RESULTS: Eighty-two per cent of participants reported improved comprehension of orientating anatomical structures. All participants (100%) noted improved confidence in surgical planning. Ninety-four per cent believed that the technology was an invaluable surgical tool in postgraduate training. CONCLUSIONS: Augmented reality has the potential to change the face of surgery in the 21st century. This technology can be used to improve surgical training, especially in an environment where hands-on training is limited and virtual learning is promoted. [ABSTRACT FROM AUTHOR]

In minimally invasive surgery, such as cardiac ablation, magnetically steered catheters made of variable‐stiffness materials can enable higher dexterity and higher force application to human tissue. However, the long transition time between soft and rigid states leads to a significant increase in procedure duration. Here, a fast‐response, multisegmented catheter is described for minimally invasive surgery made of variable‐stiffness thread (FRVST) that encapsulates a helical cooling channel. The rapid stiffness change in the FRVST, composed of a nontoxic shape memory polymer, is achieved by an active cooling system that pumps water through the helical channel. The FRVST displays a 66 times stiffness change and a 26 times transition enhancement compare with the noncooled version. The catheter allows for selective bending of each segment up to 127° in air and up to 76° in water under an 80 mT external magnetic field. The inner working channel can be used for cooling an ablation tip during a procedure and for information exchange via the deployment of wires or surgical tools. [ABSTRACT FROM AUTHOR]

Wearing facepieces is discussed in the context of increasing the volume of rebreathed air. We hypothesized that rebreathed air volume increases with increasing filtering facepiece (FFP) class and that persons breathing via facepieces compensate for the additional dead-space. We have determined the effective amount of rebreathed air for a surgical masks and FFP2 and FFP3 respirators in a physical model and determined tidal volumes, breathing frequency, blood oxygen saturation, and transcutaneously measured blood carbon dioxide partial pressure (PCO2) in lung-healthy subjects breathing without and with facepieces at rest and during exercising on a recumbent ergometer. Rebreathed air volume increased with the facepieces' protection class and with increasing inspiration volume by 45 ± 2 ml to 247 ± 1 ml. Ambient airflow reduced rebreathed air volume by 17% up to 100% (all p < 0.001). When wearing facepieces, subjects increased tidal volume (p < 0.001) but not breathing frequency. Oxygen saturation was not influenced by facepieces. With FFP3 respirators PCO2 increased by up to 3.2 mmHg (p < 0.001) at rest but only up to 1.4 mmHg (p < 0.001) when exercising. Discomfort of breathing increased with increasing protection class of the facepiece but was consistently perceived as tolerable. We conclude that the amount of rebreathed air increases with increasing protection class of facepieces. Healthy adults were capable to compensate the facepieces' dead-space by adapting tidal volume at rest and during physical activity; thereby they tolerated moderate increases in PCO2. Ambient airflow may considerably reduce the amount of facepiece related rebreathed air. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the minimum number of operations required for itinerant nurses in the operating room to master the skills needed to operate the Ti-robot-assisted spinal surgery equipment. Additionally, we aimed to provide a corresponding basis for the development of qualification admission criteria and skill training for nurses who cooperate with this type of surgery. Nine operating room itinerant nurses independently performed Ti-robot equipment simulations using a spine model as a tool, with 16 operations per trainee. Four evaluation indices were recorded: time spent on equipment preparation and line connections, time spent on image acquisition and transmission, time spent on surgical spine screw placement planning, and time spent on robot arm operation. Individual and general learning curves were plotted using cumulative sum analysis. The number of cases in which the slope of the individual learning curves began to decrease was 3–11 cases, and the number of cases in which the slope of the general learning curve began to decrease was 8 cases. The numbers of cases in which the learning curves began to decrease in the four phases were the 5th, 8th, 11th, and 3rd cases. Itinerant nurses required at least eight cases to master the equipment operation skills of Ti-robot-assisted spinal surgery. Among the four phases, the image acquisition and transmission phases and the surgical spine screw placement planning phase were the most difficult and must be emphasized in future training. [ABSTRACT FROM AUTHOR]

Background: The Endometriosis Fertility Index (EFI), is a crucial validated surgical tool used for predicting fertility outcomes in women with endometriosis. This study aims to assess the concordance between a preoperative clinical and instrumental EFI evaluation (uEFI) and the EFI score obtained during an exploratory laparoscopy prior to surgery (sEFI). Methods: This study presents preliminary data from a broader observational cohort study. The Least Function score for the uEFI was calculated using a modified version of the original surgical EFI by incorporating a clinical examination, advanced ultrasound, and hysterosalpingo-foam sonography (HyFoSy). Results: The preoperative estimation of the EFI (uEFI) demonstrated a high concordance (k = 0.695, ρs = 0.811) with the sEFI. Remarkably, the surgical interventions led to a significant improvement in the EFI values, with 80% of the intermediate EFI transitioning to a high level, thereby highlighting the positive impact of surgery on fertility outcomes. Conclusion: This study highlights the accuracy of preoperative EFI estimation (uEFI) and its strong agreement with intraoperative assessment. It underscores the potential of a preoperative management tool to guide the allocation of infertile women with endometriosis to operative laparoscopy, direct assisted reproductive technology (ART), or spontaneous attempts at pregnancy. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients are more vulnerable to medical adhesive‐related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI. Aim: To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy. Study Design: This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes. Results: The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p =.121), including the severity of the lesions (p =.902). However, partial (p =.003) and overall (p <.001) detachment of the tapes were more frequent in the silicone group. Conclusions: Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective. Relevance to Clinical Practice: There is no evidence to support the extensive use of silicone tape in this context. [ABSTRACT FROM AUTHOR]

HSP is a heterogeneous group of rare genetic diseases. In childhood, little is known of the development and psychological manifestations. Retrospective analysis of 87 patients with childhood-onset HSP. Patient consent was obtained and data regarding gross motor, fine motor, and language development; equipment usage; surgical procedures; cognition; and mood were collected at each clinic visit and by phone call and analyzed using mean, median, range, and interquartile ranges (IQRs). The cohort contained 18 genetic types of HSP. Participant data ranged from birth to 36 years. Follow-up was variable spanning from a single clinic visit to 24 years of longitudinal visits. The mean age in months of sitting = 7.37, median = 6, range = 5 to 48, IQR = 0; crawling mean = 9.6, median = 9, range 7 to 23, IQR = 0; pulling to stand mean = 10.7, median 9, range: 9 to 36, IQR = 0; and the age for walking was mean = 16.25, median = 15, range = 11 to 63 IQR = 6. Eighteen patients did not achieve independent ambulation. Twenty-five were noted to have initial gait abnormalities. Median age for first word spoken was 12 months. Fifty-five of 87 participants were enrolled in mainstream or honors classes. Twenty-two of 87 had attention deficit disorder. Patients reported experiencing sadness around their diagnoses, and 26 of 87 reported being diagnosed with anxiety or depression. In childhood-onset HSP, motor disorder is the predominant feature; however, screening for attention deficit, anxiety, and depression is indicated. [ABSTRACT FROM AUTHOR]

Background: Several endoscopic treatments for iatrogenic perforations are currently available, with some limitations in terms of size, location, complexity, or cost. Our aims were to introduce a novel technique for closure, using an endoloop and clips, to assess its rate of technical success and post-resection complications. Methods: For closure of large perforations (diameter ≥ 10 mm), two similar techniques were implemented, using a single-channel endoscope. An endoloop was deployed through the operating channel or towed by an endoclip alongside the endoscope. Several clips were utilized to fix it on the muscular layer of defect's margins. The defect was closed, by fastening the loop either directly or after being reattached to the mobile hook. Results: This analysis included eleven patients (72% women, median age 68 years). Eight colorectal, one appendiceal, and two gastric lesions were resected, with a median perforation size of 15 mm. As confirmed by computed tomography, closure of wall defects was achieved successfully in all cases, using a median of 6 clips. Pneumoperitoneum was evacuated in 4 cases. The median hospitalization duration was 4 days, prophylactic antibiotics being prescribed for a median of 7 days. One patient had a small abdominal collection, without requiring drainage, while another presented post-resection bleeding from the mucosal defect. Conclusion: The novel techniques, utilizing a single-channel endoscope, clips, and an endoloop, ensuring an edge-to-edge suture of muscular layer, proved to be safe, reproducible, and easy to implement. They exhibit an excellent technical success rate and a minimal incidence of non-severe complications. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 pandemic, wearing medical respirators and masks was essential to prevent transmission. Objective: To quantify the effects of N95 mask usage by measuring facial skin biophysical characteristics and changes in the lipidome. Methods: Sixty healthy volunteers wore N95 respirators for 3 or 6 h. Facial images were acquired and physiological parameters were measured in specific facial areas, before and after mask‐wearing. Lipidome analysis was also performed. Results: After N95 respirator usage, facial erythema was observed in both the 3 and 6 h groups. Both sebum secretion and trans‐epidermal water loss increased significantly in mask‐covered cheeks and chins after 6 h of mask wearing compared with before mask wearing (p < 0.05). Principal component analysis revealed significant differences in lipid composition after mask wearing compared with before. The ceramide subclass NS exhibited a positive correlation with stratum corneum hydration, whereas the AP subclass was negatively correlated with trans‐epidermal water loss in the 6 h group. Conclusion: Prolonged wear of N95 respirators may impair facial skin function and alter lipidome composition. [ABSTRACT FROM AUTHOR]

Every ophthalmic surgical supply, including intraocular lenses (IOLs), IOL cartridges, and ophthalmic viscosurgical device syringes, is packaged with instructions for use (IFU). These pamphlets are printed in multiple languages and, in the case of an IOL, significantly increase the size and weight of the packaging. To eliminate this significant and unnecessary source of waste, we recommend that manufacturers move to Quick Response codes that link to online electronic IFU (e-IFU) as a sensible alternative. In addition to reducing carbon emissions and manufacturing costs, e-IFU can be updated more easily and accessed by surgeons in the clinic, where IOL models and powers are selected. Varying and inconsistent IFU requirements between different countries are a barrier to wider adoption of e-IFU by the ophthalmic surgical industry. Regulatory agencies in every country should allow and encourage e-IFU. This position paper has been endorsed by the 3 major societies that sponsor EyeSustain, a consortium of global societies dedicated to advancing sustainability in ophthalmology. [ABSTRACT FROM AUTHOR]

Reducing costs and carbon footprints are important, parallel priorities for the US health-care system. Within surgery, reducing the number of instruments that are sterilized and disposable supplies that are used for each operation may help achieve both goals. We wanted to measure the existing variability in surgical instrument and supply choices and assess whether standardization could have a meaningful cost and environmental impact. We analyzed surgeon preference cards for common general surgery operations at our hospital to measure the number of sterilizable instrument trays and supplies used by each surgeon for each operation. From this data, we calculated supply costs, carbon footprint, and median operative time and studied the variability in each of these metrics. Among the ten operations studied, variability in sterilizable instrument trays requested on surgeon preference cards ranged from one to eight. Variability in disposable supplies requested ranged from 17 to 45. Variability in open supply costs ranged from $104 to $4184. Variability in carbon footprint ranged from 17 to 708 kg CO 2 e. If the highest-cost surgeon for each operation switched their preference card to that of the median-cost surgeon, $245,343 in open supply costs and 41,708 kg CO 2 e could be saved. There is significant variability in the instrument and supply choices of surgeons performing common general surgery operations. Standardizing this variability may lead to meaningful cost savings and carbon footprint reduction, especially if scaled across the entire health system. [ABSTRACT FROM AUTHOR]

Tissue triangulation is a fundamental surgical skill in laparoscopic surgery that requires the simultaneous control of multiple surgical tools to create tension and enable tissue visualization. Robotic assistants can facilitate triangulation tasks by autonomously operating some of the tools, reducing the surgeon's cognitive workload and improving precision and safety. However, characterizing complex tissue dynamics is a significant challenge for robot-assisted tissue triangulation. This work presents Latent Regression based Model Predictive Control (LR-MPC) for tissue triangulation that guides the tissue state to lie within a target distribution in the secondary latent space. A Model Predictive Control strategy in latent space is followed for optimal robot action selection. We evaluated the proposed method in a robot-assisted triangulation task with various sizes and materials of triangular tissues. The results show that LR-MPC can achieve performance comparable to a human assistant's, demonstrating its effectiveness and robustness for autonomous tissue triangulation. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Minimally invasive mitral valve repair (MVR) is considered one of the most challenging operations in cardiac surgery and requires much practice and experience. Simulation-based surgical training might be a method to support the learning process and help to flatten the steep learning curve of novices. The purpose of this study was to show the possible effects on learning of surgical training using a high-fidelity simulator with patient-specific mitral valve replicas. METHODS Twenty-five participants were recruited to perform MVR on anatomically realistic valve models during different training sessions. After every session their performance was evaluated by a surgical expert regarding accuracy and duration for each step. A second blinded rater similarly assessed the performance after the study. Through repeated documentation of those parameters, their progress in learning was analysed, and gains in proficiency were evaluated. RESULTS Participants showed significant performance enhancements in terms of both accuracy and time. Their surgical skills showed sizeable improvements after only 1 session. For example, the time to implant neo-chordae decreased by 24.64% (354 s-264 s, P  < 0.001) and the time for annuloplasty by 4.01% (54 s-50 s, P  = 0.165), whereas the number of irregular stitches for annuloplasty decreased from 52% to 24%. The significance of simulation-based surgical training as a tool for acquiring and training surgical skills was reviewed positively. CONCLUSIONS The results of this study indicate that simulation-based surgical training is a valuable and effective method for learning reconstructive techniques of minimally invasive MVR and overall general dexterity. The novel learning and training options should be implemented in the surgical traineeship for systematic teaching of various surgical skills. [ABSTRACT FROM AUTHOR]

The acquisition and refinement of technical skills by the surgical residents are central to surgical teaching; hence, there is increasing interest in the objective assessment of surgical competence. In the field of otology, as of now, there are limited studies for the assessment of surgical competence, also, various subjective methods are being used to assess this vital aspect of training. This study aimed to validate and use an objective assessment tool for the valuation of surgical skills in a tertiary care teaching institute in the Indian subcontinent. Surgical competence of the residents in temporal bone dissection was assessed on a Likert scale by using a grading scale developed by Wan et al., after obtaining necessary permissions. Junior residents in ENT who had completed one year of residency in otolaryngology were asked to perform temporal bone surgery (cortical mastoidectomy) and were marked according to the proforma by two senior experienced otologists. The Cronbach's alpha value was.86 which is an indicator of good technical validity. In our study, we have validated a grading scoring scale used by Wan et al. to objectively assess the ability of an otology resident to perform temporal bone surgery. It is recommended for use in Indian scenario due to its good technical validity. The use of a Likert scale to individually rate each competency makes the evaluation precise and simple. [ABSTRACT FROM AUTHOR]

Introduction: Numerous techniques have been described to repair inherently unstable bilateral rostral fractures of the mandible. However, these can require significant expertise and specialised equipment and have numerous risk factors for surgical site complications. Case Summary: A novel technique to repair bilateral mandibular fractures in the foal is described. A 32-day old foal presented for assessment and treatment of bilateral fractures of the rostral body of the mandible. The fractures were stabilised with two crossed Steinmann pins, placed through the rostral mandible at the level of the lateralmost incisor and across the intermandibular space into the opposing hemimandible, aiming for the level of the second cheek tooth. The foal was comfortable enough to nurse immediately after recovery from anaesthesia and was discharged the next day. When presented for pin removal eight weeks post-surgery, there was bony callous formation at both fracture sites, considered adequate for pin removal. One pin had been prematurely lost. At follow-up seven months later, no long-term complications were reported. Relevance: The cross-pin technique achieved sufficient stabilisation of the bilateral mandibular fractures to allow healing. Surgical insertion of cross pins is technically easier compared to internal fixation, external skeletal fixation, U-bar fixation and intra-oral splinting. Advantages include reduced surgical time, simple surgical equipment, low implant cost and potentially lower risk of surgical site complications and infection. Further studies with larger numbers of cases and longer-term follow-up are required. [ABSTRACT FROM AUTHOR]

Copyright of Health & Society is the property of Instituto de Ensino e Pesquisa Periodicojs and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Mycobacterium abscessus is ubiquitous in the environment and seldom causes infections in immunocompetent individuals. However, skin and soft tissue infections caused by M. abscessus have been reported in recent years. Additionally, the cutaneous infections or outbreaks post cosmetic surgery caused by M. abscessus have been increasing due to the popularity of plastic surgery. The main modes of transmission are through contaminated saline, disinfectants, or surgery equipment, as well as close contact between patients. This article describes three patients who were admitted to our hospital between November 2019 and October 2020. They presented with long-term non-healing wounds caused by M. abscessus infection after undergoing plastic surgery. Symptoms presented by the three patients included swelling, ulceration, secretion, and pain. After identification of M. abscessus with Ziehl-Neelsen staining and MALDI-TOF MS system, the patients were treated with surgical debridement and clarithromycin. Conclusion: It is important to note that a long-term wound that does not heal, especially after plastic surgery, should raise suspicion for M. abscessus infection. The infection mechanism in these three patients may have been due to exposure to surgical equipment that was not properly sterilized or due to poor sterile technique by the plastic surgeon. To prevent such infections, it is important to ensure proper sterilization of surgical equipment and saline. [ABSTRACT FROM AUTHOR]

Hospitals and the healthcare system contribute significantly to global warming, due to the energy use, water use and waste produce going directly to landfill. The operating theatre environment contributes to 70% of all hospital waste, and a proportion of this is due to unused surgical supplies, such as those stocked but never used as they go past their use-by date. To evaluate how use-by dates are identified and assigned to surgical equipment, and if there are opportunities to re-use, or re-sterilise this equipment in order to reduce waste from the operating theatre environment. Use-by dates are assigned to ensure sterility and longevity of the device, and are assigned based on risk analysis, retrospective and prospective assessment. Incineration is the mainstay of disposal of unused medical devices, but there are alternative options such as re-processing in specific circumstances. A large volume of hospital waste is due to operating theatres, and there is movement towards developing more sustainable methods of dealing with expired surgical equipment. This is however in the early stages, with further research required to confirm if these methods will be safe for patients, and beneficial to the environment. • Operating theatres contribute to 70% of hospital waste • Expiry dates on surgical equipment are assigned based on the guarantee of sterility • There are some options available to use surgical equipment after the expiry date has passed • Repurposing, reprocessing and refurbishing equipment has all been suggested and trialled • Further research is required to identify the safety of re-processing expired equipment [ABSTRACT FROM AUTHOR]

This article discusses the diagnosis and treatment of non-pigmented basal cell carcinoma (BCC), the most common type of skin malignancy. Non-pigmented BCC can be challenging to diagnose due to its lack of pigment. The article describes a case study of a 59-year-old female with non-pigmented BCC on her nose. The diagnosis was made using dermoscopy, reflectance confocal microscopy (RCM), and high-frequency ultrasound (HFUS). Mohs micrographic surgery was performed to remove the tumor, guided by HFUS to accurately delineate the surgical boundary. The article concludes that noninvasive imaging techniques, such as dermoscopy, RCM, and HFUS, can aid in the diagnosis and treatment of non-pigmented BCC. [Extracted from the article]

The article discusses the importance of preoperative preparation and planning in rhinoplasty. It introduces a web-based application called Fanalysis, which is a simplified version of the software Rhinobase. Fanalysis allows rhinoplasty surgeons to analyze and plan surgeries by accessing the program from anywhere in the world via the internet. The application requires the upload of frontal, lateral, and basal pictures with a ruler for calibration. Surgeons can use the program to perform photographic and aesthetic analysis, as well as create an operative plan based on the findings. The article concludes that Fanalysis is a helpful tool for facial analysis and rhinoplasty planning. [Extracted from the article]

The article discusses the use of customized cutting guides in pelvic tumor resection surgery. The study conducted on cadavers compared two different designs of cutting guides and found no significant differences in performance regarding accuracy and ergonomics. However, the study highlights the need for further research to determine the advantages and disadvantages of using customized cutting guides in terms of patient survival and implant survival. The article also suggests that future studies should focus on evaluating resection accuracy and incorporating MRI findings into guide design. Overall, while the use of customized cutting guides shows promise, their implementation should be carefully considered due to high costs and the absence of long-term results and benefits. [Extracted from the article]

Background: Robotic-assisted complete mesocolic excision is an advanced procedure mainly because of the great variability in anatomy. Phantoms can be used for simulation-based training and assessment of competency when learning new surgical procedures. However, no phantoms for robotic complete mesocolic excision have previously been described. This study aimed to develop an anatomically true-to-life phantom, which can be used for training with a robotic system situated in the clinical setting and can be used for the assessment of surgical competency. Methods: Established pathology and surgical assessment tools for complete mesocolic excision and specimens were used for the phantom development. Each assessment item was translated into an engineering development task and evaluated for relevance. Anatomical realism was obtained by extracting relevant organs from preoperative patient scans and 3D printing casting moulds for each organ. Each element of the phantom was evaluated by two experienced complete mesocolic excision surgeons without influencing each other's answers and their feedback was used in an iterative process of prototype development and testing. Results: It was possible to integrate 35 out of 48 procedure-specific items from the surgical assessment tool and all elements from the pathological evaluation tool. By adding fluorophores to the mesocolic tissue, we developed an easy way to assess the integrity of the mesocolon using ultraviolet light. The phantom was built using silicone, is easy to store, and can be used in robotic systems designated for patient procedures as it does not contain animal-derived parts. Conclusions: The newly developed phantom could be used for training and competency assessment for robotic-assisted complete mesocolic excision surgery in a simulated setting. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with metastatic spinal cord compression (MSCC) are usually treated with stabilizing surgery with implants and subsequent radiotherapy. Recently, spinal implants consisting of carbon (CI) instead of titanium (TI) has been introduced. This is expected to decrease the deflection of radiation and thereby improve diagnostic imaging. However, we do not know whether it is equally safe and effective to use CI instead of TI in MSCC patients. The aim of this study was to examine the safety and effectiveness of CI in patients with MSCC. We compared 80 patients stabilized with CI versus 83 with TI. The peri-operative blood loss in the CI-group was significantly lower than in the TI-group. There were no significant differences between the groups with regard to mean survival, mean BMI, mean ASA-score, or the number of patients with revisions. Surgical treatment with CI for MSCC is safe and an equally sufficient treatment when compared to TI. Recently carbon spinal implants have been introduced in the treatment of patients with metastatic spinal cord compression (MSCC). This is expected to decrease the deflection of radiation and improve diagnostic imaging and radiotherapy when compared to titanium implants. The aim of this study was to determine the safety and effectiveness of spinal carbon instrumentation (CI) in patients with MSCC in a large cohort study. A total of 163 patients received instrumentation between 1 January 2017 and 31 December 2021. A total of 80 were stabilized with CI and 83 with TI. The outcome measures were surgical revision, postsurgical survival, peri-operative bleeding, and surgery time. The peri-operative blood loss in the CI-group was significantly lower than that in the TI-group: 450mL vs. 630mL, (p = 0.02). There were no significant differences between the groups in mean survival (CI 9.9) vs. (TI 12.9) months (p = 0.39), or the number of patients needing a revision (CI 6) vs. (TI 10), (p = 0.39). The median duration of surgery was 121 min, (p = 0.99) with no significant difference between the two groups. Surgical treatment with CI for MSCC is safe and an equally sufficient treatment when compared to TI. [ABSTRACT FROM AUTHOR]

Machining of bone tissue is a significant procedure in many surgical interventions. Due to the limited research on this topic, understanding the processes occurring during bone processing is crucial for designing tools that optimize the surgical process. This paper presents a model of machining cortical bone with a negative rake angle tool based on three cutting modes. The model was prepared based on experimental data from the orthogonal cutting of cortical bone tissue, numerical simulations, and theoretical models considering the presence of the stagnation zone. Special attention was given to the influence of bone anisotropy on chip formation, chip morphology, and the type and propagation of cracks depending on the orientation of osteons relative to the cutting edge. The analysis of crack morphology and chip structure revealed the mechanisms involved in the material's destruction, which were incorporated into the prepared model. The experimental results confirm the consistency with the proposed model. Based on the prepared cutting model, it is possible to determine the threshold depths of cutting that allow for controlled processing of bone surfaces, predicting the milling machine and the type of formed chips. The model developed based on experimental data is the first for cortical bone tissue. This analysis holds significant theoretical and practical importance for developing innovative orthopedic tools and surgical methods. [ABSTRACT FROM AUTHOR]

Background: Aim of the current study was to present the results of the implementation phase of a robotic liver surgery program and to assess the validity of the IWATE difficulty score in predicting difficulty and postoperative complications in robotic liver surgery. Methods: Based on the prospective database of the Interdisciplinary Robotic Center of Ulm University Hospital, the first 100 robotic liver surgeries were identified and analyzed. Perioperative parameters (duration of surgery and blood loss) and postoperative parameters including morbidity, mortality, and length of hospital stay were assessed and the results were compared between different IWATE difficulty categories. Results: From November 2020 until January 2023, 100 robotic liver surgeries were performed (41 female, 59 male; median age 60.6 years, median BMI 25.9 kg/m2). Median duration of surgery was 180 min (IQR: 128.7), and median blood loss was 300 ml (IQR: 550). Ninety-day mortality was 2%, and overall morbidity was 21%, with major complications occurring in 13% of patients (≥ grade 3 according to Clavien/Dindo). A clinically relevant postoperative biliary leakage was observed in 3 patients. Posthepatectomy liver failure occurred in 7% (4 Grade A, 3 Grade B). Duration of surgery (p < 0.001), blood loss (p < 0.001), CCI (p = 0.004), overall morbidity (p = 0.004), and length of hospital stay (p < 0.001) were significantly increased in the IWATE 'expert' category compared to lower categories. Discussion: Robotic surgery offers a minimally invasive approach for liver surgery with favorable clinical outcomes, even in the implementation phase. In the current study the IWATE difficulty score had the ability to predict both difficulty of surgery as well as postoperative outcomes when assessing the complexity of robotic liver surgery. Therefore, the role of the IWATE score in predicting these outcomes highlights its importance as a tool in surgical planning and decision-making. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of using prefilled syringes in the administration of medication during anesthesia. Medication errors are a significant cause of preventable harm, and the World Health Organization has recognized the need to address this issue. Prefilled syringes can reduce the risk of errors and improve patient safety by eliminating the need for multiple steps in the preparation and administration of injectable medicines. They also have advantages in terms of human factors, infection control, sustainability, and reducing cognitive load for healthcare staff. Despite the evidence supporting their use, prefilled syringes are not widely adopted in the field of anesthesia. The authors argue that it is time for prefilled syringes to be used everywhere and call for healthcare organizations to prioritize their implementation. [Extracted from the article]

OBJECTIVE To compare the results of abdominal CT with exploratory laparotomy in the dog. ANIMALS 100 client-owned dogs from 1 academic institution. METHODS Medical records were searched for dogs that had undergone a preoperative abdominal CT scan read by a board-certified veterinary radiologist followed by an exploratory laparotomy. CT and surgical reports were compared. RESULTS The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97%. Overall, there was no evidence that proportion agreement differed on the basis of body condition score, time interval between CT and surgery, or oncologic versus nononcologic disease. CLINICAL RELEVANCE Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. When performing a specific abdominal surgery, it is acceptable for the surgeon to fully explore the abdomen or forego it for a smaller approach to the organ of interest if an abdominal CT was performed prior. [ABSTRACT FROM AUTHOR]

Surgical approach to head and neck region requires in depth anatomical knowledge and refined surgical skills due to highly critical and complex anatomy of this region. To look for the benefit of cadaveric hands-on workshop on enhancing the surgical knowledge and confidence of the participants. Freshly frozen cadavers were used for this hands-on course in the department of Anatomy, AIIMS Raipur involving 32 residents and ENT specialists. This course involved the interactive lectures and live surgical demonstration on issues related to neck dissection, thyroid, and parotid surgery followed by a hands-on practice by the residents. A positive feedback was given by the participants in regards to the cadaveric hands-on workshop. Almost 4/5th of the participants found the present experience to be extremely helpful and all of them believed the cadaveric hands-on workshops should be conducted regularly as a learning tool and enhancement of surgical skills. Cadaveric hands-on dissection is a very effective practice for refining surgical skills. It can be used to study basic surgical procedures or extremely complex surgeries having intricate anatomy. [ABSTRACT FROM AUTHOR]

Background: Proximal junctional kyphosis (PJK) is a common complication following corrective surgery for adolescent idiopathic scoliosis (AIS) with a Lenke 5 curve. Previous studies have suggested that PJK may be associated with osteopenia, which is prevalent in AIS patients. MRI-based vertebral bone quality (VBQ) scores have been proposed as a valuable tool to assess preoperative bone quality. However, accurately measuring VBQ scores in Lenke 5 AIS patients with a structural lumbar curve can be challenging. Recently, a simplified S1 VBQ score has been proposed as an alternative method when the traditional VBQ score is not applicable. This study aims to evaluate the predictive value of the simplified S1 VBQ score in predicting the occurrence of PJK after corrective surgery for Lenke 5 AIS. Methods: We conducted a retrospective analysis of patient data to assess the predictive utility of the S1 VBQ score for PJK in Lenke 5 AIS patients. Demographic, radiographic, and surgical data were collected, and S1 VBQ scores were calculated based on preoperative T1-weighted MRI images. Univariate analysis, linear regression, and multivariate logistic regression were performed to identify potential risk factors for PJK and to assess the correlation between other variables and the S1 VBQ score. Receiver operating characteristic analysis and area under the curve values were used to evaluate the predictive efficiency of the S1 VBQ score for PJK. Results: A total of 105 patients (aged 15.50 ± 2.36 years) were included in the analysis, of whom 24 (22.9%) developed PJK. S1 VBQ scores were significantly higher in the PJK group compared to the non-PJK group (2.83 ± 0.44 vs. 2.48 ± 0.30, P < 0.001), and there was a significant positive correlation between the S1 VBQ score and proximal junctional angle (PJA) (r = 0.46, P < 0.0001). Multivariate analysis revealed that the S1 VBQ scores and preoperative thoracic kyphosis (TK) were significant predictors of PJK. Conclusion: This study provided evidence that higher S1 VBQ scores were independently associated with PJK occurrence following corrective surgery for Lenke 5 AIS. Preoperative measurement of the S1 VBQ score on MRI may serve as a valuable tool in planning surgical correction for Lenke 5 AIS. [ABSTRACT FROM AUTHOR]

The facial sinus is a recess of the lateral retrotympanum located between the chorda tympani (ChT) and facial nerve (FN). Chronic otitis media with cholesteatoma often spreads from the pars flaccida to the facial sinus (FS). In stapedotomy, if an unfavorable ChT type is encountered, there is a need for removal of bone between the ChT and FN. The aim of the study was to assess FSs in adults and children according to Alicandri-Ciufelli classification, to measure FS width and depth in computed tomography scans, evaluate the correlation between measurements and different types of facial sinuses, and provide a clinical context of these findings. Cone Beam Computed Tomography (CBCT) of 130 adults and High Resolution Computed Tomography of 140 children were reviewed. The type of facial sinus was assessed according to Alicardi-Ciufelli's classification in different age groups. Width of entrance to facial sinus (FSW) and depth of FS (FSD) were evaluated among age groups. Type A of FS is dominant in both adult and children populations included in the study. The average depth of FS was 2.31±1.43 mm and 2.01±0.90 in children and adults respectively. The width of FS was 3.99±0.69 and 3.39±0.98 in children and adults respectively. The depth of FS (FSD) presented significant deviations (ANOVA, p <0.05) among all three types and age groups. In 116/540 (21.5%) cases the value of FSD was below 1 mm. The qualitative classification of facial sinuses into types A, B and C, introduced by Alicandri-Ciufelli and al. is justified by statistically significant differences of depth between individual types of tympanic sinuses. Type A sinuses may be extremely shallow (<1 mm - As) or normal (>1 mm - An). Preoperative assessment of CT scans of the temporal bones gives crucial information about type and size of facial sinus. It may increase the safety of surgeries in this area and play a role in choosing an optimal approach and surgical tools. [ABSTRACT FROM AUTHOR]

Purpose: In case of soft tissue sarcomas (STS), an en-bloc resection with safe margins is recommended. To ensure safe removal without tumor rupture, STS of the groin area, retroperitoneal or pelvic mesenchymal tumors may require incision or resection of the inguinal ligament. Solid reconstruction is mandatory to prevent early and late postoperative femoral hernias. We present here a new technique of inguinal ligament reconstruction. Methods: Between September 2020 and September 2022, patients undergoing incision and/or resection of inguinal ligaments during a wide en-bloc resection of STS of the groin area in the Department of General Surgery in Strasbourg were included. All patients had an inguinal ligament reconstruction with biosynthetic slowly resorbable mesh shaped as a hammock, pre- or intraperitoneally, associated or not with loco-regional pedicled muscular flaps. Results: A total of 7 hammock mesh reconstructions were performed. One or several flaps were necessary in 57% of cases (4 patients): either for inguinal ligament reconstruction only (n = 1), for recovering of femoral vessels (n = 1), and for both ligament reconstruction and defect covering (n = 2). The major morbidity rate was 14.3% (n = 1), related to a thigh surgical site infection due to sartorius flap infarction. After a median follow-up of 17.8 months (range 7–31), there was neither early nor late occurrence of post-operative femoral hernia. Conclusions: This is a new surgical tool for inguinal ligament reconstruction with the implementation of a biosynthetic slowly resorbable mesh shaped as a hammock, which should be compared to other techniques. [ABSTRACT FROM AUTHOR]

Coronavirus (COVID-19) is the infectious agent responsible for the transmission of SARS (severe acute respiratory syndrome). When an infected person coughs, talks, or breathes, it spreads as small droplets of fluid from the mouth and nose of the infected person. Sanitary masks help prevent the spread of the virus from the person wearing the mask to others. This new behavior may cause a number of problems in interpersonal interactions. The goal of this paper is the emotion estimation of masked faces. It presents two major parts. At the first level, we created a system for identifying sanitary masks, using CNN. At the second one, we developed an emotion estimation system in order to estimate the classification rates of a masked face. It consists of three steps: face element detection, feature point localization, and classification. We used the well-known Viola and Jones algorithm in order to achieve the first step. We used several techniques to estimate emotions (SVM, KNN and deep learning). We made comparisons of the obtained results. Particular attention is also given to the effect of face masks on the performance of various methods. [ABSTRACT FROM AUTHOR]

Purpose: Recently, a surgical suction filter device was introduced which aims at generating a suction filter-derived bone grafting substitute (SF-BGS). The osteogenic capacity of this grafting material, however, is unclear. MicroRNAs (miRNAs) and osteogenic mRNAs may influence these processes. The aim of this study was therefore to investigate the quality of the SF-BGS by determining the expression of miRNAs and osteogenic mRNAs. Methods: Samples were collected during non-union surgery. Upon exposure of the intramedullary canal, the surgical vacuum system was fitted with the suction filter device containing collagen complex and synthetic β-TCP: (Ca3(PO4)2, granule size 5–8 mm, total volume 10 mL (Cerasorb Foam®, Curasan AG, Kleinostheim, Germany). As a control, venous blood was used as in current clinical practice. Samples were snap-frozen and mechanically disrupted. MiRNAs and mRNAs were isolated, transcribed, and pooled for qPCR analysis. Lastly, mRNA targets were determined through in silico target analyses. Results: The study population consisted of seven patients with a posttraumatic long bone non-union (4♀; mean age 54 ± 16 years). From the array data, distinct differences in miRNA expression were found between the SF-BGS and control samples. Osteogenic marker genes were overall upregulated in the SF-BGS. Qiagen IPA software identified 1168 mRNA targets for 43 of the overall deregulated miRNAs. Conclusion: This study revealed distinctly deregulated and exclusively expressed osteogenic miRNAs in SF-BGS, as well as overall enhanced osteogenic marker gene expression, as compared to the venous blood control group. These expression profiles were not seen in control samples, indicating that the derived material displays an osteogenic profile. It may therefore be a promising tool to generate a BGS or graft extender when needed. [ABSTRACT FROM AUTHOR]

To explore the clinical effect of "micromovement" in preventing intraoperative acquired pressure injures (IAPIs) among patients experiencing surgery in supine position. A total of 200 patients accepting elective surgery in supine position from 10 May 2023 to 4 July 2023 at Shulan (Hangzhou) Hospital were selected and randomized into two groups (experimental group, n = 100; control group, n = 100). For control group patients, soft silicone foam dressing was applied to the sacrococcygeal region. On the basis of the treatment for control group patients, "micromovement" was implemented among experimental group patients. During this process, the operating table was tilted for 15° leftwards and rightwards alternately every 1 h, and the tilt angle was maintained for 5 min to prevent IAPIs. Finally, comparisons between the two groups were made in terms of the sacrococcygeal IAPI incidence, relative temperature differences (ΔT) on sacrococcygeal skin, and job satisfaction of nurses. Compared with control group patients, patients from the experimental group exhibited lower IAPI incidence (2% vs. 10%), reduced ΔT between the sacrococcygeal skin and surrounding normal skin [0 (−0.1, 0.1) vs. 0.2 (−0.2, 0.4)], and elevated job satisfaction of nurses (80% vs. 66%). All the differences were statistically significant (p < 0.05). "Micromovement" implemented intraoperatively among patients receiving surgery in supine position is able to lower the IAPI incidence by five times and elevate job satisfaction of nurses. [ABSTRACT FROM AUTHOR]

Studying states and state transitions in the brain is challenging due to nonlinear, complex dynamics. In this research, we analyze the brain's response to non-invasive perturbations. Perturbation techniques offier a powerful method for studying complex dynamics, though their translation to human brain data is under-explored. This method involves applying small inputs, in this case via photic stimulation, to a system and measuring its response. Sensitivity to perturbations can forewarn a state transition. Therefore, biomarkers of the brain's perturbation response or "cortical excitability" could be used to indicate seizure transitions. However, perturbing the brain often involves invasive intracranial surgeries or expensive equipment such as transcranial magnetic stimulation (TMS) which is only accessible to a minority of patient groups, or animal model studies. Photic stimulation is a widely used diagnostic technique in epilepsy that can be used as a non-invasive perturbation paradigm to probe brain dynamics during routine electroencephalography (EEG) studies in humans. This involves changing the frequency of strobing light, sometimes triggering a photo-paroxysmal response (PPR), which is an electrographic event that can be studied as a state transition to a seizure state. We investigate alterations in the response to these perturbations in patients with genetic generalized epilepsy (GGE), with (n = 10) and without (n = 10) PPR, and patients with psychogenic non-epileptic seizures (PNES; n = 10), compared to resting controls (n = 10). Metrics of EEG time-series data were evaluated as biomarkers of the perturbation response including variance, autocorrelation, and phase-based synchrony measures. We observed considerable differences in all group biomarker distributions during stimulation compared to controls. In particular, variance and autocorrelation demonstrated greater changes in epochs close to PPR transitions compared to earlier stimulation epochs. Comparison of PPR and spontaneous seizure morphology found them indistinguishable, suggesting PPR is a valid proxy for seizure dynamics. Also, as expected, posterior channels demonstrated the greatest change in synchrony measures, possibly reflecting underlying PPR pathophysiologic mechanisms. We clearly demonstrate observable changes at a group level in cortical excitability in epilepsy patients as a response to perturbation in EEG data. Our work re-frames photic stimulation as a non-invasive perturbation paradigm capable of inducing measurable changes to brain dynamics. [ABSTRACT FROM AUTHOR]

Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021–March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities. [ABSTRACT FROM AUTHOR]

Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology. [ABSTRACT FROM AUTHOR]

Objective: The present study was conducted with an attempt to explore the overall efficacy of large-channel spinal endoscopy technology in elderly patients with segmental lumbar spinal stenosis. Methods: We included a total of 68 elderly patients with segmental lumbar spinal stenosis in our hospital from February 2021 to March 2023. The participants were randomly and equally distributed into the study group and the control group using a random number table method. The control group received the open lumbar decompression surgery, and the study group received the lumbar decompression under large-channel spinal endoscopy technology. We compared the surgical conditions of the two groups, including pain level, Oswestry Disability Index (ODI) score, and Japanese Orthopedic Association (JOA) score before surgery, 1 week after surgery, 3 months after surgery, and 1 year after surgery. In addition, we compared the efficacy and adverse reactions 1 year after surgery between the two groups. Results: Our findings revealed that the operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay in the study group were significantly lower than those in the control group (p < 0.05). There was no statistically significant difference in the degree of pain between the two groups before surgery (p > 0.05), and the pain intensity of the study group was significantly lower than that of the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). Similarly, preoperative ODI and JOA scores were not significantly different between the two groups (p > 0.05), while they were significantly lower in the study group than those in the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). Before surgery, no significant difference was seen in therapeutic efficacy between the two groups (p > 0.05), whereas the efficacy was remarkably improved in the study group comparing to the control group at 1 week, 3 months, and 1 year after surgery (p < 0.05). All patients in this study were followed up for 10 to 16 months, with an average of 13.29 ± 1.28 months. The incidence of adverse reactions in the study group was significantly lower than that in the control group (p < 0.05). Conclusions: Large-channel spinal endoscopy technology exerted promising results in elderly patients with segmental lumbar spinal stenosis, in terms of reducing the surgical time, intraoperative bleeding, postoperative drainage volume, and hospital stay. The approach also alleviated pain, reduced ODI and JOA scores, and restored lumbar function, with decreased incidence of adverse reactions, thereby promoting patient recovery. It is considered valid for wide clinical application. [ABSTRACT FROM AUTHOR]

During the realm of cardiovascular health, where disease remains strong, cardiopulmonary bypass (CPB) is a crucial tool in surgical interventions. Navigating through CPB and the turbulent waters of shock can unveil a difficult opponent called vasoplegia. Despite the heart's efforts to maintain its rhythm, the body may experience a state of low systemic vascular resistance, a key feature of vasoplegia. Physicians commonly resort to vasopressor medications to fight this condition, however, vasoplegia's subtle nature can resist these efforts, leading to catecholamines resistance and increased risks of mortality. To tackle this issue, the medical field has introduced new treatment options such as angiotensin II, a non-catecholamine vasopressor, and nitric oxide scavengers, providing hope for vasoplegia management. Our investigation explores the characteristics, risk factors, and pathophysiology of vasoplegia. Vasoplegic syndrome typically occurs after cardiothoracic surgery, causing high-output shock with compromised systemic vascular resistance. The syndrome's core lies in the dysregulation of vasoconstriction and vasodilation in smooth muscle cells, influenced by various mechanical and patient-specific factors. A promising advancement is the emergence of catecholamine-sparing agents, showing potential in managing vasoplegia. Recent accounts suggest new treatment strategies, highlighting the need for largescale clinical trials to validate findings and establish optimal management approaches. The ongoing fight against vasoplegia provides hope for improved outcomes in cardiovascular care as discoveries shape the field. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic limitation has led to a variety of psychiatric manifestations in humans. These effects were brought about by insufficient planning and a lack of awareness of the epidemic. Infrastructure, human resources, and steady supply are all important, as is the transportation of medications, food, and surgical supplies for the patients. Managing biomedical waste, which includes collecting and segregating it, comes last, includes its storage and transit. Including the challenges, they face with regards to the disposal of dead bodies. [ABSTRACT FROM AUTHOR]

Objective A retrospective study was conducted to explore the efficacy of bioabsorbable poly-L-lactic acid sternal pins in sternal closure in infants after cardiac surgery. Methods A total of 170 infantile patients who underwent cardiac surgery were divided into the steel wire group (group A), the PDS cord group (group B), and the steel wire + sternal pin group (group C). The occurrence of the thoracic deformity was evaluated by vertebral index (VI), frontosagittal index (FSI), and Haller index (HI) values; the stability of the sternum was evaluated by detecting sternal dehiscence and displacement. Results By comparing the absolute values of the differences in VI, FSI, and HI in the three groups, it was found that the difference values of VI and HI in group C were significantly lower than those in group B (p = 0.028 and 0.005). For the highest deformation index, the deformation rate of infants in group C before discharge and during the 1-year follow-up was lower than that in group A and group B (p = 0.009 and 0.002, respectively). The incidence of sternal displacement in group C was also significantly lower than that in groups A and B (p = 0.009 and 0.009). During the 1-year follow-up, there was no sternal dehiscence, and the sternum healed completely in the three groups. Conclusion The use of "steel wire + sternal pin" for sternal closure in infants after cardiac surgery can reduce the occurrence of sternal deformity, reduce anterior and posterior displacement of the sternum, and improve sternal stability. [ABSTRACT FROM AUTHOR]

The management of macular hole defects has undergone a significant transformation with the advent of advanced diagnostic tools and surgical techniques. These developments have enabled the effective treatment of macular holes that were previously considered untreatable. Although the majority of patients exhibit a positive response to initial treatment, a subset of patients may develop refractory macular holes that necessitate multiple surgeries for closure. In these instances, the utilization of amniotic membrane grafts to aid in the closure of large retinal holes presents a promising alternative. This report details the successful closure of a refractory giant macular hole (15 sq. mm) in a patient using an amniotic membrane graft, with improvement in visual acuity. [ABSTRACT FROM AUTHOR]

Transmission of an airborne disease can occur when an individual exhales respiratory particles that contain infectious pathogens. Surgical face masks are often used to reduce the amount of respiratory aerosol emitted into the environment by an individual while also lowering the concentration of particles the individual inhales. Respiratory aerosol generation is activity-dependent with high person-to-person variability. Moreover, mask fit differs among people. Here, we measure the efficacy of surgical masks (EN14683 Type IIR) in reducing both aerosol (0.3 − 20 µm diameter) and droplet (20 − 1000 µm diameter) emission during breathing, speaking and five speech and language therapy tasks performed by a human cohort. When participants wore a surgical face mask, measured particle number concentrations at the front of the mask were always lower than that for breathing without mitigation in place. For breathing and speaking, the through-mask filtration efficiencies were 80% and 87%, respectively, while for voice therapy tasks the through-mask filtration efficiencies ranged from 89% ("Hey!") to 95% (/a::/). Size-dependent through-mask filtration efficiencies were high (80 – 95%) for particles 0.5 − 2 µm diameter, with masks filtering a greater fraction of larger particle sizes. For particle sizes >4 µm diameter, filtration efficiencies of surgical face masks for all tested respiratory tasks were ∼100%. Surgical face masks significantly reduced the number of particles emitted from all respiratory activities. These results have implications for developing effective mitigations for disease transmission through inhalation. [ABSTRACT FROM AUTHOR]

Objective: This review aims to update healthcare workers on the current scientific understanding of hospital-acquired infections, with a focus on describing the pathophysiology and patterns of antimicrobial resistance, particularly concerning Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. Methods: Data on hospital-acquired infections were collected globally, with a specific emphasis on the Eastern Mediterranean, South-East Asia, Europe, and the Western Pacific regions. Infection rates, predominant pathogens, and antimicrobial resistance patterns were analyzed to provide insights into the current landscape of nosocomial infections. Results: Hospitals in the Eastern Mediterranean and South-East Asia regions reported the highest rates of nosocomial infections (11.8% and 10.0%, respectively), while rates in Europe and the Western Pacific were 7.7% and 9.0%, respectively. Infections typically arise from invasive medical equipment and surgical operations, with lower respiratory tract and bloodstream infections being particularly hazardous. Gram-negative bacterial infections, notably, exhibit worrisome antibiotic resistance patterns, potentially developing multiple mechanisms against various antibiotics. Conclusion: The emergence of antimicrobial resistance presents a significant threat to patient safety, compounded by challenges in discovering new antibiotics. Factors such as high costs and lengthy drug development processes contribute to this concern. Healthcare workers must remain abreast of evolving antimicrobial resistance patterns, especially concerning pathogens like Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, to implement effective infection control measures and preserve the efficacy of existing antimicrobial agents. [ABSTRACT FROM AUTHOR]

Background: The electronic pen needle holder (EPNH) was developed to enhance surgical precision, reduce operative time, and improve patient outcomes. By integrating microergonomics, penization, and electronics with surgical instruments, the EPNH aims to provide surgeons with a tool that minimizes hand strain and maximizes control during delicate procedures. Methods: The EPNH was ergonomically designed to fit the surgeon's hand, using titanium for its strength and biocompatibility. It was manufactured through industrial-grade 3D printing, and its mechanical properties were verified using finite element analysis. A force-sensitive resistor and vibratory mechanism were integrated to provide real-time feedback and assistance during surgeries. Results: Testing by 10 neurosurgeons demonstrated significant precision, control, and efficiency improvements. The EPNH reduced hand strain and fatigue, allowing longer, more comfortable operation times. The time required for suturing tasks has decreased by 40% compared to traditional needle holders. Surgeons reported high satisfaction with the EPNH's performance and usability. Conclusion: The EPNH represents a major advancement in surgical instrument design, offering enhanced precision, reduced hand strain, and increased efficiency. Its innovative features and ergonomic design make it a valuable tool for improving surgical outcomes and transforming microsurgical practices. [ABSTRACT FROM AUTHOR]