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Background: When using Motivational Interviewing (MI), once resistance or ambivalence are resolved and motivation is solidified, many practitioners struggle with how best to transition the discussion toward action planning, while still retaining the spirit and style of client centeredness, i.e., moving from the WHY phase to the HOW phase of counseling in a style that is MI-consistent. For many, there is a perception that the counseling style, skills, and strategies used to build motivation are distinct from those used in the action planning phase. The WHY to HOW transition does not, however, necessitate abandoning a client-centered style for a more overtly educational or directive style. Goal setting, action planning, provision of advice, and relapse prevention can be implemented from an autonomy supportive, MI consistent framework. Method: To this end, this article will present a new class of reflection, which we have termed “action reflections”, that can be used to help bridge the WHY-HOW gap. Action reflections (AR) allow the clinician to maintain a tone and orientation that are consistent with MI, i.e. autonomy support; guiding versus directing, during the action phase of counseling. They differ from reflecting change talk as they focus not on the WHY of change, but the HOW, WHEN, or WHERE. Action Reflections (ARs) also differ from the more common type of reflections such as those that focus on client feelings, rolling with resistance, or acknowledging ambivalence as ARs usually contain a potential concrete step that the client has directly or obliquely mentioned. Like any type of reflection, ARs represent the clinician's best guess for what the client has said or, more apropos here, where the conversation might be heading. Conclusion: This article describes the various types of ARs and provides examples of each to help clinicians incorporate them into their behavior change counseling. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy is considered the 'gold standard' to perform left-lateral sectionectomy with results identical to those of open surgery, yielding decreased postoperative pain and disability, reduced hospital stay, and shortened patient recovery time. As the emphasis on minimizing the invasiveness of surgical techniques continues, laparoendoscopic single site (LESS) surgery is quickly evolving. The purpose of this study was to compare the results of laparoscopic left-lateral sectionectomy performed using the traditional approach or LESS approach with a case-matched analysis for tumor size, type of resection, and surgical indications. Methods: Thirteen patients who underwent LESS left-lateral sectionectomy are considered the study group (LESS group) and compared with 13 patients who underwent left-lateral sectionectomy with traditional laparoscopic approach (conventional group). Results: There were no significant differences between groups for length of surgery (165 min in conventional group vs. 195 min in LESS group), blood loss (150 mL in conventional group vs. 175 mL in LESS group), conversion to open surgery, histological tumor exposure, and requirements of postoperative analgesics. One patient in the LESS group died of cardiac failure due to an unknown severe aortic valve stenosis. No differences were recorded for postoperative complications (23.1% in both groups) and median length of postoperative stay (4 days in both groups). Conclusions: For left-lateral hepatic sectionectomy, LESS surgery is technically feasible and as safe as traditional laparoscopic surgery in terms of intraoperative and postoperative results, even though requiring both hepatobiliary and laparoscopic technique experience. [ABSTRACT FROM AUTHOR]

Background and Aim: During catheter exchange for percutaneous endoscopic gastrostomy (PEG), endoscopic or radiological observation is widely used to confirm that the catheter is placed correctly. However, to carry out these procedures in all patients at every catheter exchange costs time and money. It is therefore important to develop a reliable and safe method, which can also be used outside the clinic, to check the exchanged catheter. We examined the usefulness and safety of intragastric observation using a small-diameter rigid telescope, which can be inserted through the catheter lumen of a PEG tube. Methods: Before and after catheter exchange, observation was carried out using the rigid telescope E02700 (external diameter: 2.7 mm; Nisco Co., Tokyo, Japan). After air insufflation by the novel air-supplying adaptor, the rigid telescope was inserted through the button catheter for observation of the fistula and gastric lumen with guidewire introduction. Next, the old gastrostomy catheter was replaced by a new one, using the guidewire technique. Subsequently, the telescope was re-inserted to check the fistula and gastric lumen. Results: With this technique, observation inside the stomach as well as inside the fistula was achieved without any complication during all 80 exchange trials in the 55 patients studied. A homemade adaptor was used effectively to convey air and water into the stomach during the observation. Conclusion: It is suggested that observation inside the stomach using a small-diameter rigid telescope at the time of gastrostomy exchange is useful and safe for checking the location of the newly fixed catheter. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) <35 kg/m. This is a prospective cohort study. Patients with T2DM and BMI <35 kg/m who underwent SGJB between January 2009 and June 2011 at DIPRECA Hospital, in Santiago, and Hospital Base, Osorno, Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36-62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m (25-34.9 kg/m). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m. [ABSTRACT FROM AUTHOR]

Introduction: We herein report the short-term results of the newly developed modified technique of Billroth I (modified B-I; pylorus reconstruction) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. Patients and Methods: Distal gastrectomy with this technique was performed in 20 patients (age, 41 to 86 years [mean, 68.5 ± 11.8 years], male/female = 12:8) with gastric cancer from June 2006 through December 2009. These patients were compared with another 20 patients who underwent conventional B-I after distal gastrectomy (age, 41 to 85 years [mean, 69.3 ± 8.69 years], male/female = 11:9). The side effects of gastric surgery evaluated in this study were the degree of remnant gastritis, the presence of dumping syndrome, and the degree of weight loss. Results: By gastrografin contrast imaging on the fifth day after pylorus reconstruction, the remnant stomach was not dilated and gastrografin flowed physiologically to the duodenum without backward reflux into the remnant stomach. By gastroscopy at 6 months after the operation, DGR and the degree of remnant gastritis after pylorus reconstruction was lower than those of conventional B-I ( P = 0.00068). The bile acid concentration of remnant gastric juice of pylorus reconstruction was lower than that of conventional B-I (55.5 ± 93.5 vs. 1,369.5 ± 2,502.1 μmol/L, P = 0.0415). Weight loss at 1 year after distal gastrectomy was less in pylorus reconstruction compared with conventional B-I (6.2 ± 5.2% vs. 9.8 ± 8.7%, P = 0.0725). Conclusion: Pylorus reconstruction is a simple and safe anastomotic technique that reduces the side effects of B-I reconstruction. [ABSTRACT FROM AUTHOR]

Abstract: DNA methylation, the conversion of cytosine to 5-methylcytosine, is an important epigenetic modification involved in gene regulation. DNA methylation is essential for normal development whereas abnormal methylation has been implicated in pathological conditions including cancer. To evaluate the extent and variation of genome-wide DNA methylation and its changes during cellular differentiation and tumorgenesis as well as the interplay with histone modifications, accurate and reproducible quantification of the genomic DNA methylation level is required. These measurements have so far been achieved only by sophisticated and costly techniques. Here we report the generation of an enzyme-linked immunosorbent assay (methDNA-ELISA) for the accurate quantification of global DNA methylation levels. The linear region of this methDNA-ELISA ranges from 1 to 10%, making it highly suitable for the typical ranges from 2 to 6% in mammalian genomes. This method requires 10ng of isolated DNA per sample, thus permitting investigation with minimal amounts of DNA previously not applicable for global DNA methylation analysis, e.g., clinical biopsies or cells collected by microdissection. [Copyright &y& Elsevier]

Morphological quantification of the complex structure of hierarchical geomaterials is of great relevance for Earth science and environmental engineering, among others. To date, methods that quantify the 3D morphology on length scales ranging from a few tens of nanometers to several hundred nanometers have had limited success. We demonstrate, for the first time, that it is possible to go beyond visualization and to extract quantitative morphological information from X-ray images in the aforementioned length scales. As examples, two different hierarchical geomaterials exhibiting complex porous structures ranging from nanometer to macroscopic scale are studied: a flocculated clay water suspension and two hydrated cement pastes. We show that from a single projection image it is possible to perform a direct computation of the ultra-small angle-scattering spectra. The predictions matched very well the experimental data obtained by the best ultra-small angle-scattering experimental setups as observed for the cement paste. In this context, we demonstrate that the structure of flocculated clay suspension exhibit two well-distinct regimes of aggregation, a dense mass fractal aggregation at short distance and a more open structure at large distance, which can be generated by a 3D reaction limited cluster-cluster aggregation process. For the first time, a high-resolution 3D image of fibrillar cement paste cluster was obtained from limited angle nanotomography. [ABSTRACT FROM AUTHOR]

Abstract The objective of this paper is to investigate the firm's optimal advertising and pricing strategies when introducing a new product. We extend the existing signaling literature on advertising spending [...]

Abstract With the increase in new product introductions in consumer packaged goods categories, supermarkets are reluctant to accept new products. Therefore, it is very important for manufacturers to convince retailers [...]

Byline: Eric Waarts (1), Berend Wierenga (2) Keywords: competitive response; managerial decision making; new product introductions Abstract: Competitive reactions to new product introductions can be explained by observable characteristics related to the event, and by the interpretations of these factors by the defending competitors. A general model of competitive response is developed to explore the mediating role of interpretation factors between event characteristics and reaction decisions, and to study the contextual factors that moderate the relationship between event characteristics and interpretations. Results clearly demonstrate that if the interpretation factor is not taken into account researchers may overlook the influence of important variables explaining competitive reactions. Also, results indicate heterogeneity among managers regarding their interpretation of observable characteristics. Possible moderating factors are explored. The outcomes of this study are important both for new scientific insights in competitive reaction decision making, and for managers who act in the competitive arena. Author Affiliation: (1) Rotterdam School of Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherland (2) Rotterdam School of Management, Erasmus University Rotterdam, The Netherland Article History: Registration Date: 16/10/2004

Background: Conventionally described standard techniques of forequarter amputation may not be suitable for patients presenting with neglected or maltreated very large tumors of the proximal humerus. Patients and methods: Eleven patients with unsalvageable malignant tumors of proximal humerus, who underwent forequarter amputation using a new technique between Jan 2008 to March 2010, were retrospectively analysed. This new single incision anterior approach involves supine positioning of patients, ligation of axillary vessels in the axilla followed by resection of muscles from lateral border and inferior angle of scapula, resection of lateral one-third of clavicle; resection of muscles from vertebral border and superior angle of scapula by applying superolateral traction without any incision over acromioclavicular axis or posterior scapular skin. Results: The average age was 16.27 year and minimum follow-up was 6 months (range 6-24 months). There were seven males and four females. Average duration of surgery was 62 min (range 55-90). Blood loss ranged from 400 to 750 ml. One patient had superficial infection and one patient with metastatic lesion died at 6 months follow-up. Conclusions: This technique is safe, easy, less time consuming, involves small single incision in supine position, has better wound healing and can be used for both small and large tumors of proximal humerus with or without involvement of axillary vessels. Although there was no local recurrence for last 24 months but a long term follow-up is required to comment on its actual rate. [ABSTRACT FROM AUTHOR]

Objective. It is extremely important to establish sufficient exposure and room for manipulation during endoscopic thyroidectomy. To solve this problem, the authors have developed a new technique for retraction of the strap muscles perfected during 500 cases of breast-approach endoscopic thyroidectomy. Methods. The new technique encompasses the use of 3 styles of retractor: the suture retractor, the button retractor, and the adjustable button retractor. These retractors are all easy to make and are all useful in different situations. Conclusions. The new technique is a safe and cost-effective method. It reduces the operation time required to obtain good exposure without transecting the strap muscles. In addition, it is minimally invasive and confers cosmetic benefits. [ABSTRACT FROM PUBLISHER]

Abstract: In this paper, a new reliable technique for solving systems of Volterra integral equations of the second kind has been introduced. This new method is resulted from HPM by a simple modification. This modification is based on the existence of Taylor expansion of the kernel and source terms. To illustrate the new modification on HPM some examples are presented. Comparisons of the results of applying modified HPM and classical HPM reveal the new technique is very effective and convenient. [ABSTRACT FROM AUTHOR]

Introduction: A model of orthotopic liver transplantation in swine was developed to investigate an advanced reperfusion approach. Thereby, we consciously disclaim otherwise commonly practiced venovenous bypass during the recipient operation. Material and Methods: Ten liver transplantations were performed according to the described technique without using venovenous bypass. In each swine the observation period was 48 h. Results: All transplantations were carried out after a median cold ischemic time of 307.5 min (295-340); the median warm ischemic time in these cases was 25 min (20-32). Eight of 10 swine survived 48 h after the operation. Conclusion: Orthotopic liver transplantations in the recipient swine are feasible even without using venovenous bypass. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The study of the sharp effort makes it possible to check the web thickness, to determine the transverse reinforcements and the diagram of stop of the longitudinal reinforcements. The proposals and suggestions on this subject are diversified, especially relative with the type of the transverse reinforcement most effective, and their positions in the beam. The present study proposes a new method, to show the shearing action developed in the 4-points bending test, on prismatic beams of dimensions 10*20*120 cm, through rods confined by metal grids laid out in the zone of influence of the shearing action tilted to 45°. The influence of shearing on the mechanical behavior of the reinforced concrete structures is quantified by an experimental investigation and a numerical study. The confrontation of the experimental and theoretical results shows a satisfactory agreement. [ABSTRACT FROM AUTHOR]

Caudal block is one of the most popular and effective techniques of regional anesthesia in pediatric surgery. Good anatomic knowledge and accurate adherence to guidelines pertaining to the technique and to drug administration is necessary to perform this block safely. The usual approach is well-known and has been extensively described, but failure is seen in some cases. Another approach is the 'no turn' technique, which is a new method developed in the Ain-Shams University, Pediatric Surgical Unit by the author. It has a high success rate and can be easily learned and implemented even by junior staff. [ABSTRACT FROM AUTHOR]

The article presents a study of analyzing the correlation of papillomaviruses (HPV) deoxyribonucleic acid (DNA) and lymph nodes in cervical cancer patients. It mentions that 18 cervical cancer patients were included in the study and surgical procedure which consists of systematic pelvic lymphadenectomy, followed by radical hysterectomy is performed. It resulted to a non significance correlation between positive HPV DNA test in the cervix and lymph node metastasis.

This paper presents a new surgical technique of inguinal hernia repair in which both crura of the aponeurosis of the external oblique abdominal muscle and transverse fascia were used for complex reconstruction of the entire musculopectineal hiatus. Between 2nd December 2003 and 29th April 2005, 250 patients (233 male and 17 female) underwent inguinal hernia repairs using our own technique. The inguinal canal was opened together with the posterior wall, dividing the transverse fascia into two flaps. The lower flap was inserted into the femoral opening and sewn to the pectineal ligament, whereas the upper flap with both crura of the aponeurosis of the external oblique abdominal muscle were used for three-fascia reconstruction of the posterior wall of the inguinal canal. The study group was randomly chosen from patients undergoing surgery due to inguinal hernias in our hospital. Procedures were carried out under subarachnoid anaesthesia; postoperative pain was treated with methamizol or ketoprofen. Patients were discharged 48 h after surgery. The postoperative complications included one hernia recurrence and one testicular atrophy. The remaining complications were transient and included prolonged wound healing, transient skin hypoaesthesia around the wound or testis oedema. The technique used strengthens the musculopectineal hiatus, effectively preventing recurrences of inguinal as well as femoral hernias. [ABSTRACT FROM AUTHOR]

Background: This paper presents the outcomes of inguinal hernia repairs in 1520 patients operated on between 1998 and 2007. The musculopectineal hiatus was reconstructed with both crura of the aponeurosis of the external obNque abdominal muscle and the transverse fascia using our own technique, Material and methods: In the 10-year period analysed, three periods were distinguished in which successive modifications of the surgical technique were used. Period I (255 repairs) -- the inguinal canal alone was secured to provide protection against hernia recurrences. Period II (497 procedures) plasticity of the inguinal canal was carried out; in patients with increased risk of development of a femoral hernia found intrsoperatively, the femoral ring was additionally secured, thus complex reconstruction of the entire musculopectinesl hiatus was performed. Period III (766 procedures) complex reconstruction of the entire musculopectinest hiatus was performed in all patients, irrespective of the hernia type and the extent of fascial tissue impairment. Results: In one case, the urinary bladder was intraoperatively injured, which was diagnosed and secured without further consequences in the postoperative course. Amongst 1520 repairs performed, 35 inguinal hernia recurrences and 14 femoral hernia recurrences were observed. In the early postoperative period, complications such as prolonged wound healing, skin hypoaesthesia around the wound or testis oedema were transient, and typical of inguinal hernia repairs from external access in terms of their number and quality. Conclusions: Complex reconstruction of the musculopectineal hiatus, as a management standard, virtually eliminated the possibility of hernia recurrences. The modifications introduced were found to be suitable as the suggested technique secures all places of decreased resistance of the groin. [ABSTRACT FROM AUTHOR]

Wstęp: Przedstawiono wyniki leczenia operacyjnego 1520 pacjentów z przepukliną pachwinową, zope-rowanych w latach 1998-2007, u których do plastyki rozworu mięśniowo-grzebieniowego wykorzystano obie odnogi rozcięgna mięśnia skośnego zewnętrznego brzucha i powięź poprzeczną według własnego sposobu operacyjnego. Materiał i metody: W analizowanym 10-leciu wyszczególniono 3 grupy chorych, w których stosowano kolejne modyfikacje metody operacyjnej. Okres I (255 operacji) -- przed nawrotem przepukliny zabezpieczano jedynie kanał pachwinowy. Okres II (497 operacji) -- wykonywano plastykę kanału pachwinowego, a u chorych, u których śródoperacyjnie stwierdzono podwyższone ryzyko powstania przepukliny udowej, zaopatrywano dodatkowo pierścień udowy, wykonując tym samym kompleksową naprawę catego rozworu mięśniowo-grzebieniowego. Okres III (768 operacji) -- z założenia wykonywano kompleksową naprawę całego rozworu mięśniowo-grzebteniowego u wszystkich chorych, niezależnie od charakteru przepukliny i stopnia osłabienia tkanek powięziowych. Wyniki: W jednym przypadku śródoperacyjnie uszkodzono pęcherz moczowy, co zostało rozpoznane i zaopatrzone, bez dalszych powikłań pooperacyjnych. W całkowitej liczbie 1520 przeprowadzonych operacji stwierdzono: 35 nawrotów przepukliny pachwinowej i 14 przepukliny udowej. We wczesnym okresie pooperacyjnym powikłania, takie jak: przedłużone gojenie rany, przejściowa niedoczulica skóry wokół rany czy obrzęk jądra, miały charakter przejściowy, były typowe dla operacji przepukliny pachwinowej z dostępu zewnętrznego, zarówno co do liczby, jak i jakości powikłań. Wnloski: Kompleksowa naprawa rozworu mięśniowo-grzebieniowego, zastosowana jako standard postępowania, praktycznie wyeliminowała możliwość powstania przepukliny nawrotowej. Wprowadzone modyfikacje należy uznać za celowe, proponowana technika operacyjna zaopatruje wszystkie miejsca zmniejszonej oporności pachwiny [ABSTRACT FROM AUTHOR]

Aim: Prolongation of pregnancy in cases of fetal membrane prolapse into the vagina during the second trimester is difficult using conservative therapy. After pushing the membranes back into the cervix, emergency cervical cerclage may be advantageous in improving the neonatal outcome. We have been managing membrane repositioning and emergency cervical cerclage with a technique using a rubber balloon device (known as a ‘ mini metreu’ in Japan), and we examined the efficacy of this technique in five cases. Methods: Our management was as follows: Initially, the full bladder technique was attempted under general anesthesia. If this was not effective, amnioreduction was performed by transabdominal amniocentesis. After the membrane repositioning using a mini metreu, double suture cervical cerclage (McDonald method + Shirodkar method) was performed. Results: The diameter of the bulging prolapsed membranes ranged from 30–84 mm, with a mean of 52 mm. Cerclage was successfully performed in all of the five cases. Prolongation of the pregnancy period was from 22–107 days (average; 77.6 ± 28.9 days). In cases 1–4, healthy newborns were delivered, but in case 5 sudden intrauterine fetal death due to umbilical cord complications occurred at 24 weeks of gestation. Conclusion: It appears that long-term prolongation of pregnancy is possible, when performing membrane repositioning using the mini metreu and emergency cervical cerclage for fetal membrane prolapse into the vagina. [ABSTRACT FROM AUTHOR]

Gynecomastia is an extremely disturbing deformity affecting males, especially when it occurs in young subjects. Such subjects generally have no hormonal anomalies and thus either liposuction or surgical intervention, depending on the type and consistency of the breast, is required for treatment. If there is slight hypertrophy alone with no ptosis, then subcutaneous mastectomy is usually sufficient. However, when hypertrophy and/or ptosis are present, then corrective surgery on the skin and breast is mandatory to obtain a good cosmetic result. Most of the procedures suggested for reduction of the male breast are usually derived from reduction mammaplasty methods used for females. They have some disadvantages, mainly the multiple scars, which remain apparent in males, unusual shape, and the lack of symmetry with regard to the size of both breasts and/or the nipple position. The author presents a new, simple method that has proven superior to any previous method described so far. It consists of a horizontal excision ellipse of the breast’s redundant skin and deep excess tissue and a superior pedicle flap carrying the areola-nipple complex to its new site on the chest wall. The method described yields excellent shape, symmetry, and minimal scars. A new method for treating gynecomastis is described in detail, its early and late operative results are shown, and its advantages are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Non-destructive observation methods for coarse sediments are usually limited to two dimensions, for instance in opened cores or at the surface. We report a trial of a promising new method for three-dimensional imaging of gravelly sediments: Magnetic Resonance Imaging (MRI). MRI maps contrasts in density and relaxation properties of protons, which are very different for sediment and water in the pores. Images of glass bead mixtures show that the local porosity varies with sorting patterns or imperfect sample mixing, illustrating the potential for this non-destructive imaging method. As a quantitative test, we verify that a macroscopic sediment property – porosity – compares well to a standard lab determination and a recent model for predicting porosity for arbitrary grain size distributions. Finally we discuss potential applications and limitations of MRI to porosity and permeability, sedimentary structures, benthic life and slow groundwater or mass flows. [Copyright &y& Elsevier]

Purpose: We propose a new technique of regional anesthesia that combines suprascapular nerve block (SSNB) and axillary nerve block (ANB) in arthroscopic shoulder surgery. Methods: Twenty consecutive patients undergoing arthroscopic procedures for shoulder cuff diseases were included in the trial. SSNB was performed by introducing the stimulating needle approximately 2 cm medial to the medial border of the acromion and about 2 cm cranial to the superior margin of the scapular spine until supraspinatus or infraspinatus muscle contractions were elicited. Following negative aspiration, 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected. ANB was performed; a line was drawn between the lateral-posterior angle of the acromion and the olecranon tip of the elbow. The location was about 2 cm cranial to the convergence of this line with the perpendicular line from the axillary fold. The needle was introduced approximately 2 cm cranial to this crossing point to elicit deltoid muscle contractions, and another 15 mL of the same anesthetic mixture was injected. Five mL of the same mixture was injected into each portal of the arthroscopic area. During surgery, patients were sedated with the use of midazolam. General anesthesia was not performed. Acceptance of the technique was assessed through a postsurgical survey of those treated. Results: No serious complications occurred. None of the patients required opiates, analgesics, or general anesthesia during the surgical procedure. Postoperative pain control, which was assessed using a visual analog scale, was effective during the observation time. The total demand for nonopiate analgesics during the first 24 postoperative hours was negligible. Patient satisfaction and comfort were satisfactory. Conclusions: Combining SSNB and ANB is an effective and safe technique for intraoperative anesthesia and postoperative analgesia for certain procedures of shoulder arthroscopic surgery. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Abstract: Background: The morbidity and mortality rates of anastomosis leakage of the gastrointestinal system, are high. In this study we covered the colonic anastomosis with polypropylene mesh on the safety of the anastomosis was investigated. Methods: Twenty female albino rabbits were divided into two groups. First of all, a segmental colon resection was performed in both the groups and a single layer of anastomosis was made. In addition, a polypropylene mesh as long as the circumference of the anastomosis in the study group. All the rabbits were sacrificed on the 10th postoperative day and the explosion pressure of the anastomosis, histopathological investigation of the anastomotic contour, and peritoneal adhesion were compared. Results: The anastomoses of all the subjects in the control group had exploded and the average explosion pressure was 149 ± 16 mmHg. However, in the study group, the anastomoses did not explode in nine (90%) of the subjects, whereas it exploded in only one (10%) with a pressure of 260 mmHg. The average explosion pressure in the study group was 315 ± 30 mmHg (p < 0.0001). No significant difference was established between the groups according to the histopathological classification of the anastomotic contour performed according to the Ehrlich–Hunt model (p > 0.05). Peritoneal adhesions of the groups is not statistically different (p > 0.05). Conclusion: During the short follow-up period, this new technique significantly increased the safety of the anastomosis, moreover it did not cause any increase in peritoneal adhesions. This success has most probably occurred as a result of the external mechanical support to the anastomosis. [Copyright &y& Elsevier]

Abstract: The switching behavior of a previously fabricated and tested SiC transistor is studied in Class-C amplifier in TCAD simulation. The transistor is simulated for pulse input signals in Class-C power amplifier. The simulated gain (dB), power density (W/mm) and power added efficiency (PAE%) at 500MHz, 1, 2 and 3GHz was studied using computational TCAD load pull simulation technique. A Maximum PAE of 77.8% at 500MHz with 45.4dB power gain and power density of 2.43W/mm is achieved. This technique allows the prediction of switching response of the device for switching amplifier Classes (Class-C–F) before undertaking an expensive and time consuming device fabrication. The beauty of this technique is that, we need no matching and other lumped element networks for studying the large signal behavior of RF and microwave transistors. [Copyright &y& Elsevier]

The article presents abstracts of several studies on environmental geochemistry. Some of the abstracts presented include "Biogeochemical Cycling of Nutrients in Karstic Catchments, Southwestern China: Linkages to Changes of Eco-Environments," by Congqiang Liu and "Emerging Organic Contamination in China," by Guibin Jiang and colleagues.

Background: In 1995, Morinaga reported a new technique for the treatment of hemorrhoids, hemorrhoidal artery ligation (HAL), which uses a specially designed proctoscope coupled with a Doppler transducer for identification and ligation of hemorrhoidal arteries. Methods: Because the arteries carrying the blood inflow are ligated, internal pressure of the plexus hemorrhoidalis is decreased. Results: We report the results of the first 308 patients (189 male and 119 female; median age 50.1 years) who have been treated at our department since 2002 and followed-up for a median period of 18 months. Eighty-nine patients had grade II, 192 patients had grade III, and 27 patients had grade IV hemorrhoids. The acute symptoms of hemorrhoids were treated immediately by performing HAL. Conclusions: Our study showed that HAL is painless, effective, and has a low rate of complications. It can be applied in an outpatient setting and is an good alternative to all other hemorrhoid treatment methods. [ABSTRACT FROM AUTHOR]

Background: This paper presents the results of the operative treatment of patients with femoral hernias using our own method. Material and methods: Between 3.04.98 and 14.12.2004, 35 patients underwent femoral hernia repair using a transinguinal access. The hernia ring was secured with a pediculated flap taken from the medial crus of the aponeurosis of the external oblique abdominal muscle; the inguinal canal was strengthened by duplication of the transverse fascia and lateral crus of the aponeurosis. Results: During the postoperative period, neither femoral nor inguinal hernia recurrences were found; the wounds were healed by first intention. In only 3 patients was transient hypoaesthesia within the fossa ovalis skin observed, which subsided spontaneously. No other complications developed. Conclusions: A transinguinal access provides good conditions for repair of the femoral hernia sac and for intraoperative diagnosis of multiple hernias as it is safe in the preparation of femoral foramen structures. The operative technique proposed strengthens the myopectoneal hiatus without causing tension, effectively preventing recurrences of femoral and inguinal hernias. The use of the patient's own fascial tissue (pediculated fascial flap) in the vicinity of the femoral vein and deep lymphatic system of the lower limb is safe and creates no risk of thrombosis or lymphorrhagia. [ABSTRACT FROM AUTHOR]

Objective: To develop a technique that would permit the identification of dendritic cells (DC) in small volumes of preterm neonatal cord blood in order to investigate neonatal immune response in relation to infection and preterm labor. Methods: We used three-color flow cytometry and a fixed quantity of fluorospheres to determine absolute cell numbers. Four red cell lysis techniques, sample dilution, time delay experiments, and a comparison with traditional Ficoll cell separation techniques were performed. Absolute numbers of DC recovered using each technique were calculated and compared. Results: With increasing time delay, there was a statistically significant reduction in the numbers of leukocytes in adult blood. In contrast, there was a significant increase in leukocytes in umbilical cord blood. Sample dilution did not significantly affect the total number of leukocytes or DC. The use of the reagent Optilyse B (Immunotech, Oxford, UK) combined with an additional washing step produced the best discrimination of all populations based on light scatter properties. For the same blood sample, antibody labeling of whole blood resulted in a greater recovery of DC when compared to prior cell purification using a Ficoll density gradient. Conclusion: Using traditional Ficoll cell separation, cell manipulation requires large volumes of blood and leads to cell loss and alteration in phenotype. We have validated a novel method using small volumes of whole blood, diluted if necessary, and using red cell lysis to enable analysis of small volumes of preterm neonatal cord blood. This may permit further analysis of the contribution of the fetal immune response in the development of spontaneous preterm labor and preterm birth due to infection. [Copyright &y& Elsevier]

Background: This paper presents the results of surgical treatment of patients with large scrotal hernias with the hernial sac left and drained using Redon's method. Material and methods: Between 10.07.1998 and 03.12.2004, sixty patients underwent indirect scrotal hernia repairs. The inguinal canal was reconstructed with the peduncled fascial flap taken from the medial crus of the aponeurosis of the external oblique abdominal muscle. The second basic element of surgery involved leaving the funicular part of the hernial sac in place having been drained using Redon's method with hypotension. The drain was removed between the 2nd and 4th postoperative day, depending on any persisting leakage. The average time of removal was 48 hours. Results: During the postoperative period the following complications developed: 3 recurrences, 13 cases of transient testis oedema, 6 cases of hypoasthesia in the operation wound area, 2 cases of epidydimitis, 1 scrotal hydrolece in the hernial sac, 1 purulent testitis requiring amputation of the testis together with the spermatic cord. Conclusions: The operative technique used strengthens the inguinal canal without causing tension, effectively preventing recurrences of inguinal as well as femoral hernias. Leaving the peripheral hernial sac in place eliminates possible intraoperatrive damage to the spermatic cord while Redon's drainage method provides good conditions for the accretion of the walls of the sac and its later atrophy. [ABSTRACT FROM AUTHOR]

There is no optimum surgical method of repair for rectoceles; however, recent interest in the use of the circular hemorrhoidal stapler gun to treat rectoceles has stirred interest. We describe our early results using the circular hemorrhoidal stapler gun for repair of rectoceles. Seven patients (median age, 45 (range, 31-62) years; all females) have been treated. All seven patients presented with incomplete or difficult defecation, four patients required digital vaginal manipulation, and all patients had tried a variety of aperients to aid defecation. The procedure involved two pursestrings and one firing of the circular hemorrhoidal stapler gun. No perioperative complications were encountered. At a median of six (range, 1- 10) months follow-up, all patients were able to defecate without difficulty or manipulation. None of the patients required any medication to aid bowel evacuation after surgery. These promising early results support the use of stapled mucosectomy for the repair of rectoceles. [ABSTRACT FROM AUTHOR]

Conservative surgery has become the treatment of choice for diffuse jejunoileal Crohn’s Disease. Previous research described a conservative approach both for multiple strictures located in close proximity to each other and for long stenoses. The side-to-side enteroenteric anastomosis has gained popularity and has lead to nonresectional surgery even for those patients who, until now, were considered suitable only for resection. This technique however, presents in our hands some disadvantages represented mainly by early restenosis at the two edges of the strictureplasty, probably caused by the sutures between the diseased and the thickened part of the bowel. We propose a new technique called “side-to-side diseased to disease-free anastomosis,” which consists of dividing the bowel and the mesentery at the beginning of the stenoses and suturing the disease-free bowel above the stenoses to the diseased bowel. This procedure could avoid early restenosis at the two ends of the strictureplasty. Moreover, it is faster and safer to perform because the knots of the sutures are tied to the normal bowel with less risk of bleeding. [ABSTRACT FROM AUTHOR]

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A new technique used for polishing chemical vapor deposition (CVD) diamond films has been investigated, by which rough polishing of the CVD diamond films can be achieved efficiently. A CVD diamond film is coated with a thin layer of electrically conductive material in advance, and then electro-discharge machining (EDM) is used to machine the coated surface. As a result, peaks on the surface of the diamond film are removed rapidly. During machining, graphitization of diamond enables the EDM process to continue. The single pulse discharge shows that the material of the coated layer evidently affects removal behavior of the CVD diamond films. Compared with the machining of ordinary metal materials, the process of EDM CVD diamond films possesses a quite different characteristic. The removal mechanism of the CVD diamond films is discussed. [ABSTRACT FROM AUTHOR]

A new technique of integral representations in ℂ n , which is different from the well-known Henkin technique, is given. By means of this new technique, a new integral formula for smooth functions and a new integral representation of solutions of the ∂-equations on strictly pseudoconvex domains in ℂ n are obtained. These new formulas are simpler than the classical ones, especially the solutions of the ∂-equations admit simple uniform estimates. Moreover, this new technique can be further applied to arbitrary bounded domains in ℂ n so that all corresponding formulas are simplified. [ABSTRACT FROM AUTHOR]