Direct Pressure Research Articles

Resection and postoperative pazopanib for intraspinal recurrent solitary fibrous tumor: illustrative case.

Intracranial solitary fibrous tumors (SFTs) rarely recur in the spinal space. Only 4 cases of spinal recurrence from intracranial SFT have been reported; therefore, the optimal treatment of recurrent spinal SFT remains unclear. A 53-year-old woman with a history of resection of a right occipital anaplastic SFT presented with progressive back and side pain. She was diagnosed with an intradural extramedullary tumor ventral to the spinal cord at the T5-7 level. She underwent tumor resection with T5-6 laminectomy and T4 and T7 partial laminectomy. The tumor was completely removed in a piecemeal fashion using an ultrasonic aspirator with careful control of bleeding. Her symptoms quickly improved after the surgery, and she returned to normal life. The tumor was diagnosed as SFT. Pazopanib was administered postoperatively. Despite the recurrence of the intracranial tumor, the patient was alive without recurrence of the spinal tumor 14 months after resection. Although rare, intracranial SFTs have a risk of spinal recurrence. Complete resection of a recurrent spinal SFT can be achieved even in the ventral location. Pazopanib could be a possible therapeutic option for preventing local tumor recurrence in the management of recurrent spinal SFT. https://thejns.org/doi/10.3171/CASE24217.

Awareness of school teachers about students common emergencies during school time in the eastern region, Saudi Arabia: A cross-sectional study.

Schools have to ensure student safety and well-being. However, medical emergencies involving injuries are common, requiring teachers to provide prompt first aid before professional care arrives. This study assessed knowledge and awareness of first aid among school teachers to identify areas needing improvement. This cross-sectional study surveyed 371 teachers from the eastern region primary schools using a standardized questionnaire assessing first aid knowledge across areas like bleeding control, fractures, seizures, choking, and burns. Demographic factors were analyzed for correlations with knowledge levels. Pearson's Chi-square tests analyzed bivariate relationships comparing correct knowledge identification percentages across teacher sociodemographic. The level of statistical significance was at a P value <0.05 across tests. Only 157 teachers felt able to appropriately handle medical emergencies. Major knowledge gaps existed regarding airway obstruction and chemical injuries, with 168 unable to identify correct responses for choking first aid and 105 unsure of chemical burn management steps. Appropriate fracture management was lacking, with just 70 correctly endorsing nose pinch for nosebleeds. Cardiopulmonary resuscitation knowledge was inadequate, with 57 of teachers unaware of the basics. Teachers demonstrating higher knowledge levels overwhelmingly had prior first aid training (153, 66.5%) compared to untrained counterparts (89, 63.1%). The study revealed poor first aid knowledge among elementary school teachers for effectively managing child emergencies. Strategies enhancing delivery must address barriers around training access, knowledge attrition, and variability in baseline skills through sustainable system-wide policies applied nationally. Fulfilling schools' ethical obligations toward maintaining student safety requires urgent reforms to bolster emergency preparedness.

A Clinical Comparison of ErCr:YSGG Laser and Scalpel Techniques in Gingival Depigmentation.

Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. We conducted a double-blind, randomized trial with a split-mouth design. Forty participants were selected from the university's dental clinic and randomly assigned to receive either the Er,Cr:YSGG laser (2780 nm) or surgical scalpel. Pain intensity and smile satisfaction were assessed post-surgery, and treatment duration was evaluated. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and to track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and to monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (p > 0.05). A significant examiner variability was noted in GMR scoring (β &#61; -1.2 for Examiner 2; p < 0.001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). Patient satisfaction with smile significantly improved (p < 0.001). Treatment type did not influence postoperative pain levels. The Er,Cr:YSGG laser required longer surgery times (p < 0.001). Under the conditions of the present study, both Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures.

Detection of contractility changes in the heart from arterial blood pressure data using symmetric Projection Attractor Reconstruction

The potential for unintended drug induced changes in cardiac contractility is a major concern in medicines development. Whilst direct left ventricular pressure (LVP) measurement is the gold standard for measuring cardiac contractility in vivo, it is resource intensive and poses a welfare burden on research animals. In contrast, arterial blood pressure (BP) measurement has fewer challenges. Symmetric Projection Attractor Reconstruction (SPAR) is a signal processing technique which transforms physiological time-series signals into a corresponding visual image (‘attractor’), amplifying morphology changes within physiological waveforms. It was hypothesized that SPAR analysis of BP signals would provide a surrogate measure of cardiac contractility by specifically amplifying the maximum slope of the systolic upstroke. BP (abdominal aorta) signals obtained from beagle dogs, treated with positive and negative inotropes, were retrospectively analysed to identify signal features that correlated with the maximum upslope of the LVP signal from simultaneously acquired LVP recordings. SPAR transformation of BP signals quantified drug induced changes in the maximum slope of the systolic upstroke. We identified key SPAR metrics that provided >0.8 correlation with the LVP maximum upslope, outperforming the BP systolic upstroke alone. This was observed for all 4 different drugs, doses and time points evaluated across studies. Thus, we conclude that the SPAR measures derived from the BP signal could be used as a first pass in vivo screen to flag any risk of drug induced changes in cardiac contractility during the conduct of non-clinical medicines development, potentially reducing or replacing the need to perform direct left ventricular measurements.

Hemostatic nanofibers/chitosan composite aerogel for potential chemo-photothermal therapy

Incomplete resection of tumor tissue and bleeding during skin cancer surgery can easily lead to early tumor recurrence and metastasis. In this study, a three-dimensional doxorubicin (DOX) loaded poly (lactic-co-glycolic acid) (PLGA) nanofibers/chitosan (CS) aerogel composite with hemostasis and chemo-photothermal effect was successfully prepared by electrospinning and lyophilization. The highly porous PLGA/MXene/DOX nanofibers@CS aerogel (PMD@CS) demonstrated exceptional photothermal conversion and pH/temperature-responsive drug release properties, which inhibited the growth of tumor cells, showing a potential chemo-photothermal effect. Furthermore, the nanofibers/aerogel composite showed desired hemostatic efficacy and biocompatibility, with a blood coagulation index of 65.1 ± 1.9% and a blood coagulation time within 3 min, indicating its potential for rapid bleeding control. This nanofibers/aerogel composite with bifunction of chemo-photothermal synergetic therapy and hemostasis can be an antineoplastic biomedical material for the prevention of postoperative tumor recurrence and metastasis.

Gear contact fatigue prediction under mixed elastohydrodynamic lubrication with ellipsoidal asperity rough surface: Experimental and numerical investigation

A three-dimensional(3D) line-contact mixed lubrication model and contact fatigue life prediction model for gears are established, considering the elastoplastic contact of ellipsoidal asperities and their interactions. The localized lubrication states across the actual 3D rough surfaces are visually depicted. The direct asperity contact pressures calculation exhibits greater accuracy and universality. The proposed mixed lubrication model can be applied accurately and efficiently to heavy-load conditions. The synergistic mechanisms of multi-scale surface integrity parameters, such as surface morphology-lubrication coupling, hardness gradient, and residual stress, on gear contact fatigue has been revealed. The results reveal that surface roughness significantly affects the competitive failure mechanism between surface-initiated micropitting and subsurface-initiated macropitting. The increase in surface compressive residual stress is more sensitive to the enhancement of near-surface and subsurface fatigue lives, compared to the increase of peak residual stress and the depth of peak residual stress. The proposed physics-based gear contact fatigue life prediction model has been validated through gear contact fatigue experiments under various operating conditions. The maximum deviation between the predicted and experimental fatigue lives is within 10%. This paper presents theoretical methodologies and data-driven support for optimizing the design and manufacturing processes of gears, specifically focusing on enhancing anti-fatigue properties.

Intracapsular Enucleation of Cervical Sympathetic Chain Schwannoma: Improved Strategy of Intraoperative Hemostasis and Better Outcome.

Objective: Intracapsular enucleation (ICE) of cervical sympathetic chain schwannoma (CSCS) is associated with technical difficulties, with diffuse hemorrhage being the main challenge in our previous attempts. This article presents our new strategy for achieving better hemostasis during ICE procedures in CSCS cases. Methods: A retrospective review of CSCS cases treated at our tertiary medical institution was undertaken between April 2018 and February 2024. Only cases with successful ICE were included. Results: A total of 8 cases were included, with 4 male and 4 female patients and an age range of 23 to 77 (average and median ages were 48.5 and 49.5 years, respectively). The presenting symptom was a neck mass for all the patients, with 4 masses on the left and 4 on the right sides. Enucleation was first undertaken for the first 3 cases (before March 2022), followed by hemostasis; this strategy was quite difficult and time-consuming. For the remaining 5 cases, a new strategy was developed to preemptively manage any potential nourishing vessel between the capsule and tumor parenchyma, which significantly decreased operation time (P = .0155) and facilitated hemorrhage control. First bite syndrome (FBS) was avoided in all cases. Postoperative Horner's syndrome (HS) was avoided in 1 patient (Case 6, new strategy) but occurred in 7 patients, taking 8 days to 1 month to recover with the new strategy (4 patients), significantly shorter (P = .0364) than before (3 patients, 1-3 months). The median duration of follow-up was 20 months. No recurrence was documented. Conclusions: ICE was achieved for CSCS cases, especially with our newly developed strategy, by preemptively and securely managing potential nourishing vessels. Operation time and duration of recovery of postoperative HS could both be shortened. Moreover, FBS could be avoided.

Control of Haemorrhage in Orthopaedic Trauma.

This paper aims to outline current practices and examine promising new advancements in the modern management of haemorrhage in orthopaedic trauma. Many prehospital and perioperative haemorrhage control strategies and techniques have been available to clinicians for multiple decades, yet our understanding and utilisation of these practices continues to be refined and optimised. There is a particular focus in this article on issues related to resuscitation and coagulation in trauma. We examine the complex mechanisms that lead to coagulopathy in trauma patients as well as the transformative effect tranexamic acid has had in limiting blood loss. We also explore some emerging technologies such as endovascular interventions and clot-stabilising dressings and devices that are likely to have a significant impact going forward.

Persistent varices in cured patients: Understanding the role of hepatic venous pressure gradient

Background & AimsEtiologic factor removal (ER) drives recompensation and improves portal hypertension in cirrhosis. Esophageal varices (EV) and portosystemic shunts (PSS) have been found in patients despite hepatic vein pressure gradient (HVPG) dropping below 10mmHg after ER, questioning HVPG accuracy in reflecting true portal pressure in the setting of ER. We aim to evaluate the correlation of HVPG with direct portal pressure (DPP) in patients with persistence of EV after ER despite HVPG < 10mmHg. MethodsBicentric "proof of concept" study evaluating HVPG and ultrasound guided percutaneous DPP in patients with HCV or alcohol related cirrhosis with persistent varices, and HVPG<10mmHg after at least 5 years of ER. Results7 patients with HCV and 3 with alcohol-related cirrhosis with persistent varices, and HVPG <10mmHg after at least 5 years of ER were included. At evaluation, all patients had a patent portal vein and were compensated. Median platelet counts were 129.5 (95-145) 10ˆ9/ml, and LSM 16.15 (14.4-22.3) kPa. In 5 patients, EV remained the same size (2 large and 3 small), and 5 downsized to small after ER. Wedge hepatic vein pressure [Median 19 (16.5-20) mmHg] and portal pressure [Median 18 (15-19.5) mmHg] had an excellent correlation (R =0.93, p<0.0001). Portal pressure gradient (PPG) confirmed the absence of clinically significant portal hypertension as identified by HVPG across all the patients. ConclusionHVPG accurately reflects PPG in the context of HCV and alcohol-related cirrhosis regression. After ER, EV may persist despite HVPG <10mmHg. The benefit of prophylaxis in patients with EV and HVPG <10mmHg is unknown. Future studies with clinical endpoints are needed to validate our findings. Impact and implicationsDespite a favorable evolution after removal of the etiological factor, varices persist in some patients and there is a lack of concise guidelines for the evaluation and management of portal hypertension in this population. Our research underscores the persistence of varices in absence of clinically significant portal hypertension, and significantly, demonstrates the accuracy of hepatic venous pressure gradient (HVPG) in reflecting portal vein pressure in this specific patient group. These findings emphasize the crucial role of HVPG in the assessment of portal hypertension after etiological factor removal and lay the groundwork for further investigation into clinical outcomes and the necessity of non-selective beta-blockers (NSBB) in individuals with persistent varices after the removal of etiologic factor.

Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection

BackgroundDengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases.Case PresentationA 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay.ConclusionsDengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.

Ecological Perspective, Perception, and Attitude of Local Communities Toward Managing and Utilizing the Mangrove Ecosystem in Lampung Province, Indonesia

Mangrove damage is caused by environmental changes in the surrounding area as well as direct and indirect pressures on the existence of mangroves. The preservation of mangrove forests is inseparable from the perceptions and behavior of the community in managing and utilizing mangrove forests. Community decisions to take action in the environment will be rooted in the reciprocal relationship created between humans and their environment. This research investigates the history of mangrove management and the ecological perspectives, attitudes, and perceptions of communities toward managing and utilizing mangroves and compares the management and ecology of two mangrove areas in Lampung Province, Indonesia. This study used structured questionnaires with 97 respondents in Margasari and 48 in Sidodadi who live around mangrove forests. The question related to utilizing mangrove ecology, community perceptions of mangrove forests, and participation in mangrove management. The results showed that the people of Margasari and Sidodadi had positive perceptions of mangrove forests. The number and frequency of people participating in mangrove management in Sidodadi were higher than those in Margasari, but in general, the participation in both villages was low. Neither village utilizes mangrove timber. The utilization of nontimber mangrove products in Margasari is more diverse than in Sidodadi; Margasari has ten types of utilization, while Sidodadi has only four types. The condition of mangrove vegetation cover during the last ten years has the same trend; mangrove cover area has decreased, although there was a slight increase in Sidodadi. Different factors influence the decrease; in Margasari, it is influenced by natural factors, while in Sidodadi, it is influenced by human factors.

Platelet transfusion prior to major surgery in a thrombocytopenic dog

AbstractFresh platelet concentrate (FPC) is described as the product of choice for the control of bleeding due to severe thrombocytopenia and has recently become commercially available in the UK. We report a successful, prophylactic FPC transfusion when given in combination with tranexamic acid prior to fracture repair in a 4‐year‐old Whippet. The patient presented with right radial and ulnar fractures and severe thrombocytopenia (platelet count 23 × 109/L). Viscoelastic coagulation monitoring (VCM) revealed coagulopathy, with prolonged clot formation times, but other coagulation parameters were within normal limits. One unit (65 mL) of FPC was given pre‐operatively. The dog underwent surgery without excessive bleeding and experienced no complications. Post‐transfusion VCM showed improved clot formation and clot strength. Transfusion of FPC in combination with tranexamic acid increased this dog's ability to clot, suggesting that it is an effective perioperative therapy for severely thrombocytopenic patients requiring urgent surgery.

Pneumonectomy following penetrating trauma with ECMO as postoperative support: case report – (Lung trauma and ECMO)

BackgroundPenetrating thoracic injuries have a significant risk of morbi-mortality. Despite the advancements in damage control methods, a subset of patients with severe pulmonary vascular lesions and bronchial injuries persists. In some of these cases, post-traumatic pneumonectomy is required, and perioperative extracorporeal membrane oxygenation (ECMO) support may be required due to right ventricular failure and respiratory failure.Case descriptionA male was brought to the emergency department (ED) with a penetrating thoracic injury, presenting with massive right hemothorax and active bleeding that required ligation of the right pulmonary hilum to control the bleeding. Subsequently, he developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his condition and facilitate recovery.ConclusionsPenetrating thoracic injuries with severe pulmonary vascular lesions may need pneumonectomy to control bleeding. ECMO support reduces the associated mortality by decreasing the complications rate. A multidisciplinary team is essential to achieve good outcomes in severe compromised patients.

Protective effects of 2-methoxyestradiol against hypoxic pulmonary hypertension in neonatal rats

To investigate the protective effects of 2-methoxyestradiol (2ME) against hypoxic pulmonary hypertension (HPH) in neonatal rats. Ninety-six Wistar neonatal rats were randomly divided into a normoxia group, a hypoxia group, and a hypoxia + 2ME group, with each group further subdivided into 3-day, 7-day, 14-day, and 21-day subgroups, containing eight rats each. The hypoxia and hypoxia + 2ME groups received daily subcutaneous injections of saline and 2ME (240 μg/kg), respectively, while the normoxia group was raised in a normoxic environment with daily saline injections. Right ventricular systolic pressure (RVSP) was measured using the direct pressure method. Pulmonary vascular morphology was assessed using hematoxylin and eosin staining, with metrics including the percentage of medial thickness of small pulmonary arteries relative to the external diameter (MT%) and the cross-sectional area of the media of small pulmonary arteries relative to the total cross-sectional area (MA%). Immunohistochemistry was used to detect the expression levels of hypoxia-inducible factor-1α (HIF-1α) and proliferating cell nuclear antigen (PCNA) proteins, while real-time quantitative PCR was used to to assess HIF-1α and PCNA mRNA levels. Compared to the normoxia group, the hypoxia and hypoxia + 2ME groups showed increased RVSP and upregulated HIF-1α and PCNA protein and mRNA expression levels at 3, 7, 14, and 21 days after hypoxia (P<0.05). Furthermore, at 7, 14, and 21 days after hypoxia, the hypoxia group showed increased MT% and MA% (P<0.05). In comparison to the hypoxia group, the hypoxia + 2ME group exhibited reduced RVSP and downregulated HIF-1α and PCNA protein and mRNA expression levels, along with decreased MT% and MA% at 7, 14, and 21 days after hypoxia (P<0.05). 2ME may protect against HPH in neonatal rats by inhibiting the expression of HIF-1α and PCNA and reducing pulmonary vascular remodeling. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 757-764.

Clinical Study and Management of Epistaxis.

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion.

Comparison of Conventional versus Modified Preperitoneal Pelvic Packing in Patients with Bleeding Pelvic Fractures: A Single-Center Retrospective Pilot Study.

Background: Bleeding pelvic fractures have high mortality rates, primarily due to severe hemorrhage. Treatment options include mechanical stabilization based on preperitoneal pelvic packing (PPP), resuscitative endovascular balloon occlusion of the aorta, and angioembolization (AE). The bilateral preperitoneal approach, which uses three pads on each side, is the conventional PPP method. We aimed to compare the bilateral preperitoneal approach with a modified approach, involving selectively packing only heavily bleeding areas, in terms of clinical outcomes and mortality risks. Methods: We included patients who underwent PPP and compared the outcomes between conventional (three sponges placed on each side) and modified PPP (selective packing of critical areas). The primary outcome was 30-day mortality; the secondary outcomes included 24 h mortality, pelvic complications, and transfusion requirements. Univariate and multivariate analyses were performed to determine risk factors for 30-day and 24 h mortality. Results: Among the 47 included patients, 19 and 28 underwent conventional and modified PPP, respectively. There were no significant between-group differences in the 24 h (26.3% vs. 42.9%, p = 0.247) and 30-day mortality rates (47.4% vs. 60.7%, p = 0.366). Using univariate and multivariate analyses, initial lactate levels and the decision to perform AE were found to be significant risk factors for mortality. However, the selected PPP method was not a risk factor for 30-day mortality (odds ratio [OR], 2.22; 95% confidence interval [CI], 0.27-18.26; p = 0.457) or 24 hr mortality (OR, 1.77; 95% CI, 0.24-13.19; p = 0.557). Conclusions: The modified PPP method may be considered in patients with bleeding pelvic fractures for effective bleeding control while minimizing potential complications associated with the conventional PPP.

Evaluation of a newly developed oral and maxillofacial surgical robotic platform (KD-SR-01) in head and neck surgery: a preclinical trial in porcine models

Traditional open head and neck surgery often leaves permanent scars, significantly affecting appearance. The emergence of surgical robots has introduced a new era for minimally invasive surgery. However, the complex anatomy of the head and neck region, particularly the oral and maxillofacial areas, combined with the high costs associated with established systems such as the da Vinci, has limited the widespread adoption of surgical robots in this field. Recently, surgical robotic platform in China has developed rapidly, exemplified by the promise shown by the KangDuo Surgical Robot (KD-SR). Although the KD-SR has achieved some results comparable to the da Vinci surgical robot in urology and colorectal surgery, its performance in complex head and neck regions remains untested. This study evaluated the feasibility, effectiveness, and safety of the newly developed KD-SR-01, comparing it with standard endoscopic systems in head and neck procedures on porcine models. We performed parotidectomy, submandibular gland resection, and neck dissection, collected baseline characteristics, perioperative data, and specifically assessed cognitive workload using the NASA-TLX. None of the robotic procedures were converted to endoscopic or open surgery. The results showed no significant difference in operation time between the two groups (P = 0.126), better intraoperative bleeding control (P = 0.001), and a significant reduction in cognitive workload (P < 0.001) in the robotic group. In conclusion, the KD-SR-01 is feasible, effective, and safe for head and neck surgery. Further investigation through well-designed clinical trials with long-term follow-up is necessary to establish the full potential of this emerging robotic platform.

Robotic caudo-peripheral approach for liver parenchymal transection in anatomical liver resections for hepatocellular carcinoma

Liver parenchymal transection is a challenging step during hepatic resection, particularly when using robotic platforms that require specific skills to optimize this phase. Pedicle division at the beginning of the liver parenchyma helps to better identify the resection plane and minimizes blood loss. The three-dimensional (3D) high-definition vision and the robotic Maryland allow for clear identification of the hepatic pedicles that could be dissected or divided without the need for a laparoscopic ultrasonic dissector. The caudo-peripheral technique, combined with the Maryland bipolar Kelly clamp crushing technique, is a useful approach to complete parenchymal transection and achieve safe anatomical resections in cases of hepatocellular carcinoma (HCC) with multi-pronged bleeding control. This is essential for expediting the procedure, reducing the number of intermittent clamping times, and minimizing the risk of ischemia-reperfusion injury. In this setting, perfect synchronization between the surgeon operating at the console and the bedside assistant is crucial. Advances in artificial intelligence (AI) systems have shown great potential to redefine clinical care management, preoperative planning, and intraoperative decision making for patients with HCC. This paper describes the most relevant details of our technique, its theoretical background, advantages, and limitations. Moreover, minimally invasive surgery offers the opportunity to share surgical experiences and technical progress through multimedia videos. This represents a modern and effective teaching tool to accelerate the learning process and overcome the challenges of the most complex procedures by offering surgeons various solutions to common technical problems.

Prothrombin Complex Concentrate as a Key Adjunct in Massive Hemorrhage Management in Placenta Accreta Spectrum Disorder: A Case Report

Placenta accreta spectrum disorder (PASD) is a severe obstetric complication associated with significant hemorrhage risk. This report highlights the successful use of prothrombin complex concentrate (PCC) as part of a multidisciplinary approach to managing a case of massive hemorrhage in PASD. A 36-year-old woman, G3P2002, at 33 weeks gestation, diagnosed with placenta previa totalis and suspected PASD, underwent a planned cesarean hysterectomy. The surgery was complicated by 5200 mL hemorrhage due to placental invasion and bladder injury. Hemodynamic instability was managed with massive transfusion protocol activation, including PCC, tranexamic acid, and packed red blood cells. Intra-abdominal packing was performed for hemostasis, and the bladder injury was repaired. Continued PCC administration in the ICU, along with other supportive measures, resulted in hemorrhage control and stabilization. The patient was successfully extubated and discharged after a second surgery to remove packing. This case emphasizes the vital role of PCC in the multidisciplinary management of massive hemorrhage in PASD. Early recognition of PASD risk factors and prompt intervention, including PCC administration, are crucial for optimal maternal outcomes.

Evaluation of Lateral and Vertical Gingival Displacement Produced by Three Different Gingival Retraction Systems using Impression Scanning: An in-Vivo Original Study

Isolation of the prepared margin along with control of gingival fluid and haemorrhage is an important factor to register finish lines, which can be achieved by displacing the gingiva away from the abutment which helps in better visualization of the prepared tooth surface. This study utilized digital scanning of rubber based impression material to compare the amount of gingival displacement produced by 3M ESPE capsule, plain retraction cord and impregnated retraction cord.  Aims: The aim of the study was to compare lateral and vertical gingival displacement produced by the three materials  Settings and Design: Case-Control  Methods and Material: Twenty participants requiring a full coverage restoration were selected. Gingiva around each tooth requiring a crown was retracted using the three materials and a rubber based impression was made. The impression was scanned using EXOCAD software to obtain readings for gingival displacement for control group, non- impregnated cord, impregnated cord and retraction paste.  Statistical analysis used: The scores were analysed in SPSS software using one way ANNOVA and post hoc analysis  Results: Significant difference was seen among all trial groups when compared to control. Highest mean vertical displacement was seen in clinical trial II (non- impregnated cord) followed by trial III ( retraction paste).  Conclusions: Impregnated cord and retraction paste both produced adequate retraction for the margings to be registered. Use of paste was less time consuming and less traumatic for the patient and therefore can be substituted for retraction cords.