Decreased Recovery Time Research Articles

Editorial Comment

The model builder who assembles a ship in a bottle takes on the challenge of working through a small opening. The difficulty of the approach is its appeal. In contrast, the ability to do major procedures through small incisions and ports has defined benefits beyond working with reduced exposure and the loss of haptic feedback. It improves cosmesis, decreases recovery time, lessens discomfort, and shortens the hospital stay. If an operation can be performed through a series of ports, it is logical to extend the basic idea and question whether it is possible to work through fewer ports, a single large port or a number of closely situated ports. The benefits, cosmetically, are clear; however, the potential risk of steric hindrance between the camera and instruments is increased. How this method is superior to the standard minimally invasive method (outside of cosmesis) is still unclear. Transumbilical Multiport Laparoscopic Orchiopexy in Children: Comparison With Standard Laparoscopic OrchiopexyUrologyVol. 80Issue 6PreviewTo compare the clinical outcomes of transumbilical multiport laparoscopic orchiopexy (TMLO) vs standard laparoscopic orchiopexy (SLO) for 1-stage management of impalpable testes in children. Full-Text PDF ReplyUrologyVol. 80Issue 6PreviewWe appreciate the insightful comments on our report. After the first description of urologic laparoendoscopic single-site surgery (LESS) in 2007,1 emerging studies have reported the lower postoperative morbidity and improved cosmetic outcome of LESS for almost all urologic procedures. However, the expensive cost of the specific devices and the long learning curve of LESS have severely limited its application in many countries, especially the developing countries. Thus, it is currently urgent to seek a feasible and alternative procedure. Full-Text PDF

Outcome after thoracoscopic ventral stabilisation of thoracic and lumbar spine fractures

Background and PurposeThoracoscopic-assisted ventral stabilisation for thoracolumbar fractures has been shown to be associated with decreased recovery time and less morbidity when compared with open procedures. However, there are a limited number of studies evaluating late clinical and radiological results after thoracoscopic spinal surgery.MethodsWe performed an analysis of the late outcomes of thoracolumbar fractures after minimally invasive thoracoscopic ventral instrumentation. Between August 2003 and December 2008, 70 patients with thoracolumbar fractures (T5-L2) underwent ventral thoracoscopic stabilisation. Tricortical bone grafts, anterior plating systems (MACS-System), and cage implants were used for stabilisation. Outcomes measured include radiologic images (superior inferior endplate angle), Visual Analogue Scale (VAS), VAS Spine Score, quality of life scores SF-36 and Oswestry Disability Index (ODI).ResultsForty seven patients (67%, 47 out of 70) were recruited for the follow up evaluation (2.2 ± 1.5 years). Lower VAS Spine scores were calculated in patients with intra- or postoperative complications (44.7 (± 16.7) vs. 65.8 (± 24.5), p=0.0447). There was no difference in outcome between patients treated with bone graft vs. cage implants. Loss of correction was observed in both bone graft and titanium cage groups.InterpretationThe present study demonstrates diminished long-term quality of life in patients treated with thoracoscopic ventral spine when compared with the outcome of german reference population. In contrast to the other patients, those patients without intra-operative or post-operative complications were associated with improved outcome. The stabilisation method (bone graft versus spinal cage) did not affect the long-term clinical or radiographic results in this series.

Non-anesthesiologist Administered Propofol With or Without Midazolam for Moderate Sedation—the Problem Is Not “Which Regimen” but “Who’s Regimen”

Propofol is a unique sedative that combines a rapid onset of action (30–45 s) with a short duration of effect (4–8 min), which makes it an ideal agent for relatively short outpatient procedures such as esophagogastroduodenoscopy (EGD) and colonoscopy. There is no doubt that propofol-based sedation has additional benefits compared to traditional sedation. When compared with traditional sedation in previous meta-analyses, propofol-based sedation had similar rates of adverse effects, provided higher patient satisfaction for most endoscopic procedures, decreased time to sedation, decreased recovery time (and may therefore decrease discharge time compared with traditional sedation) and increased the quality of endoscopic examination [1–3]. Recently, in Western countries, the main issue with propofol-based sedation has been, not ‘‘which regimen’’ is used but ‘‘who administers’’ the sedation. Non-anesthesiologist administration of propofol (NAAP) retains the advantages of propofol-based sedation while maintaining patient safety and lowering costs [4]. With regard to safety, Rex et al. [5] reported the largest safety data with NAAP, including 223,656 published and 422,424 unpublished cases. Propofol may cause hypoventilation, hypotension, and bradycardia relatively frequently, but severe adverse effects are extremely rare. Deaths occurred in two patients with pancreatic cancer, a severely handicapped patient with mental retardation, and a patient with severe cardiomyopathy. NAAP has a lower mortality rate than published data on endoscopist-delivered benzodiazepines and opioids and a comparable rate to published data on general anesthesia by anesthesiologists. In the author’s opinion, the main point of controversy regarding NAAP is the cost. Two indirect calculation studies found that propofol was at least as cost-effective as traditional sedation for colonoscopy and EUS [6, 7]. The indirect cost-effectiveness was attributable to a higher daily number of procedures due to shorter post-procedure recovery times. Although propofol is more efficient than conventional regimens in terms of induction and recovery times, it is only cost-effective compared with standard sedation when administered by a registered nurse under the supervision of the endoscopist [8]. Anesthesia professionaldelivered sedation has become increasingly common when performing colonoscopy and EGD in both the United States and European countries. From 2003 to 2007 in the USA, the involvement of anesthesiologists in colonoscopy almost tripled, from 9 to 25 % of colonoscopies, and this will be increased[50 % by 2015 [9]. Hassan et al. [10] calculated the costs related to NAAP implementation at a national level for a screening colonoscopy program in the USA— propofol administration by nurses rather than by anesthesiologists would result in savings of 3.2 billion USD over a 10-year period. Their calculations assumed 28.3 million screening colonoscopies over 10 years, including 9.8 million colonoscopies (34.8 %) with propofol-based sedation. This would translate into savings per colonoscopy of 326.5 USD (3.2 billion/9.8 million). In France, fecal testing has been chosen for colorectal cancer screening; it is the most cost-effective method since 90 % of colonoscopies there are performed with intravenous sedation which may only be administered by anesthesiologists [11]. Anesthesiologist involvement adds 285 % to the cost of a colonoscopy (EUR 740 vs. EUR 192, respectively, for a colonoscopy with vs. without an anesthesiologist). S.-H. Lee (&) Division of Gastroenterology, Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Cheonan, Choongnam 330-721, Korea e-mail: ygun99@hanmail.net

Ergonomics Principles Associated With Laparoscopic Surgeon Injury/Illness

This study sought to investigate the prevalence of laparoscopic surgeon injury/illness symptoms and evaluate associations between symptoms and operating room ergonomics. Although laparoscopic procedures significantly benefit patients in terms of decreased recovery times and improved outcomes, they contribute to mental fatigue and musculoskeletal problems among surgeons. A variety of ergonomic interventions and applications are implemented by surgeons to reduce health problems. Currently, there is a gap in knowledge regarding a surgeon's individual assessment of the operating room, an assessment that, in turn, would prompt the implementation of these interventions. A new survey instrument solicited information from surgeons (N = 61) regarding surgeon demographics, perception, frequency of operating room equipment adjustment, and self-reported symptoms. Surgeons responded to questions addressing safety, ergonomics, and fatigue in the operating room, using a 5-point Likert-type scale that included the option undecided. Surgeons who responded undecided were more likely to experience symptoms of injury/illness than respondents who were able to assess the features of their operating rooms. Symptoms were experienced by 100% of participants. The most prevalent symptoms were neck stiffness, back stiffness, and back pain. This study supports hypotheses that surgeons are experiencing body part discomfort and indicators of fatigue that may be associated with performing laparoscopy. Results suggest that awareness, knowledge, and utilization of ergonomic principles could protect surgeons against symptoms that lead to occupational injury. The purpose of this brief report is to convey the importance of ergonomic principles in the operating room, specific to laparoscopic surgery and surgeon injury/illness symptoms.

Long-term results of office-based pneumatic retinopexy using pure air

AimsThe long-term results of office-based pneumatic retinopexy (PR) using only filtered air were evaluated in a case series of rhegmatogenous retinal detachments with more than 3 years of follow-up, on...

무산소성 운동이 투기선수들의 근피로 및 혈중 염증반응 지표에 미치는 영향

The purpose of this study was investigate to the effect of anaerobic exercise on V·O2max level, muscle fatique(CPK, LDH) and imflammatory makers(IL-6, CRP, TNF-α). The subject of this study were 28 people(4 groups; control, Wrestling, Taekwondo, and Judo athletes group). The data from this study were analyzed using One-way ANOVA and Repeated measures ANOVA. The following conclusions were obtained by comparing and analyzing the measurement value pre, post, and recovery of anaerobic exercise according to the combat training. First, the groups with combat training showed the higher enhancement than the control group(p.001). Second, in the change of muscle fatigue and imflammatory makers, combat training groups were decreased recovery time more than control group(p.001), Therefore, this study suggested that the makers of muscle fatique and imflammation could be enhanced by combat training.

Methanogen community structure-activity relationship and bioaugmentation of overloaded anaerobic digesters

Accumulation of acids in anaerobic digesters after organic overload can inhibit or stop CH 4 production. Therefore, methods to reduce acid concentrations would be helpful. One potential method to improve recovery involves bioaugmentation, addition of specific microorganisms to improve performance. In this study, transiently overloaded digesters were bioaugmented with a propionate-degrading enrichment culture in an effort to decrease recovery time. Biomass samples from 14 different, full-scale anaerobic digesters were screened for specific methanogenic activity (SMA) against propionate; the microbial communities were also compared. SMA values spanned two orders of magnitude. Principal component analysis of denaturing gradient gel electrophoresis (DGGE) banding patterns for a functional gene ( mcrA) suggested an underlying community structure-activity relationship; the presence of hydrogenotrophic methanogens closely related to Methanospirillum hungatei and Methanobacterium beijingense was associated with high propionate SMA values. The biomass sample demonstrating the highest SMA was enriched for propionate degrading activity and then used to bioaugment overloaded digesters. Bioaugmented digesters recovered more rapidly following the organic overload, requiring approximately 25 days (2.5 solids retention times (SRTs)) less to recover compared to non-bioaugmented digesters. Benefits of bioaugmentation continued for more than 12 SRTs after organic overload. Bioaugmentation is a promising approach to decrease recovery time after organic overload.

Online availability upgrades for parity-based RAIDs through supplementary parity augmentations

In this article, we propose a simple but powerful online availability upgrade mechanism, S upplementary P arity A ugmentations( SPA ), to address the availability issue in parity-based RAID systems. The basic idea of SPA is to store and update the supplementary parity units on one or a few newly augmented spare disks for online RAID systems in the operational mode, thus achieving the goals of improving the reconstruction performance while tolerating multiple disk failures and latent sector errors simultaneously. By applying the exclusive OR operations appropriately among supplementary parity, full parity, and data units, SPA can reconstruct the data on the failed disks with a fraction of the original overhead that is proportional to the supplementary parity coverage, thus significantly reducing the overhead of data regeneration and decreasing recovery time in parity-based RAID systems. Our extensive trace-driven simulation study shows that SPA can significantly improve the reconstruction performance of the RAID5 and RAID5+0 systems, at an acceptable performance overhead imposed in the operational mode. Moreover, our reliability analytical modeling and sequential Monte-Carlo simulation demonstrate that SPA is consistently more than double the MTTDL of the RAID5 system and improves the reliability of the RAID5+0 system noticeably.

Sports Hernia

Groin injuries are a common occurrence in elite-level athletes. These injuries can cause significant pain and disability, leading to prolonged periods of inactivity and consternation among athletes, coaches, athletic trainers, and physicians alike. The differential diagnosis for groin pain is vast and spans multiple disciplines, including orthopaedics, general surgery, urology, gynecology, and neurology. Sports hernias are one cause of chronic groin pain in athletes and are distinct entities from classic hernias. They are often caused by a deficient posterior wall of the inguinal canal, but may also involve concurrent injuries, such as conjoint and adductor tendinopathies and nerve entrapment. Understanding the complex lower abdominal, pelvic, and hip anatomy and pathophysiology of sports hernias is crucial to making an accurate diagnosis and providing appropriate treatment options. Newer, less invasive surgical repair techniques show promising early results in improving pain and decreasing recovery time.

Field Anesthesia of Wild Ring-tailed Lemurs (Lemur catta) Using Tiletamine–Zolazepam, Medetomidine, and Butorphanol

Telazol has been commonly used for field anesthesia of wild lemurs, including ring-tailed lemurs (Lemur catta). Telazol alone provides good induction, but doesn't cause adequate muscle relaxation and sedation for collecting consistent somatic measurements and high-quality dental impressions that are sometimes needed. Variability in induction response has been seen between individuals that have received similar dosages, with young lemurs seeming to need more anesthetic than mature lemurs. This investigation evaluated Telazol induction in young (2.0-4.9 yr) and mature (> or = 5.0 yr) ring-tailed lemurs and compared postinduction supplementation with medetomidine or medetomidine-butorphanol. Forty-eight lemurs were anesthetized with Telazol administered via blow dart; then, 20 min after darting, they were supplemented via hand injection with either medetomidine (0.04 mg/ kg) or medetomidine-butorphanol (0.04 mg/kg and 0.2 mg/kg, respectively). The odds ratio for young lemurs to need more than one dart for induction, relative to mature lemurs, was 3.8, even though the initial dose of Telazol received by young lemurs (19 +/- 7 mg/kg) was significantly higher than the initial dose administered to mature lemurs (12 +/- 5 mg/kg). The total Telazol dosage was also significantly different between young lemurs (33 +/- 15 mg/kg) and mature lemurs (18 +/- 9 mg/kg). Both medetomidine and medetomidine-butorphanol provided good muscle relaxation and sedation for all procedures. Physiologic values were similar between the two protocols. Oxygen saturation by pulse oximetry was generally good, although there were a few SaO2 values < 90%. Recoveries were smooth, but long. Time to head up was correlated with total Telazol dosage in mature lemurs. In young lemurs, time to standing was correlated with Telazol induction dosage and time of last Telazol administration. Lemurs that received hand injections of Telazol took longer to recover than those that did not. Further refinements are needed to increase induction reliability and to decrease recovery time, particularly in young lemurs.

Regional block anesthesia in a patient with factor V Leiden mutation and axillary artery occlusion

Anesthetic management of patients with coagulation disorders presents safety and technical challenges. This case describes a 58-year-old woman with factor V Leiden mutation who required distal saphenous vein harvest and axillo-brachial bypass to treat axillary artery occlusion. The patient underwent surgery with satisfactory anesthesia using infraclavicular brachial plexus block, thoracic paravertebral block, and unilateral subarachnoid block. These three regional anesthetic interventions were performed in lieu of general anesthesia to minimize risks of thrombotic events, pain, and to decrease recovery time. Despite higher failure rates of regional anesthesia, longer time required for procedures, and added discomforts during surgery, the benefits may outweigh risks for selected high-risk patients, including those with factor V Leiden mutations.

Breast reconstruction using deep inferior epigastric artery perforator flap

Breast reconstruction with autologous tissue has been generally accepted as a reliable procedure, the preferred donor site being lower abdominal tissue. To sacrifice the minimal amount of muscle tissue and to reduce donor site morbidity, the concept of a perforator flap was applied to the fields of breast reconstruction, such as the deep inferior epigastric artery perforator (DIEAp) flap. The DIEAp flap provides essentially the same soft tissue components as the transverse rectus abdominis muscle (TRAM) flap while significantly reducing harvesting of the rectus muscle from the abdominal wall, thereby minimizing donor site morbidity; which includes abdominal weakness, hernia, and postoperative pain, with decreased recovery time. However, there are some concerns about the tedious and risky dissection of intramuscular perforators, and the variable vascularity of the flap supplied by tiny perforators. According to our novel flap harvesting techniques, using bipolar electrocauterization for intramuscular dissection is useful in preventing injury to the tiny perforators. Including some fibers of rectus muscle and soft tissue without full isolation and skeletonization around the pedicles is also useful for prevention of vascular injury and intraoperative vessel spasms. Moreover, the flap must include 2 to 3 reliable perforators, regardless of lateral or medial rows, for prevention of postoperative fat necrosis. The superficial inferior epigastric vein can provide additional venous drainage. These surgical tips can aid in overcoming the pitfalls of the DIEA perforator flap in breast reconstruction. The DIEAp flap is an excellent choice for breast reconstruction. According to our experience, it has been shown to be a safe and reliable method for providing good results and patient satisfaction with minimal donor morbidity in breast reconstruction.

Experimental analysis of AC loss and recovery characteristics for proposal of effective thickness of spacers in pancake type

For the design of superconducting fault current limiter, the research about recovery time and AC loss is essential issue because this characteristic is closely related to stability and efficiency. In general, superconducting fault current limiter (SFCL) modules can be made into pancake or solenoid type coil. While the pancake type coil has smaller AC loss, it has longer recovery time compared with the solenoid type coil. In this paper, a new pancake type coil was proposed to decrease recovery time by improving their cryogenic condition. A new pancake type coil is made with spacers between adjacent superconducting tapes. However, as the thickness of the spacer was increased, the AC loss was increased unlike the recovery characteristic. From the experimental results, our group confirmed that the pancake type coil with the spacer has trade-off relationship between AC loss and recovery characteristics with the spacer thickness. The proposed results in this paper would be utilized to design superconducting fault current limiters.

The S-Plus lift: a short-scar, long-flap rhytidectomy

As rhytidectomy is one of the most elective surgical procedures, there is a strong trend toward less aggressive operative techniques. The authors introduce the S-Plus lift, a 'long flap' superficial musculo-aponeurotic system (SMAS) imbrication technique that diminishes risks, decreases recovery time, and yields long-lasting results. This paper describes a novel approach to mid-facial rejuvenation that combines the limited incision of an S-lift with two SMASectomies, purse-string suture imbrication of the extended supraplatysmal plane (ESP) and SMAS, and malar soft tissue suspension. SMAS excisions are performed pre-auricularly, and in the region overlying the anterior edge of the parotid gland. Purse-string imbrication sutures are designed to close the SMAS defects, pull the soft tissues of the neck upward, pull the jowl and lower face posteriorly and superiorly, and tighten the platysma. Ancillary purse-string suture lifts the malar fat pad and cheek soft tissues vertically, which achieves mid-face fullness and lifting. Compared to S-lift, the technique extends its efficacy in those patients who have moderate-to-severe mid-facial laxity, prominent nasolabial folds, and platysma redundancy. A review of 144 consecutive S-Plus lifts performed by a single surgeon (SBH), with at least 6 months of follow-up, was performed. Over a 3-year period, 130 (90.3%) females and 14 (9.7%) males underwent S-Plus lift. S-Plus lift as primary rhytidectomy was performed in 132 (91.7%) and as secondary in 12 (8.3%) cases. Complication rate was low and comparable with other techniques of rhytidectomy. The S-Plus lift is a novel, hybrid technique with pleasing results, short down-time, and high patient satisfaction rate. The technique combines two SMASectomies with purse-string suture imbrication of the ESP and SMAS, and malar fat suture suspension.

Effects of XS® Energy Drink on aerobic exercise capacity

This project examines effects of taking XS® Energy Drink for the purpose of enhancing aerobic exercise capacity and performance. XS® Energy Drink contains B vitamins, caffeine, taurine, and an adaptogen blend and is primarily designed and marketed to stimulate alertness; however, it is also marketed to athletes claiming to enhance performance. Our hypothesis is that consuming the XS® Energy Drink before exercise increases aerobic capacity and the time to muscle fatigue when compared with a placebo. We also hypothesize that consuming XS® Energy Drink before exercise decreases recovery time. Twelve physically fit 18–24 year olds performed two VO2 max tests according to a modified Ellestad Treadmill Protocol using a randomized double‐blind cross over method. We found no significant differences with XS® Energy Drink: VO2 max (p = 0.99), time until muscle fatigue (p = 0.48), maximum heart rate (p = 0.66), VE max (p = 0.10), time at which R &gt; 1 (p = 0.50), or recovery time to 50% VO2 max (p = 0.67). We found the second trial to be significantly longer than the first (p = 0.01) likely due to desire to improve exercise time or familiarization with testing procedures. Our results show no physiological effects of XS® Energy Drink; however, we have not eliminated a possibility of psychological advantage. Supported by an undergraduate research fellowship and University Honors Program grant from Wright State University (KMS).

Cod Today and None Tomorrow: The Economic Value of a Marine Reserve

Abstract Using data from what was once one of the world’s largest capture fisheries, the northern cod fishery, the economic value of a marine reserve is calculated using a stochastic optimal control model with a jump-diffusion process. Counterfactual analysis shows that with a stochastic environment an optimal-sized marine reserve in this fishery would have prevented the fishery’s collapse and generated a triple payoff: raising resource rents even if harvesting was “optimal”; decreasing recovery time for the biomass to return to its former state, smoothing fishers’ harvests and resource rents; and lowering the chance of a catastrophic collapse following a negative shock. (JEL Q22, Q57)

Development and Characterization of an Overtraining Animal Model

Development of an endurance training-overtraining protocol for Wistar rats that includes increased workload and is characterized by analyses of performance and biomarkers. The running protocol lasted 11 wk: 8 wk of daily exercise sessions followed by 3 wk of increasing training frequency (two, three, and four times), with decreasing recovery time between sessions (4, 3, and 2 h) to cause an imbalance between overload and recovery. The performance tests were made before training (T1) and after the 4th (T2), 8th (T3), 9th (T4), 10th (T5), and 11th (T6) training weeks. All rats showed significantly increased performance at T4, at which time eight rats, termed the trained group (Tr), were sacrificed for blood and muscle assays. After T6, two groups were distinguishable by differences in the slope (alpha) of a line fitted to the individual performances at T4, T5, and T6: nonfunctional overreaching (NFOR; alpha < -15.05 kg x m) and functional overreaching (FOR; alpha >or= -15.05 kg x m). Data were presented as mean +/- SD. FOR maintained the performance at T6 similar to Tr at T4 (530.6 +/- 85.3 and 487.5 +/- 61.4 kg x m, respectively). The FOR and the Tr groups showed higher muscle citrate synthase activity (approximately 40%) and plasma glutamine/glutamate ratio (Gm/Ga; 4.5 +/- 1.7 and 4.5 +/- 0.9, respectively) than the sedentary control (CO) group (2.8 +/- 0.5). The NFOR group lost the performance acquired at T4 (407.3 +/- 88.2 kg x m) after T6 (280.5 +/- 93.1 kg x m) and exhibited sustained leukocytosis. NFOR's Gm/Ga (3.1 +/- 0.2) and muscle citrate synthase activity were similar to CO values. The decline in performance in the NFOR group could be related to the decrease in muscle oxidative capacity. We observed a trend in the Gm/Ga and leukocytosis that is similar to what has been sometimes observed in overtrained humans. This controlled training-overtraining animal model may be useful for seeking causative mechanisms of performance decline.

Decrease recovery time with proper pain management

Decrease recovery time with proper pain management

Decrease recovery time with proper pain management

Decrease recovery time with proper pain management

Decrease recovery time with proper pain management

Decrease recovery time with proper pain management