Evidence Of Leakage Research Articles

Non-Thermal Atmospheric Pressure Plasma as an Adjunct to Intestinal Anastomosis: A Pilot Study on Preventing Anastomotic Leaks

Anastomotic leaks remain a significant challenge in intestinal surgery, often leading to severe complications. This study investigated a novel approach to enhance anastomotic healing and reduce the risk of leaks by combining traditional suturing and stapling techniques with non-thermal atmospheric pressure plasma (NTAPP) application. NTAPP, a cold atmospheric plasma generated through the ionization of ambient air, has been shown to possess antimicrobial, hemostatic, and wound-healing properties. NTAPP promotes sterilization, coagulation, and tissue regeneration by generating reactive oxygen and nitrogen species, potentially strengthening anastomotic union. This pilot study evaluated the efficacy of NTAPP in three patients undergoing intestinal anastomosis. Following the standard surgical procedure, NTAPP was applied directly to the anastomotic site. Postoperative outcomes were monitored for six months, including anastomotic leaks and healing rates. Preliminary results demonstrated promising outcomes. All three patients exhibited successful sealing of the anastomosis, with no evidence of leakage during the follow-up period, providing reassurance and confidence in the potential of sutures, staples, and NTAPP. These findings suggest that NTAPP can significantly improve the safety and efficacy of intestinal surgeries by reducing the incidence of anastomotic leaks. While further research with a larger sample is necessary to confirm these initial findings, the results of this study provide a strong foundation for exploring the potential of NTAPP as a valuable adjunct to conventional surgical techniques for preventing anastomotic leaks. This innovative approach could reduce postoperative complications, improve patient outcomes, and enhance the overall quality of care in intestinal surgery.

Conservation and Avoided Deforestation: Evidence from Protected Areas of Tanzania

Tanzania dedicates a substantial proportion (38%) of its territory to conservation, with a large number of Protected Areas (PAs) managed under various regimes. Nevertheless, the country still experiences high rates of deforestation, which threaten the ecological integrity and socio-economic benefits of its forests. We utilized the Global Forest Change Dataset (2012–2022) and implemented a Propensity Score Matching (PSM) approach followed by a series of binomial logit regression modeling. Our objectives were to evaluate (1) the likelihood of PAs in avoiding deforestation compared with unprotected forest landscapes, (2) the variability in effectiveness among the different PA management regimes in avoiding deforestation, (3) evidence of leakage, defined here as the displacement of deforestation beyond PA boundaries as a result of protection inside PAs. Our findings reveal that, despite ongoing deforestation within and outside of PAs, conservation efforts are, on average, three times more likely to avoid deforestation compared with unprotected landscapes. However, the effectiveness of avoiding deforestation significantly varies among the different management regimes. National Parks and Game Reserves are nearly ten times more successful in avoiding deforestation, likely because of the stringent set of regulations and availability of resources for implementation. Conversely, Nature Forest Reserves, Game Controlled Areas, and Forest Reserves are, on average, only twice as likely to avoid deforestation, indicating substantial room for improvement. We found little evidence of the overall leakage as a consequence of protection. These results highlight the mixed success of Tanzania’s conservation efforts, suggesting opportunities to enhance the effectiveness of many less protected PAs. We conclude by proposing potential strategic pathways to enhance further the climate and ecosystem benefits of conservation in Tanzania.

627. LEFT THORACOSCOPIC PRIMARY REPAIR OF ESOPHAGEAL PERFORATION SECONDARY TO BOERHAAVE SYNDROME

Abstract Background With the advancement of the minimally invasive surgical techniques, more and more acute surgical conditions including esophageal perforations can be performed safely using minimally invasive surgical approach. Methods A middle aged male patient presented to our department with 3 days history of epigastric pain and vomiting. He was febrile on admission and investigation revealed the left sided esophageal perforation due to Boerhaave Syndrome with left sided pleural effusion. He underwent left thoracoscopic primary repair of esophageal perforation and wash out successfully. This is the video of the thoracoscopic primary repair of the perforation. Patient was put in the right lateral semi prone position, the area of perforation was identified by careful dissection of the pleura and repaired was performed in 2 layers. The pleura cavity was washed out with warm saline and underwater sealed chest tube drain was inserted. Results Post operatively patient was transferred to surgical intensive care unit for 1 day. Patient was kept nil by mouth with parenteral nutrition for 7 days. Contrast study was performed on post operative day 7 and started oral feeding when there was no evidence of leakage. Patient recovered and discharged well. Conclusion Thoracoscopic primary repair with wash out of spontaneous esophageal perforation secondary to Boerrhave Syndrome is challenging however it is safe and can be performed successfully. https://drive.google.com/file/d/1JTfJLV-ngUBwzMybGV4FL8EEQB-ysj9O/view

Thoracoscopic primary repair of esophageal atresia and tracheoesophageal fistula: Our early experience

Background: Thoracoscopic repair of esophageal atresia (EA) and tracheoesophageal fistula (TEF) has been practiced more frequently in the past two decades. This study focuses on assessing our early experience with implementing this minimally invasive technique in neonates. Methods: Neonates with EA/TEF who were admitted to the NICU at Ain Shams University hospitals during the period from 2021 to 2022 were enrolled in the study. Thoracoscopic primary repair was performed for neonates with a body weight exceeding 2 kg. Neonates with associated major cardiac, pulmonary, and neurological anomalies and long gap atresia were excluded from the study. Results: A total of 38 neonates presented with EA/TEF during the study period. Out of these neonates, 12 cases underwent thoracoscopic primary repair. The thoracoscopic approach was used to complete all necessary repairs, and no intraoperative complications occurred. The mean operating time was 125 minutes, ranging from 105 to 150 minutes. No evidence of leakage was found in any case, as determined by both clinical and radiological contrast swallow examinations. The mean ventilation time was 7.2 days, and the mean hospital stay was 21 days. There were four deaths attributed to complications related to barotrauma and sepsis. Conclusion: Thoracoscopic repair of EA can be performed safely, which yields favorable functional and cosmetic outcomes. However, it remains a challenging procedure that requires a long learning curve.

Fabrication of high‐performance acrylate grouting materials from tailor made magnesium acrylate solutions

AbstractAcrylate grouting (AG) material is a low‐viscosity aqueous solution capable of forming an elastic water‐plugging gel after being injected into seepage cracks. This study highlights the fabrication and performance of AG materials, specifically emphasizing the use of magnesium acrylate (MgDA) as the principal precursor for the polymer gel network. Additionally, 2‐(dimethylamino)ethyl methacrylate (DMAEMA) serves as a bifunction crosslinker and accelerator, while sodium persulfate and potassium ferricyanide act as initiator and retarder, respectively. AG materials are made of these four key ingredients mixed in an aqueous solution, and then polymerized into a highly elastic water‐plugging gel. Our systematic investigation indicated that the MgDA and DMAEMA concentrations significantly influence the performance of the AG material. The optimized AG material formulation containing 24% MgDA and 1.4% DMAEMA, exhibited an elongation at break of 1040%, a water absorption of 67% and a compressive strength of 363 kPa in grouted sand. The gel time could be adjusted from under 20 s to more than 20 min, offering versatility to meet various application requirements. Beyond its good bonding performance and superior extrusion resistance, the AG materials displayed excellent water‐plugging effect. Impressively, even after extending the closed water test to 360 days, the gel displayed no significant change in color or signs of degradation, and the treated crack remained in a deep dry state with no evidence of leakage, confirming the AG material's superior durability. With its advantageous permeability and excellent water‐plugging effect, the AG material is well‐suited for applications in micro‐crack sealing, seepage prevention and stratum reinforcement grouting.

Institutional Experience of Routine Radiation Surveillance of Delay and Decay Tanks Facility in a Department Having High-dose Iodine Therapy Unit.

Radioactive solid and liquid waste generated by patients after high-dose iodine therapy may lead to significant radiation exposure if not properly handled. This study was conducted to monitor the radiation exposure along the sewerage drainage system of the high-dose iodine therapy ward and to rule out leakage if any, that might pose a potential radiation hazard to the general public (sewerage workers) and radiation health professional. The sewerage drainage system from isolation wards has multiple gate valves to regulate sewerage flow from the high-dose iodine therapy ward into delay and decay tanks (DDT) built, especially for the purpose. Radiation surveillance was done using a Geiger-Muller counter-based survey meter at 11 different locations on a weekly basis for 12 weeks. A total of 26 patients underwent high-dose iodine ablation therapy during the study period in our department, with the highest recorded radiation exposure rate in the sewerage draining system in the 9th week of patient admission. This was at the common gate valve junction (location B) that directed sewerage waste from all four isolation rooms into the common pipeline leading to DDT. Minimal radiation exposure was recorded within Atomic Energy Regulatory Board -prescribed limits with no evidence of leakage. A routine radiation survey is an important component of overall radiation safety in the nuclear medicine department, including sewerage delay tank facilities, which helps keep the radiation exposure to acceptable levels by identifying timely leakage.

Single Early Intravesical Instillation of Epirubicin for Preventing Bladder Recurrence after Nephroureterectomy in Upper Urinary Tract Urothelial Carcinoma.

We aimed to assess the effectiveness of early single intravesical administration of epirubicin in preventing intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. Patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy between November 2018 and May 2022 were retrospectively reviewed. Intravesical epirubicin was administered within 48 hours if no evidence of leakage was observed. Epirubicin (50 mg) in 50 mL normal saline solution was introduced into the bladder via a catheter and maintained for 60 minutes. The severity of adverse events was graded using the Clavien-Dindo classification. We compared intravesical recurrence rate between the two groups. Multivariate analyses were performed to identify the independent predictors of bladder recurrence following radical nephroureterectomy. Epirubicin (n=55) and control (n=116) groups were included in the analysis. No grade 1 or higher bladder symptoms have been reported. A statistically significant difference in the intravesical recurrence rate was observed between the two groups (11.8% at 1 year in the epirubicin group vs. 28.4% at 1 year in the control group; log-rank p=0.039). In multivariate analysis, epirubicin instillation (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.20 to 0.93; p=0.033) and adjuvant chemotherapy (HR, 0.29; 95% CI, 0.13 to 0.65; p=0.003) were independently predictive of a reduced incidence of bladder recurrence. This retrospective review revealed that a single immediate intravesical instillation of epirubicin is safe and can reduce the incidence of intravesical recurrence after radical nephroureterectomy. However, further prospective trials are required to confirm these findings.

SP34. Development of Sutureless Vaso-Lock for Vascular Anastomosis

PURPOSE: Micro- and macrovascular anastomoses involve suturing together of blood vessels, which is a critical foundational surgical skill. However, it faces many challenges, such as decade-long training and inherent dexterity of the surgeon. Procedures are long and expensive, require specialized operating rooms and equipment, making them prohibitive in many hospitals. Our team has created a unique anastomotic device, Vaso-Lock, as a sutureless coupler. Vaso-Lock is intraluminal, holding free vessel ends together with traction by anchors. We aim to apply Vaso-Lock to change the paradigm of surgical training and practice, and improve technical capabilities for vascular anastomosis. METHODS: We have utilized 3D-printing to prototype Vaso-Locks with quick design adjustments. Vaso-Lock maintained its intact structure after ethylene oxide sterilization, which was evaluated by scanning electron microscope. Vaso-Lock was deployed in a porcine model for anastomosis of common carotid artery and internal jugular vein. Doppler ultrasound was used to longitudinally assess patency, blood flow velocities, and lumen preservation. Histological studies were performed to evaluate endothelialization and device-vessel interface biocompatibility. RESULTS: Vaso-Lock maintained anastomosis of common carotid artery to internal jugular vein in 3 porcine, with no evidence of leakage after deployment. Doppler ultrasonography demonstrated the mixture of arterial and venous blood inside the Vaso-Lock. During the extraction of Vaso-Lock, no blood clots were identified at the anastomosis site. Guidewire went through the explanted blood vessels anastomosed by the Vaso-Lock without resistance. In terms of histological analysis, we performed four types of staining: H&E, Masson’s Trichrome (blue for collagen), Verhoeff-Van Gieson (black for elastin), and Alizarin Red (red for calcium). All tissue sections with Vaso-Locks displayed open lumen at the anastomosis site. Inflammation cells, along with collagen bundles, appeared around anchors of the Vaso-Lock. Calcium was identified around the Vaso-Lock at 2-week. Intimal growth occurred under the Vaso-Lock at 6-week. We are examining the effect of Vaso-Lock on cellular structure of the blood vessel by immunohistochemistry. We are also evaluating heparinized Vaso-Lock in terms of its long-term patency and biocompatibility. CONCLUSIONS: Vaso-Lock maintained patency at least 6 weeks for arteriovenous anastomosis along with a natural healing response in a porcine model. This novel device will dramatically enhance the efficiency with an assortment of micro- and macrovascular anastomoses ranging from tissue flaps to arteriovenous fistula creations, making anastomosis globally available.

Management of a central corneal perforation in the emergency room: Tenon patch technique.

PurposeCorneal perforations are defined as a solution of continuity in the cornea. Usually, these cases evolve to the formation of a corneal-iridial scar or require surgical intervention. The tenon patch graft represents a good alternative to other methods and has many advantages.ObservationA 63-year-old patient who had been followed for severe dry eyes due to rheumatoid arthritis for 10 years presented to the emergency room with a central corneal perforation, partially sealed by the iris, accompanied by significant corneal edema in the right eye. Given the clinical picture that had been developing for 5 days, we decided to perform a tenon patch graft on the perforation. At 4 weeks of follow-up, globe integrity was maintained with a well-placed tenon patch. No evidence of leakage in the Seidel test was noted.ConclusionThe tenon patch graft represents a good alternative in the management of corneal perforations and has many advantages, among which the feasibility in an emergency, allowing a corneal graft afterwards.

Novel multifunctional robotically assisted bipolar instrument for simultaneous radiofrequency sealing and transection: preclinical and single-center experience

BackgroundA novel robotic-assisted bipolar radiofrequency (RF) multifunctional vessel seal-and-transection instrument (SynchroSeal, Intuitive Surgical, Inc., Sunnyvale, CA) has been developed. The objective of the current paper is to describe the design of SynchroSeal based on bench studies, assess the safety of SynchroSeal in ex vivo and in vivo porcine studies, and provide early clinical context.MethodsSynchroSeal grasping, energy activation time, and jaw temperature were evaluated with those of the Harmonic Ace+7. Data were analyzed with descriptive statistics, with Mann–Whitney for comparisons and statistical significance p < 0.05. Ex vivo and in vivo animal safety assessments of tissue after SynchroSeal use were evaluated for burst pressure, thermal spread, and acute sealing. Last, a single-center analysis of the technical metrics of SynchroSeal and Vessel Sealer Extend (robotically assisted seal-and-transection instrument) in bariatric cases is provided.ResultsBench studies of SynchroSeal and Harmonic Ace+7 evidenced SynchroSeal’s greater slip resistance force (8.4 ± 1.0 vs. 3.1 ± 0.4 N; p = 0.0002), lower grip pressure (3.0 ± 0.2 vs. 4.2 ± 0.5 kg/cm2; p = 0.0002), faster seal time (1.5 ± 0.4 vs. 11.6 ± 2.5 s; p < 0.0001), lower mean jaw temperature (109.7 ± 7.2 vs. 247.4 ± 8.6 °C; p = 0.0051), and faster cooling to 40 °C (53.6 ± 2.1 vs. 68.0 ± 3.5 s; p = 0.0051). SynchroSeal’s mean burst pressures after seal-and-transection and seal only modes were, respectively, 1169.1 ± 393.1 mmHg and 1159.2 ± 454.6 mmHg. Mean thermal spreads were, respectively, 1.2 ± 0.6 mm and 1.5 ± 0.55 mm. In the chronic animal study, 102 vessels were sealed; at 3 weeks post-procedure, there was no evidence of leakage or adverse events, such as non-target tissue thermal spread or tissue damage. In bariatrics cases, SynchroSeal was activated more frequently per case; however, its mean activation time was significantly shorter than Vessel Sealer Extend. No adverse events were reported for either device.ConclusionsSynchroSeal’s multifunctional design provides enhanced sealing and transection capabilities with an acceptable safety profile.

Assessing cumulative water impacts from shale oil and gas production: Permian Basin case study

Quantifying impacts of unconventional oil and gas production on water resources and aquatic habitats is critical for developing management approaches for mitigation. The study objective was to evaluate impacts of oil and gas production on groundwater and surface water and assess approaches to reduce these impacts using the Permian Basin as a case study. Water demand for hydraulic fracturing (HF) was compared to water supplies. We also examined contamination from surface spills. Results show that water demand for HF peaked in 2019, representing ~35% of water use in non-mining sectors. Most HF water was sourced from aquifers with ~1,100 wells drilled in the Ogallala aquifer in 2019. The State monitoring network did not show regional groundwater depletion but was not sufficiently dense to address local impacts. Groundwater depletion is more critical in the western Delaware Basin within the Permian Basin because groundwater is connected to large flowing springs (e.g. San Solomon Springs) and to the Pecos River which has total dissolved solids ranging from ~3000 to 14,000 mg/L. Most produced water (70–80%) is disposed in shallow geologic units that could result in overpressuring and potential groundwater contamination from leakage through ~70,000 abandoned oil wells, including orphaned wells. While there is little evidence of leakage from abandoned wells, the state monitoring system was not designed to assess leakage from these wells. Oil spill counts totaled ~11,000 in the Permian (2009–2018). Approaches to mitigating adverse impacts on water management include reuse of PW for HF; however, there is an excess of PW in the Delaware Basin. Treatment and reuse in other sectors outside of oil and gas are also possibilities. Data gaps include reporting of water sources for HF, PW quality data required for assessing treatment and reuse, subsurface disposal capacity for accommodating PW, and spills from PW in Texas.

412 Polytetrafluoroethylene(PTFE) Pledgets Masquerading As A Pseudo-Aneurysm Of Left Ventricle Apex. A Case Report

Abstract Background TransCatheter Aortic Valve Implantation (TAVI) is now established as an alternative for open aortic valve replacement in high-risk patients with severe calcified degenerative aortic stenosis. Case presentation Here we report a case of a 78 tears old female patient who presented six months following transapical TAVI with a pulsatile mass over the left anterior mini thoracotomy wound. Transthoracic echocardiography showed suspicion of a left ventricular apical aneurysm with no evidence of free pericardial fluid.Contrast enhanced CT reported a large pseudo-aneurysm arising from the apex of the left ventricle extending through the left anterior thoracic wall. She was scheduled for emergency surgical exploration via median sternotomy. Upon median sternotomy there were dense pericardial adhesions limiting the mobilization of the heart specially the apex, which necessitated establishment of cardiopulmonary bypass. The heart was arrested, and the dissection was completed. The cavity in connection with the ventricular apex had purulent contents and the site of the TAVI ventriculotomy was secure with the PTFE pledgets in place with no evidence of leakage. Samples of the cavity fluids had pus cells, but no organisms were grown. The patient made an uneventful recovery and was discharged home 6 days postoperatively. Discussion PTFE pledgets are frequently used in cardiac surgery to support surgical closure. These pledgets on a contrast enhanced CT scan can make it difficult to correctly diagnose and may mimic anastomotic leaks as both give similar hyper-dense appearance on contrast enhanced CT scan

ENDOSCOPIC STENTING IN THE TREATMENT OF RECURRENT EPIPHRENIC DIVERTICULUM AFTER LAPAROSCOPIC DIVERTICULECTOMY. CLINICAL CASE REPORT

Epiphrenic diverticulum, also known as a pulsion diverticulum, is a rare type of esophageal diverticulum occurring in the distal 10 centimeters of the esophagus. They are most commonly 4-10 cm above the gastric cardia representing 10% of all esophageal diverticula. Laparoscopic diverticulectomy has become the treatment of choice. This clinical case study is dedicated to minimally invasive treatment of recurrent epiphrenic diverticulum after laparoscopic diverticulectomy. A 74-year-old male patient was admitted to the hospital with complaints of dysphagia, regurgitation and halitosis. The examination revealed a 5 cm epiphrenic diverticulum with sings of inflammation. Laparoscopic transchiatal diverticulectomy, the Dor (anterior) fundoplication, cruroraphia and mediastinal drainage were performed. The patient was discharged on the 11-th postoperative day. The patient exhibited dysphagia relapse during a 3-month follow-up. Taking into account the previous surgical treatment and the habitus endoscopic esophageal stenting was chosen as the technique of choice for management. Under intravenous anesthesia a partially covered metal self-expandable stent 10 cm x 1.8 cm was inserted into the distal esophagus. Next day control fluoroscopy showed stable stent position and no evidence of leakage. The water-soluble contrast agent reached stomach freely. The patient was discharged on the 2nd post-operative day. Within 4 months after having a stent placed, the patient feels well and oral feeding is satisfactory. In terms of literature search we have not come across any reference to the post-epiphrenic diverticulectomy recurrence treatment, so the management was chosen individually based on the comorbid status of the patient. The installation of a partially covered metal self-expandable stent allowed to promptly eliminate dysphagia and design features enabled to achieve stent stable position. A partially covered metal self-expandable stent can be considered effective in the post-epiphrenic diverticulectomy recurrence treatment.

Sleeve Resection for Rectosigmoid Endometriosis

Study Objective The purpose of this video is to demonstrate the technical bases of a new conservative surgical technique, called Sleeve Resection (SR), for the treatment of endometriosis infiltrating the rectosigmoid wall. Design The SR technique was used as an alternative to the shaving and discoid resection techniques. Setting Lesions infiltrating the muscular layer of the wall of the low, medium, high rectum or sigmoid, separated or contiguous, were excised using a endoscopic linear stapler inserted through intentional colpotomy or using the existing vaginal opening during hysterectomy or endometriosis resection infiltrating the posterior vaginal fornix. Patients or Participants From June 2013 to May 2020, 82 patients, diagnosed preoperative or during surgery, underwent resection of all lesions. Interventions Lesions located in the retosigmoid were identified. Vicryl-00 stitches, transfixed in a long way in the longitudinal direction of the intestinal loop and drawn ventrally, provided an adequate individualization of the lesion margins. The endoscopic linear stapler was inserted parallel to the axis of the rectosigmoid through vaginal route for the excision of one or more lesions. Intestinal permeability was ensured through the placement of a 2.0 cm transanal probe. Additional stapling, sequential or interspersed, were used for total excision of one or multiple lesions. Measurements and Main Results All lesions were fully resected. At postoperative, there was no evidence of leakage or stenosis and neither immediate nor late intestinal obstruction up to a maximum followup of 7 years. Conclusion The laparoscopic sleeve resection technique, using the vaginal route as an access for the endoscopic linear stapler, proved to be safe and feasible for the short and medium followup and can be an alternative to traditional shaving and discoid resection techniques. A significant number of segmental resections were avoided. Future studies are needed to assure the effectiveness of this technique.

Total Laparoscopic Rectosigmoidectomy without Bowel Exteriorization: A New Surgical Technique for Endometriosis.

Study Objective The purpose of this video is to demonstrate the technical bases of a new laparoscopic technique for segmental resection of the rectosigmoid without intestinal exteriorization. Design 19 patients with indication for segmental resection of the rectosigmoid, due to infiltrative endometriosis, underwent this less invasive technique compared to classic techniques, which involves the externalization of the bowel through minilaparotomy or vaginally for intestinal resection and anvil placement. Setting The insertion of the endoscopic linear stapler and anvil, as well as the removal of the surgical specimen, were carried out through the vaginal route using intentional colpotomy or opportunely during the hysterectomy or resection of endometriosis infiltrating the posterior vaginal fornix. Patients or Participants Between June 2019 and January 2020, 19 patients underwent total laparoscopic rectosigmoidectomy to treat deep endometriosis. Interventions A 0˚ optic was introduced in a 10mm trocar and 3 auxiliary 5mm punctures were used in the inferior abdomen. Lesions located in the rectosigmoid were identified. The segment was prepared and isolated. A linear endoscopic stapler vaginally inserted was used to section the bowel. The proximal stump had its suture line opened with scissors and a purse-string suture was used to fix the anvil vaginally inserted into the abdominal cavity. A transanal circular stapler was used together with the anvil for anastomosis. Measurements and Main Results There were no intraoperative complications. At postoperative, there was no evidence of leakage, need for transfusion nor readmissions for a period of up to 60 days. Conclusion The total laparoscopic technique prevents traction and externalization of the intestinal loop through minilaparotomy or the vagina. There was a decrease in surgical time, less traction of the mesentery, preserving of vascularization and innervation, thus improving the quality of the anastomosis and protecting the nerves of the intestinal segment.

Earnings informativeness and trading frequency: Evidence from African markets

AbstractWe investigate the informativeness of earnings announcements in African stock markets and examine whether, conditional on the level of synchronicity and liquidity of stocks, market reactions are influenced by earnings characteristics. Normalized volatility indicates that earnings announcements are informative across the sample. The results are driven by less frequently traded stocks and informativeness manifests more clearly at announcement and in the post‐announcement window. There is little evidence of leakage. Informativeness is also present for highly traded stocks, notably after announcement. Cross‐sectional tests provide evidence of an effect of both earnings fundamentals and investor behaviour on stock returns around earnings announcements.

Effects of autologous platelet-rich plasma coated sutures on intestinal anastomotic healing in rabbits

The objective of this study was to investigate the intestinal anastomotic healing enhancing effect of platelets-rich plasma (PRP) using PRP-coated sutures in a rabbit model. A total of 30 mature male rabbits were divided into 3 groups (10 rabbits per group). Group 1 received uncoated sutures, group 2 received sodium acetate-coated sutures, and group 3 received PRP-coated sutures. Polyglactin 910 (Vicryl, USA), size 4-0 was used in all groups. Five rabbits of each group were euthanized on day 3 following the surgery while the remaining 5 rabbits were euthanized on day 10. Gross evaluation of the anastomotic site in PRP-coated sutures group demonstrated significantly (P < 0.05) lower adhesion formation scores on both days 3 and 10 of the study while in the control groups, evidence of leakage at the anastomotic site was present along with signs of haemorrhage and local inflammation. On day 10 in the control groups, there were strands of strong adhesions between the ileum, colon and cecum with large amount of fibrin deposited at the site of the anastomosis. Tissues of the anastomotic site revealed a significant level of hydroxyproline on day 10 in PRP-coated sutures group compared with control groups. Histopathological evaluation revealed significantly (P < 0.05) less inflammatory infiltration, and more angiogenesis and collagen deposition on day 10 in PRP-coated sutures group compared to the control groups. Results of this study clearly indicate promising healing enhancing effects of using PRP-coated sutures at intestinal anastomotic site with little to no obvious disadvantages.

Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony.

PurposeTo evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony.MethodsThis observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony.ResultsSclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening.ConclusionDiathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.

Laparoscopic Single Figure of Eight Suturing Omentopexy for the Treatment of a Perforated Duodenal Ulcer

PurposeSafe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy.MethodsLaparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis.ResultsThe mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days).ConclusionLaparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.

Assessing the Role of Group Heterogeneity in Community Forest Concessions in Guatemala’s Maya Biosphere Reserve

We use land use data from Guatemala to estimate the impact of a community forest concession policy on avoided deforestation when accounting for group heterogeneity. Our analysis includes communities with significant forestry experience, along with communities comprising recent settlers with primarily agricultural backgrounds. Employing a matched difference-in-differences approach, we compare deforestation in community concessions relative to a matched control area. We find the concession policy reduced deforestation throughout the study region, with the most significant effects in the recently settled concessions. While there is also evidence of leakage in this group, overall, there is a net reduction in deforestation.