Loss Volume Research Articles

Analytical vulnerability functions for assessing fatalities in masonry buildings

AbstractThe assessment of human losses and injuries due to earthquakes is critical for the development of risk reduction measures. Yet, most vulnerability studies have focused on the derivation of fragility functions for structural damage, neglecting the evaluation of the human impact. In this study, we implemented a fatality vulnerability assessment procedure based on advanced structural modelling, with an application to typical limestone and granite masonry buildings in Portugal. We performed nonlinear time‐history analysis on 3D numerical models whose characteristics were sampled from statistical models representing the geometric and mechanical properties of this type of construction. Engineering demand parameters, such as volume of loss and volume of survivable space, were estimated and converted into a fatality rate based on observations from past fatal earthquakes. We compared these vulnerability functions with other proposals from the literature in which conventional fragility functions are directly combined with collapse and fatality rates. Finally, the resulting vulnerability functions were tested for two earthquake scenarios for Portugal. The results from this study indicate that the conventional approach for fatality modelling tends to underestimate human losses for strong ground shaking due to the inability to account for catastrophic structural collapses. The fatality vulnerability functions developed in this work can be directly used in probabilistic seismic risk analysis or the assessment of earthquake scenarios.

Valorization of Fruit Co-Product Flours for Human Nutrition: Challenges, Applications, and Perspectives

The fruit agro-industry is one of the sectors that stand out both in production and in the volume of losses along the supply chains, which has generated a strong concern from the nutritional, economic, social, and environmental points of view. This study is aimed at understanding the updated scenario of the conversion of fruit residues into value-added co-products, its main challenges, applications, and perspectives. For this, a literature review was conducted through Scielo, PubMed, Google Scholar, and ScienceDirect databases. The advanced search covered the period from 2018 to 2022. The evaluation of the articles showed that the drying process is an important step to obtain flours from fruit co-products with characteristics that can provide longer shelf life, practicality, and versatility of use, demonstrating great potential for inclusion in various food preparations; although difficulties persist around the technological characteristics of this raw material, they can confer a nutritional increase, in addition to the possibility of additional health benefits due to the presence of bioactive compounds and fibers inherent in these products. Indeed, although there is a long way to go in studies with co-products derived from residual fractions of fruits, strategies such as these contribute to the better management of losses along the agri-food chains while providing greater food and nutrition security for the global population on the path to sustainability.

Comparative analysis of the results of correction of congenital spinal deformity in isolated semivertebrae in preschool and primary school-age children

BACKGROUND: Despite a detailed study of the natural development of congenital spinal deformity in isolated semivertebrae and methods of surgical correction of this pathology, some issues remain unclear. The age at which surgical correction of congenital spinal deformity should be performed is a debated issue among specialists.
 AIM: To conduct a comparative analysis of the effectiveness of correction of spinal deformity in children with congenital kyphoscoliosis with isolated semivertebrae of preschool and primary school-age children.
 MATERIALS AND METHODS: We included 26 patients aged 21 months to 69 months (10 girls and 16 boys) with congenital kyphoscoliosis caused by an isolated semivertebra. The patients underwent partial or complete resection of the semivertebral disk with adjacent intervertebral disks from dorsal or combined access, correction and stabilization of congenital spinal deformity with a posterior multisupport metal structure. Participants were sectioned into two age groups: the first group children under 4 years (14 children), the second group children 6 years and older (12 children).
 RESULTS: Metal fixation during surgical treatment in children of primary school age as well as in preschool children was carried out in the majority of cases polysegmentarily. Regarding the choice of surgical treatment access, dorsal surgical access was more often preferred in the second group of patients. The duration of surgical intervention and volume of blood loss between different age groups were similar with dorsal and combined access. In the group of preschool children, destabilization of the metal structure was noted in the early postoperative period when performing control radiographs after surgical treatment in three cases. In the second group, spinal deformity of dysplastic genesis after surgical treatment was detected in three cases.
 CONCLUSIONS: The effectiveness of surgical treatment of congenital deformity is significantly higher in younger children compared to that in school-age patients.

Total Hip Arthroplasty in Patients with Idiopathic Thrombocytopenic Purpura

Background. There are no national clinical guidelines for the perioperative management of patients with idiopathic thrombocytopenia in hip arthroplasty. Most of the publications are presented in the context of general surgery, the distinguishing feature of which is the good achievement of hemostasis. However, it is impossible to achieve such a level of hemostasis with hip arthroplasty.
 The aim of the study was to evaluate the mid-term results of total hip arthroplasty in patients with primary idiopathic thrombocytopenia.
 Methods. Randomized monocenter clinical trial of 38 patients with idiopathic thrombocytopenia hip arthroplasty was performed. These patients was include in group I. As a control group, the outcomes of surgical treatment of 40 patients without thrombocytopenia over the same observation period were analyzed (group II). The mean follow-up period was 4.3 years. Exclusion criteria for the study were heparin-induced thrombocytopenia, a severe form of idiopathic thrombocytopenia in the acute stage with platelet counts less than 25109/L.
 Results. The average length of hospitalization was longer in patients with idiopathic thrombocytopenia (11.1 days). The results indicate a longer preoperative preparation, including the transfusion of hemocomponents with repeated monitoring of the parameters of the clinical blood test and coagulogram. There was no significant difference in the duration of the surgical intervention, but there were differences in the amount of intraoperative blood loss and the volume of blood transfusion. Among the patients of the group II, only 3 patients required intraoperative transfusion of one dose of erythrocyte suspension, patients of the group I more often underwent blood transfusion. In the group I, complications were noted in 5 patients, in the group II in one patient (p = 0.067), but the relative risk of complications was 5.2. Functional results 12 months after surgery didnt differ.
 Conclusions. The mid-term results of hip arthroplasty in patients with idiopathic thrombocytopenia are comparable to the results in patients of the general population. A distinctive feature of surgical intervention is an increase in the average volume of intraoperative blood loss and the need for a significantly larger transfusion of hemocomponents not only during the operation, but also in the preoperative period, which increases the duration of hospitalization.

LAPAROSCOPIC APPROACH IN THE TREATMENT OF INGUINAL HERNIAS IN PATIENTS AFTER RADICAL PROSTATECTOMY: COMPARISON OF TARR AND TER RESULTS

Aim: To compare and evaluate the immediate and long-term results of performing transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP) for the treatment of inguinal hernias after surgical treatment of prostate cancer;Material and method: the study is a clinical analytical prospective study, with the use of randomization. The study included 88 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 44) and group B (n = 44)). Patients in group A received TEP, those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups.Results: Group A: one patient had a scrotal hematoma, in 2 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 6.8%. In group B, the following postoperative complications were reported: in one case, intestinal injury, 1 case of acute urinary retention, 2 cases of scrotal hematoma. The overall incidence of early postoperative complications was 9.1%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ = 0.009, P > 0.05).Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss and the severity of the pain syndrome (P> 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was longer than in group B. (P＜0.05).

Comparative analysis of the effectiveness of the combined method of inserting pedicle screws with the free-hand technique in patients with idiopathic scoliosis

Objective. To analyze intraoperative data and results of treatment of patients with idiopathic scoliosis with two options of the open insertion of pedicle screws using the free-hand technique.Material and Methods. The data of 457 patients aged 16–35 years who underwent surgical treatment for idiopathic scoliosis by one surgeon were analyzed. In 236 patients (Group I), the screws were placed manually, and in 221 (Group II) – using power tool. The preparation of the canal for pedicle screws in both groups was performed using the free-hand technique. The correct position of the screws wasassessed intraoperatively using an image intensifier and neurophysiological monitoring. The duration of surgery and X-ray monitoring, blood loss, and the presence of intra- and postoperative complications were assessed.Results. In Group I, 4243 screws were inserted, and in Group II – 3978. The correct position of pedicle screws was recorded in 89.1 % of cases in Group I, and in 89.6 % of cases in Goup II. In Group I, the incorrect position of anchor elements was detected in 10.9 % of cases, and in Group II – in 10.4 % of cases. The number of screws re-positioned intraoperatively corresponded to the number of incorrectly positioned screws. There was a statistically significant difference in the volume of intraoperative blood loss and duration of surgery betweenpatients of both groups (p < 0.05).Conclusion. The development and active introduction of high-tech methods of surgical treatment of spinal deformities increase the number of interventions performed annually. The proposed combined method of surgical treatment seems to be optimal because manual formation of the canal reduces the risk of intraoperative complications, and the use of power tool during screw placement shortens duration of surgery and reduces blood loss.

Evaluation of the effectiveness of empirical and computational methods for determining volumes of blood loss in the surgical treatment of burned patients

Relevance. The problem of determining intraoperative blood loss in combustiology remains relevant today. With the variety of existing methods of its assessment, the issue of optimizing transfusion therapy remains debatable. Intention. To evaluate effects of the eschar excision area on the complete blood count and to compare results of computational methods for determining volumes of blood loss with actual volumes of blood exfusion. Methodology. 73 burned patients were included in the retrospective study. Early surgical excision with simultaneous autodermoplasty was performed in all patients. To achieve the study purposes, the intervention areas were compared with changes in hemoglobin, hematocrit, volume and number of red blood cells. The prospective study included 20 volunteers who donated 450 ml of the whole blood. In this group, donated volumes were compared with calculated volumes of blood loss (according to PG. Budny and G.D. Warden). The data obtained were processed via Microsoft Office Excel 2007 and IBM SPSS Statistics 20.0 using descriptive, parametric and nonparametric statistics. Results and Discussion. According to the retrospective analysis, actual areas of excision were not consistently related to the changes in complete blood count in the postoperative period. Based on the results of prospective analysis, we were able to reveal correlations between actual volumes of blood loss and changes in hemoglobin concentrations in somatically healthy volunteers (by PG. Budny). There were no similar correlations between volumes of blood loss and decreased hematocrit (by G.D. Warden). Conclusion. According to the results of the study, we couldn't confirm the effectiveness of empirical methods for determining volumes of blood loss in burned patients. The PG. Budny formula gives representative results of blood loss volumes in healthy volunteers. However, the effectiveness of this method in combustiology requires further research.

Abstract 3888: Targeting Bcl-xL in fibrolamellar hepatocellular carcinoma

Abstract Fibrolamellar hepatocellular carcinoma (FLC) is a lethal pediatric cancer affecting adolescents and young adults. Besides surgical resection, there is no approved and effective therapy. FLC is driven by a fusion oncokinase, DNAJB1-PRKACA, that arises from a deletion fusing exon 1 of DNAJB1 and exons 2-10 of PRKACA, the catalytic subunit of protein kinase A. Expression of this chimeric oncokinase is capable of recapitulating the key histologic and transcriptomic features of FLC. Using PDXs, we tested therapeutics that have been used clinically for FLC or that target pathways identified via the transcriptomic signature of FLC, in addition to an agnostic library of clinical-stage drugs. Several compounds were identified with a varying degree of efficacy in different PDX lines as compared to our control line, primary human hepatocytes. One of the top hits was irinotecan, and its active metabolite SN38. Irinotecan is a topoisomerase I inhibitor and is clinically utilized in a wide variety of adult and pediatric cancers. A second top hit was Navitoclax, an inhibitor of the anti-apoptotic proteins Bcl-2 and Bcl-xL. Tool compounds that targeted Bcl-xL, but not bcl-2 were efficacious. This suggested a possible link between Bcl-xL, which is overexpressed in some PDX lines, and the resistance profile they showed in our screen. Unfortunately, Navitoclax has an on-target and dose-limiting toxicity of thrombocytopenia, which limits its clinical application. DT2216 is a VHL-based PROTAC that degrades Bcl-xL. DT2216 has two potential benefits over Navitoclax: 1) DT2216 is a more potent than Navitoclax against various Bcl-xL dependent tumor cells; and 2) it is less toxic to platelets than Navitoclax by targeting Bcl-xl to VHL that is poorly expressed in platelets to avoid induction of severe thrombocytopenia. A phase 1 clinical trial of DT2216 in relapsed/refractory malignancies is now ongoing (NCT04886622). We tested if the combination of DT2216 and irinotecan might have a therapeutic potential in FLC. Indeed, in vitro screening of the proposed combo, DT2216 and SN38, showed an additive or a synergistical effect in 4 validated FLC cell lines. We tested both the efficacy of DT2216 on Bcl-xL levels in FLC as well as platelet counts to identify any developing thrombocytopenia. DT2216 was less disruptive to platelets than Navitoclax at therapeutically relevant pre-clinical doses. Next, we tested 4 of our PDX models for FLC using various dosing regimens to identify the most efficacious regimen with the minimum side effects. Mice cohorts were evaluated for weight loss and tumor volume. Mice treated with DT2216 and SN38 showed consistent therapeutic benefit which was not evident in controls and less notable as monotherapy. In conclusion, TOPO1 and Bcl-xL prove to be promising targets of interest in FLC. Targeting both with DT2216 and irinotecan leads to tumor shrinkage in pre-clinical models and offer a potential therapeutic/pharmacological intervention for FLC. Citation Format: Bassem Shebl, Gadi Lalazar, Denise Ng, Tova Finkelstein, Guangrong Zheng, Peiyi Zhang, Carly Rosemore, Michael Ortiz, Daohong Zhou, Sanford Simon, Philip Coffino. Targeting Bcl-xL in fibrolamellar hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3888.

Application and clinical efficacy of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy

ObjectiveTo investigate the clinical safety and efficacy of a modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN).MethodsThe clinical data of 38 patients with renal tumors who underwent the modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative-related indicators and postoperative renal function recovery were analyzed and compared between the two groups.ResultsAll patients (n = 116) finished the RAPN successfully, and none were transferred to radical or open surgery in either group. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time point in the modified early unclamping group was higher than that in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis.ConclusionThe application of a modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys without increasing the volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.

Fibrin monomer complex on postoperative day 1 is correlated with the volume of deep vein thrombosis after knee surgery

PurposePatients undergoing knee surgery are at high risk for deep vein thrombosis (DVT), which is infrequent but potentially life-threatening. It has not been identified how to efficiently detect high-risk DVT while minimizing bleeding complications from anticoagulation. We hypothesized that the degree of activation of thrombotic markers may correlate with the size of the thrombus. Therefore, we investigated the correlation between thrombotic markers and DVT thrombus volume in patients after knee surgery.MethodsThis retrospective study involved 29 patients who underwent around knee osteotomy or total / unicompartmental knee arthroplasty from 2018 to 2020. Fibrin monomer complex (FMC) at 1, and 7 days after surgery, and D-dimer at 4, and 7 days after surgery were investigated. In addition, the volume of DVT was estimated with ultrasonography at the 7 days after surgery. Body mass index, surgical time, and total volume of blood loss were also evaluated. Factors related to thrombus volume were examined statistically.ResultsNine patients (31.0%) exhibited asymptomatic distal DVT, whereas 1 patient (3.4%) experienced asymptomatic proximal DVT. No patients had pulmonary embolism. Statistical analysis showed that only FMC concentration on postoperative day 1 was significantly correlated with thrombus volume (p < 0.001, 95% confidence interval 0.41 to 0.839, r = 0.679).ConclusionsThe FMC concentration was a useful early indicator of deep vein thrombosis after knee surgery. Monitoring the FMC concentration could enable selective identification of patients with a high thrombus volume, which is associated with a high risk for pulmonary embolism.

Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis

BackgroundNon-intubated video-assisted thoracoscopic surgery (NIVATS) is increasingly performed in different types of thoracic procedures. Based on the anesthetic perspective, the outcomes of this method are limited. General anesthesia with intubation and controlled ventilation for video-assisted thoracoscopic surgery (IVATS) is a standard technique. The current study aimed to compare the pulmonary gas exchange between NIVATS and IVATS, with a focus on desaturation event.MethodsThis was a retrospective study conducted at Vajira Hospital. Data were collected from the hospital medical record database between January 9, 2019, and May 15, 2020. A propensity score-matched analysis was used to adjust the confounders by indications and contraindication between NIVATS and IVATS. The perioperative outcomes of VATS and NIVATS were compared by the regression analysis method.ResultsIn total, 180 patients were included in the analysis. There were 98 and 82 patients in the NIVATS and IVATS groups, respectively. After a propensity score matching, the number of patients with similar characteristics decreased to 52 per group. None of the patients in both groups experienced desaturation. The lowest oxygen saturation of the NIVATS and IVATS groups did not significantly differ (96.5% vs. 99%, respectively; p = 0.185). The NIVATS group had a significantly higher ETCO2 peak than the IVATS group (43 vs. 36 mmHg, respectively; p < 0.001). According to the regression analysis, the NIVATS group had a significantly shorter anesthetic induction time (Mean difference (MD) = -5.135 min (95% CI = (- 8.878)- (-1.391)) and lower volume of blood loss (MD = -75.565 ml (95%CI = (- 131.08)—(- 20.65) but a higher intraoperative ETCO2 than the IVATS group (MD = 4.561 mmHg (95%CI = 1.852—7.269). Four patients in the NIVATS group required conversion to intubation due to difficulties encountered when using the surgical technique (7.7%, p = 0.041). Seven patients in the IVATS group, but none in the NIVATS group, presented with sore throat (13.5% vs. 0%, respectively; p = 0.006). Moreover, none of the patients in both groups experienced postoperative pneumonia, underwent reoperation, or died.ConclusionsThe anesthetic and surgical outcomes of NIVATS were comparable to those of IVATS.

Recovery of cognitive functions and self-service in patients with rupture of cerebral aneurysms

There is no unified management of patients with the consequences of subarachnoid hemorrhage in the long term.Purpose of the study. To study the nature and severity of SAH, the clinical manifestation of hemorrhage, the choice of the intervention technique in the acute period of the disease for the long-term results of the treatment of aneurysms.Materials and methods. In the long-term period, at an average time of 3.5 years after aneurysmal subarachnoid hemorrhage, 100 patients were examined who underwent microsurgical intervention (n = 48), endovascular exclusion of the aneurysm from the bloodstream (n = 14), simultaneous intervention, including microsurgical intervention and extra-intracranial vascular bypass (n = 23), as well as microsurgical intervention followed by the introduction of a fibrinolytic agent into the subarachnoid space (n = 15).Results. Risk factors for unfavorable clinical recovery of patients, as well as the development of cognitive and mental disorders, were: intracerebral hematoma, dislocation syndrome, duration of temporary clipping more than 7 minutes, the volume of intraoperative blood loss of more than 300 ml. The best functional recovery in the long-term period was noted in patients who underwent microsurgical clipping of the aneurysm, supplemented by surgical revascularization (p = 0.003).Conclusion. The results of our study demonstrated the persistence of the consequences of surgical intervention for the rupture of cerebral aneurysms for a long time, which necessitates long-term observation of patients, the development of individual programs of physical and psychological rehabilitation, and clinical examination of persons at high risk.

Technological Machines Operation by Identification Method

In order to effectively organize the process of agricultural enterprises, it is reasonable to involve management tools to build optimal models of interaction of individual components of the production process. The most significant part concerning the technical and economic efficiency is the technological process. However, the harvesting and postharvesting process is of the highest priority. The current stage of the management paradigm development includes the attraction of mathematical modeling in the organizational process. The construction of mathematical models is necessary at the stage of planning, organization, control, and is aimed at choosing such parameters of the technological process that will ensure the highest economic efficiency. At the same time, the validation process of the optimal parameters of machines and equipment that separate the grain receiving is of the most importance. While solving this problem, it is necessary to consider various efficiency criteria, the main of which are “loss volumes” and “reduced costs”. The criteria for the efficiency of the technical equipment of postharvesting grain process are the permissible values of agrotechnical requirements that consider the time of safe storage of freshly harvested grain mass without pretreatment and grain shatter losses due to its overripe. It is necessary to consider the maximum allowable volumes of losses during the postharvesting technological process. In order to define the best organizational solutions the iteration principle is used until a solution that meets the restrictions on the reduced costs level is found. The mathematical modeling in technological processes is carried out with the involvement of regression models that allow predicting the qualitative indicators of the operation of the pre-cleaning machine. As a result, it is possible to choose such a mode of equipment operation that ensures the production of grain that meets the regulatory requirements for the quality of the resulting product. The novelty of this study lies in the development of optimal ways for combine harvesters functioning. The article presents the methodology and procedure of optimizing the technological process during the postharvesting process of grain. The characteristics received as a result of experiments allow us to organize the technological process in an agricultural enterprise in the most optimal way so that it is economically and technically efficient.

Use of Computerized Microtomography, Energy Dispersive Spectroscopy, Scanning Electron Microscopy, and Atomic Force Microscopy to Monitor Effects of Adding Calcium to Bleaching Gels

The aim of this study was to evaluate the mineral content, expressed by calcium (Ca) and phosphate (P), in dental enamel exposed to bleaching agents using micro-computed tomography (micro-CT), scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and atomic force microscopy (AFM). Sixty bovine dental enamel specimens were randomly divided into three groups (n=20): HP35ca (bleached using 35% hydrogen peroxide with Ca); HP35wca (bleached using 35% hydrogen peroxide without Ca); and control (without bleaching). Five specimens from each group were used for SEM and EDS analyses, 10 specimens were used for AFM analysis, and the remaining five specimens were used for micro-CT analysis. The pH of the gels was measured using a pH meter. The EDS and micro-CT data were analyzed using one-way ANOVA and Pearson's correlation test. The AFM data were analyzed using one-way ANOVA (α=0.05). The weight percentages of Ca and P obtained using EDS were similar between the bleached and control groups. Small, superficial changes were observed by SEM in the HP35wca group. The HP35ca group showed similar patterns to the control group. AFM results showed no significant changes in the enamel roughness in any of the tested groups. No significant difference in the volume or depth of structural enamel loss was found between gels with and without Ca. No mineral loss was observed in the dentin substrate. The EDS and micro-CT analysis data exhibited a high correlation (p<0.001). The addition of Ca to the bleaching gel had no beneficial effect on the bleached tooth enamel in terms of composition, mineral loss, and surface roughness. Micro-CT results exhibited a high correlation with the EDS results.

Circular stapling anastomosis with indocyanine green fluorescence imaging for cervical esophagogastric anastomosis after thoracoscopic esophagectomy: a propensity score-matched analysis

BackgroundThoracoscopic esophagectomy has been extensively used worldwide as a curative surgery for patients with esophageal cancer; however, complications such as anastomotic leakage and stenosis remain a major concern. Therefore, the objective of this study was to evaluate the efficacy of circular stapling anastomosis with indocyanine green (ICG) fluorescence imaging, which was standardized for cervical esophagogastric anastomosis after thoracoscopic esophagectomy.MethodsAltogether, 121 patients with esophageal cancer who underwent thoracoscopic esophagectomy with radical lymph node dissection and cervical esophagogastric anastomosis from November 2009 to December 2020 at Tottori University Hospital were enrolled in this study. Patients who underwent surgery before the anastomotic method was standardized were included in the classical group (n = 82) and patients who underwent surgery after the anastomotic method was standardized were included in the ICG circular group (n = 39). The short-term postoperative outcomes, including anastomotic complications, were compared between the two groups using propensity-matched analysis and the risk factors for anastomotic leakage were evaluated using logistic regression analyses.ResultsOf the 121 patients, 33 were included in each group after propensity score matching. The clinicopathological characteristics of patients did not differ between the two groups after propensity score matching. In terms of perioperative outcomes, a significantly higher proportion of patients who underwent surgery using the laparoscopic approach (P < 0.001) and narrow gastric tube (P = 0.003), as well as those who had a lower volume of blood loss (P = 0.009) in the ICG circular group were observed after matching. Moreover, the ICG circular group had a significantly lower incidence of anastomotic leakage (39% vs. 9%, P = 0.004) and anastomotic stenosis (46% vs. 21%, P = 0.037) and a shorter postoperative hospital stay (30 vs. 20 days, P < 0.001) than the classical group. According to the multivariate analysis, the anastomotic method was an independent risk factor for anastomotic leakage after thoracoscopic esophagectomy (P = 0.013).ConclusionsCircular stapling anastomosis with ICG fluorescence imaging is effective in reducing complications such as anastomotic leakage and stenosis.

The Possibilities of Thromboelastography in Assessing Safety of Neuraxial Blocks in Gestational Thrombocytopenia (Clinical Study)

Gestational thrombocytopenia (GT) is the most common type of thrombocytopenia during pregnancy. Unlike other types of thrombocytopenia, it is not accompanied by dysfunction of the cellular component of hemostasis. Currently, a quantitative decrease in platelets in GT is a contraindication to neuraxial blockades (NAB), which significantly reduces the quality of care in childbirth.The aim of the study is to determine the possibility of safe use of neuraxial blockades in gestational thrombocytopenia. A retrospective prospective study involved 70 patients who were performed delivery, depending on obstetric indications, either conservatively or surgically. The patients were divided into two groups. The main group (group No. 1) included 35 patients with gestational thrombocytopenia. The comparison group (group No. 2) consisted of 35 patients with a platelet content above 150×109/l. A comparative intergroup analysis of indicators of a general blood test, coagulogram, thromboelastography with a test for functional fibrinogen before childbirth and 2 days after delivery. The change in platelet content and its effect on the coagulation status of patients during pregnancy were retrospectively analyzed. A comparative assessment of the volume of blood loss during childbirth and the early postpartum period and the risk of complications of neuraxial blockade in patients with and without gestational thrombocytopenia was carried out.It was found that during gestational thrombocytopenia in the perinatal period, there is no decrease in coagulation potential, assessed by the results of coagulography and thromboelastography at a platelet level above 49×109/l. The investigated indicators of hemostasis did not have significant intergroup differences during pregnancy and childbirth. In the group of patients with gestational thrombocytopenia, the volume of blood loss during labor and the postpartum period did not differ from the group without thrombocytopenia, regardless of the method of delivery. The median blood loss after vaginal delivery in group 1 was 225 ml, in group 2 – 250 ml, with abdominal delivery – 572 ml and 386 ml – respectively. In this study, no complications of neuraxial blockade were observed in any of the groups.The results obtained suggest that in patients with gestational thrombocytopenia, even with a significant decrease in platelet content, it is possible to perform neuraxial blockades during labor, taking into account the clinical picture and the absence of coagulation disorders confirmed by thromboelastography.

Effect of cryoprecipitate on an increase in fibrinogen level in patients with excessive intraoperative blood loss: a single-center retrospective study

BackgroundCryoprecipitate, which contains fibrinogen and factor VIII in large quantities, is concentrated from fresh frozen plasma, and it has hemostatic effects in severe bleeding. We retrospectively examined the effects of cryoprecipitate on the increase in fibrinogen levels in patients with excessive intraoperative blood loss.MethodsNinety-seven patients who were administered cryoprecipitate during surgery between June 2014 and May 2019 were enrolled in our study and categorized according to the volume of intraoperative blood loss as follows: group A, 2000–5000 mL; group B, 5000–10,000 mL; group C, > 10,000 mL. Data were extracted from electronic medical records and electronic anesthesia records. The primary endpoint was an increase in the fibrinogen level after the administration of cryoprecipitate.ResultsNine patients with no fibrinogen data and four patients with a bleeding volume of less than 2000 mL were excluded; thus, 84 patients (A: n = 36, B: n = 37, C: n = 11) were evaluated. The mean intraoperative blood loss (mL) in groups A, B, and C were 3348 ± 791, 6688 ± 1225, and 14,281 ± 5142, respectively. The fibrinogen levels (mg/dL) before cryoprecipitate administration in groups A, B, and C were 189 ± 94, 113 ± 42, and 83 ± 29, respectively (p < 0.05 among the groups). The increase in fibrinogen level (mg/dL) after cryoprecipitate administration in group C was significantly greater than that in group A (84 ± 34 versus 50 ± 36, p < 0.01).ConclusionsThe results of this study indicate that the effect of cryoprecipitate on the increase in fibrinogen level was most apparent in patients with excessive intraoperative blood loss ≥ 10,000 mL. In addition, most patients with intraoperative blood loss ≥ 5000 mL had fibrinogen levels < 150 mg/dL which improved to ≥ 150 mg/dL after cryoprecipitate administration in approximately 70% of patients. Therefore, cryoprecipitate administration should be considered for patients with hypofibrinogenemia (≤ 150 mg/dL) experiencing severe bleeding (e.g., ≥ 5000 mL) and rapid administration of cryoprecipitate is necessary to maximize the hemostatic effect, especially when the bleeding volume exceeds 10,000 ml.

Влияние эндовидеоскопических операций при нефролитиазе на функциональное состояние почек

Introduction. In recent years, there has been a persistent trend towards an increase in the incidence of urolithiasis. The treatment of large and complex kidney stones greatest difficulty is one of the challenges. Such stones, as well as surgical methods of their removal, can have an adverse effect on the functional state of the kidneys, which confers a significant medical, social and economic problem. The purpose of this study is to identify factors affecting the functional state of the kidneys in the postoperative period when using various video endoscopic methods of surgical treatment of patients with large and complex kidney stones. Materials and methods. We analyzed the results of treatment of 97 patients with large and complex kidney stones. Depending on the treatment, all these patients were divided into three groups: 1st – 44 (45,36%) patients who underwent percutaneous nephrolithotripsy in prone position, 2nd – 29 (29,9%) patients who underwent percutaneous nephrolithotripsy in the supine position, 3rd – 24 (24,74%) of the patient who underwent pyelolithotomy with laparoscopic and retroperitoneoscopic approaches. Assessment of the area and density of stones was performed by computed tomography. The glomerular filtration rate (GFR) was calculated by CKD-PI formula and dynamic nephroscintigraphy was used to assess of each kidney function. Results. In the postoperative period, the decrease in GFR was most pronounced in the group of patients after percutaneous nephrolithotripsy in the supine position. Among the most significant factors worsening this indicator were the volume of intraoperative (r=0,410, p&lt;0,001, n=97) and postoperative blood loss (r=0,294, p &lt;0.01, n=97), duration of surgery (r=0,187, p &lt;0,1, n=97), density (r=0,426, p &lt;0,001, n=97) and the area (r=0,554, p &lt;0,001, n=97) of the concretion, as well as the body mass index (r=0,294, p &lt;0,01, n=97). Conclusions. The most significant factors that have a negative impact on the functional state of the kidneys were the density and area of the stone, the patient's body mass index and the volume of intraoperative blood loss. The least deterioration of kidney function in the postoperative period was observed with endoscopic pyelolithotomy, and the greatest – with percutaneous nephrolithotripsy in the patient's back position.

Foredune and Beach Dynamics on the Southern Shores of Lake Michigan during Recent High Water Levels

From 18 January 2013 (175.16 m a.s.l.) to 8 September 2020 (177.82 m a.s.l.), Lake Michigan experienced its fastest and highest rise (2.67 m) since 1860, when instrumental measurements began. Extensive foredunes developed since the last high lake levels began eroding in 1997 at fast rates. This study focuses on coastal morphodynamics along the 800 m coast within the central Indiana Dunes State Park on Lake Michigan’s southern shores during this time. Severe foredune erosion, in terms of total horizontal dune loss and total volume of eroded sand, occurred unevenly over the three-year period, both temporally, during a single storm, a season, a year, or three years, and spatially, in the eastern, central, and western study areas. Late autumn storms accounted for most foredune erosion in 2018 and 2019, when foredune scarps retreated up to 4 and 9 m, respectively. Erosion was highest in the updrift eastern study area, where about 8 m3/m of sand was removed in 2018 and about 19 m3/m of sand was removed in 2019. The lack of shelf ice along the shore, rising lake levels, and convective storms that triggered meteotsunamis changed the foredune erosion pattern in 2020. Erosion became most vigorous in the downdrift central (13 m scarp retreat) and western (11 m scarp retreat) study areas. The average volume of eroded sand (21.5 m3/m) was more than double that of 2019 (8 m3/m), and almost quadruple the 2018 volume (5.5 m3/m). After foredune erosion events, the beach rapidly recovered and maintained its width as the shoreline migrated landward. On many occasions following these severe erosion events the dry portion of the beach aggraded and absorbed significant sand amounts removed from the foredunes. The remaining sand was transferred to the surf zone, where it changed the sand bar morphology and led to their coalescence and flattening.

The experience of using additive technologies for three-dimensional reconstruction of the lungs in the clinical practice of a tuberculosis dispensary

The aim was to study the volume of blood loss and the duration of a surgical session in patients with destructive pulmonary tuberculosis using threedimensional anatomical models of the lungs. Methods. The study was conducted in 2020 – 2021 in the State Budgetary Healthcare Institution of the Nizhniy Novgorod region “Nizhny Novgorod Regional Clinical Tuberculosis Dispensary” as part of an internal grant from the Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation. The prospective clinical study included 80 patients. All patients were divided into two groups. The main group included 40 patients. Preoperative lung reconstruction was performed for these patients. Thoracic surgeons used the three-dimensional anatomical models of the lungs to study the syntopy of healthy and diseased tissue (visual assessment) and prepare for the surgical session (cutting the model with a scalpel). Threedimensional preoperative lung reconstruction was not performed for the other 40 patients in the control group. In this group, the thoracic surgeons did not use 3D anatomical models of the lungs. Comparison of the results in the control and the main group was carried out using the Mann – Whitney U-test and Spearman and Kendall correlation tests. The obtained data are described with absolute and relative values, boxplots reflecting median (Me) and interquartile interval (IQI), scatter plots with trend lines, and probability density plots. The level of statistical significance of differences for testing the hypotheses was chosen at p &lt; 0.05. Results. It was shown that the volume of blood loss (U = 590; p = 0.042) and the duration of surgery (U = 587; p = 0.041) in patients of the main group are smaller than in patients in the control group. A moderate correlation was established between the volume of blood loss and the duration of the surgical session (ρ = 0.54; p &lt; 0.001) in the main group using the Spearman’s test. Kendall’s test also showed a positive correlation (τ = 0.42; p &lt; 0.001). Conclusion. The established differences between the main group and control group in the volume of blood loss and the duration of surgery due to the inclusion of polymer models of the lungs in preoperative preparation of thoracic surgeons confirm our hypothesis about the effect of additive technologies on the above parameters and indicate the significance of the applied reconstruction method.