Modification Of Technique Research Articles

Total Pancreatectomy for Locally Advanced Pancreatic Adenocarcinoma with Coeliac Trunk Resection and Retrograde Gastric Revascularization Through Aorto-Hepato-Spleno Allograft.

Locally advanced pancreatic adenocarcinomas (LA-PDAC) are more frequently operated now than in the past because of new regimen chemotherapy and improvement in surgical technique.1 Resection of the coeliac trunk (CT) during pancreatoduodenectomy (PD) or total pancreatectomy (TP) is not routinely done owing to the risk of liver and gastric ischaemia.2 In this video, a patient with LA-PDAC underwent TP with CT resection and retrograde gastric revascularization through the distal splenic artery. A 57-year-old male with LA-PDAC at the head-neck junction with circumferential invasion of the CT and the mesentericoportal axis showed excellent response to chemotherapy (FOLFIRINOX, 12 cycles) and radiotherapy (54 Gy) with normalization of tumour markers. One year later, TP instead of PD was decided to avoid postoperative pancreatic fistula.3 An allograft (en Y) from bank vessels was anastomosed between the aorta and the propre hepatic artery. For gastric revascularization and to avoid the small left gastric artery, the arterial anastomosis was done on the distal part of the splenic artery, allowing retrograde vascularization through short gastric vessels. Segmental venous resection was done. Venous and arterial liver ischaemia times were 11 min and 31 min, respectively. The postoperative outcome showed asymptomatic pseudoaneurysm on the hepatic anastomosis. Pathology confirmed T1cN1R0. Nine months after surgery, no recurrence was observed. CT resection may be needed during PD. If the right gastric pedicle cannot be preserved, retrograde gastric revascularization through the splenic artery is an important technical modification. The availability of allografts from bank vessels is very useful, and the outcome is mitigated by TP.

Component Restoration in the Unilateral Intermediate Cleft Lip Rhinoplasty: Our Experience and Technique Modification

Component Restoration in the Unilateral Intermediate Cleft Lip Rhinoplasty: Our Experience and Technique Modification

Modified Canabrava technique with a 4-closed loop intraocular lens injected into the anterior chamber

The goal of this study was to describe and assess the efficacy of a new modification for scleral fixation of a 4-eyelet foldable intraocular lens (IOL) using a previous IOL injector in the anterior chamber. An uncontrolled case series was used to investigate the efficacy of this new modification of the original Canabrava technique. Intraocular pressure and visual acuity data were obtained preoperatively and postoperatively. Surgeries were performed with the new modification of the Canabrava technique in 12 patients with implantation incisions as small as 2.2 mm (3.2 to 2.2 mm). The follow-up period ranged from 1 to 13 months. Corrected distance visual acuity improved significantly in all 12 patients, from 0.38 to 0.31 logMAR, whereas the cell count from specular microscopy decreased in average (preoperatively 2191 cells/mm2; postoperatively 1843 cells/mm2) and median (preoperatively 2225 cells/mm2; postoperatively 1902 cells/mm2). This current modification of the Canabrava technique greatly simplifies the procedure, making it easier and faster and with a shorter learning curve.

A prospective single-center cohort study on a modification of the posterior sagittal anorectoplasty technique for vestibular fistula in females

A prospective single-center cohort study on a modification of the posterior sagittal anorectoplasty technique for vestibular fistula in females

Cataract surgery with endothelial keratoplasty.

This review aims to provide an updated summary of the combined approach of cataract surgery with endothelial keratoplasty (EK), addressing key considerations, including intraocular lens (IOL) choice and calculation, decision between sequential and triple EK, and modifications in surgical techniques and postoperative management. Advances in imaging techniques (Scheimpflug tomography and anterior segment optical coherence tomography) have improved the ability to detect subclinical corneal edema, aiding in surgical decision-making for EK. Recent studies comparing sequential and triple-EK indicate that both methods yield similar visual outcomes. Though triple-EK offers quicker recovery, it may have higher complication rates. The use of gases like SF6 and C3F8 for anterior chamber tamponade is evolving, with conflicting findings on their efficacy in preventing graft detachment. Furthermore, IOL selection remains crucial, as hyperopic refractive surprises are common, and hydrophilic lenses should be avoided owing to the risk of opacification after EK. The combination of cataract surgery with EK has emerged as an effective treatment for patients with corneal endothelial diseases and cataract. Careful preoperative evaluation, appropriate IOL selection, and advances in surgical techniques contribute to better outcomes, although patient-specific factors must guide the choice between sequential and triple-EK procedures.

Факторы выбора стратегий волевой регуляции у студентов вузов

<p>The article presents the results of a study of volitional regulation strategies in university students. The hypothesis was tested that the choice of strategy is determined by the nature of the tasks facing students related to self-organization of educational activities, as well as individual characteristics of students: volitional, motivational spheres, self-awareness and psychodynamic properties. To test the hypothesis, students of different levels of education studying in full-time and distance learning departments were compared using a single-factor analysis. A total of 698 people took part in the study. The multiple linear regression method was used to test the influence of individual characteristics. The following methods were used: "Action Control Scale", "Questionnaire for identifying the severity of self-control in the emotional sphere, activity and behavior", "Brief Academic Motivation Scale", PIL test, "General Self-Efficacy Scale", a modification of the Dembo-Rubinstein self-assessment technique, "Big Five Short Portrait Questionnaire (B5-10)". To assess the strategies of volitional self-regulation, students were offered a list of ways to solve problems that arise in the course of their studies, which they had to evaluate by the frequency of their use. Then, the students' answers were processed using factor analysis. As a result, six strategies were identified: "planning", "self-regulation", "self-compulsion", "additional classes", "seeking help", "detachment from the problem". It was shown that full-time and distance learning students differ significantly in five of the six strategies. Master's students more often resort to self-regulation, bachelor's students more often seek help, and specialist students more often resort to self-compulsion. It was also shown that the choice of strategies is significantly influenced by the characteristics of volitional regulation and academic motivation of students.</p>

Postmortem fingerprint identification: A novel adaptive approach to the transillumination technique using moistened black volcano powder for fragile epidermal tissue.

Postmortem identification through fingerprints often encounters significant challenges, particularly with damaged epidermal tissue, due to factors such as carbonization, putrefaction, mummification, or saponification. Traditional techniques frequently fall short in cases involving fragile skin, which complicates the collection of clear fingerprint impressions. This study presents and evaluates an adaptive modification of the transillumination technique, integrating it with moistened black volcano powder to enhance fingerprint recovery from compromised postmortem tissue. A retrospective comparative analysis was conducted on 55 cases processed at the Ricardo Gumbleton Daunt Institute of Identification, São Paulo, Brazil, from January 2012 to May 2022. Of these, 12 cases with both pre- and post-treatment records were selected, totaling 28 distal phalanx samples. The proposed technique involved applying moistened black volcano powder to the epidermis, followed by transillumination and direct photography. The enhanced technique demonstrated a significant improvement in fingerprint quality. Qualitative analysis revealed that all samples treated with moistened black volcano powder clearly presented visible ridges and minutiae, whereas four samples treated with traditional transillumination alone were insufficient for minutia marking. Quantitative analysis indicated that 75% of the samples scored +2 (greater minutiae details and contrast), with an additional 25% scoring +1 (slightly better minutiae details and contrast). The combined use of transillumination and moistened black volcano powder significantly improves the visualization of postmortem fingerprints, providing a reliable method for forensic identification in cases with fragile or compromised epidermal tissue from putrefied or carbonized skin. This technique generates high-resolution fingerprint images that are suitable for database comparison and forensic analysis.

Long-term results of primary and revision oncological endoprosthetics

BACKGROUND: Increased overall survival leads to a significant increase in the service life of implants. Currently, no joint replacement systems are failure-free, which reduces the service life. AIM: To assess and systematize the main complications of primary and revision joint replacement surgery, identify the main causes of these complications at various stages of joint replacement based on literature data and analysis of own findings in a large patient population, and develop treatment approaches. MATERIALS AND METHODS: The study included 1,292 patients with primary bone and soft tissue sarcomas, as well as metastatic and benign bone tumors, with 1,671 primary and revision joint replacement surgeries of varying extent performed between January 1992 and January 2020. The proportion of males and females who underwent joint replacement surgery was approximately equal. Joint replacement surgery was performed in 886 (68.6%) patients with primary cancer, 144 (11.1%) patients with metastases to long bones, and 262 (20.3%) patients with benign tumors. RESULTS: During the study period, the overall incidence of complications was 1.4 times higher in the revision joint replacement surgery group (38.1%) compared to the primary joint replacement surgery group (26.6%). The most common type I–IV complications included unstable implants two and more years post-surgery (type IIB) and broken implants (type IIIA). As a result of innovative modifications, the overall incidence of type I–IV complications in primary and revision joint replacement surgery decreased to 16.5% and 24.3%, respectively. The most common cancer-related complication of primary joint replacement surgery was tumor recurrence (type V), accounting for 9.5% of cases. Tapered and cylindrical stems were the best shapes for primary and revision joint replacement surgery. The best stability was observed for 60–100 mm long stems in upper extremity joint replacement and 110–150 mm long stems in lower extremity joint replacement. Stems longer than 160 mm can only be used in revision joint replacement surgery. Adequate perioperative antibiotic prophylaxis reduced the risk of implant site infections. CONCLUSION: High-quality cement mantle formation, stems that match the diameter and shape of the medullary canal, and optimal stem length decrease the incidence of early aseptic instability. The study used a set of preventive measures, including strict compliance with standardized antibiotic therapy regimens during and after surgery, surgical technique modifications, perioperative patient management, and informing patients about the risks of infectious complications. These measures decreased the incidence of early implant site infections after primary and revision joint replacement surgery for a period of 28 years. The efficacy of combination treatment for these diseases has a direct impact on the incidence of local tumor recurrence. Surgical technique modifications based on tumor grade significantly increased treatment efficacy.

Laparoscopic Vertical Clip Gastroplasty with BariClip Experience, Complications, Literature Review, and Proposal of Modification of the Original Technique.

Laparoscopic vertical clip gastroplasty (LVCG) with BariClip is a recent procedure that appears to be safe Gentileschi et al. (Obes Surg 33(1):303-12, 2023). The initial complications reported include erosion, slippage, and gastroesophageal reflux. This study aimed to report on the experience of a single surgical group, analyzing three clinical cases, conducting a literature review, and proposing a standardization of the technique. A retrospective study was conducted with data from June 2021 to October 2024. We collected the data from the procedures related to the bariatric clip made by only one surgical group; we collected 69 cases with 1 complication of this surgical group. Additionally, we described 2 clinical cases of complications related to bariatric clips from other surgical institutions and reviewed the literature related to the BariClip experience. The results are related to the evaluation of the technique and compare the different modifications implemented over the last 3years of follow-up. Furthermore, we aim to share our experience in attending to one of the most concerning complications associated with this procedure. The LVCG is a safe procedure with a low incidence of complications and positive results in %EWL. We propose several modifications to the original technique to further reduce complications, and we share the experience of both treating and resolving some of the complications we encountered.

Differential linea alba width in pediatric umbilical hernias: a comparative analysis.

This study aimed to investigate the relationship between linea alba width and unclosed pediatric umbilical hernias. A retrospective chart review was conducted on patients with pediatric umbilical hernias persisting beyond the age of 2, from April 2014 to March 2021. Additionally, data from children who underwent computed tomography (CT) for other conditions or injuries, such as diarrhea or traffic accidents, were collected from April 2010 to March 2022. The width of the linea alba was measured using ultrasonography in pediatric hernia patients and CT in children without umbilical hernias. Measurements were taken at five levels on the axial plane: at the level of the umbilicus and 1.5cm and 3cm above and below the umbilicus. The analysis included 191 children without hernias and 30 patients with unclosed hernias, all aged between 2 and 7years. The linea alba width was significantly wider in children with unclosed hernias than in children without hernias at all five measurement points (p < 0.05). The disparity was more pronounced below the umbilicus. However, no significant differences in width were observed across different age groups among children without hernias. Children with umbilical hernias exhibited wider linea albae. It is hoped that these results will contribute to modifications in surgical techniques and enhance understanding of the pathophysiology in patients with umbilical hernias.

A Half-Century of Heterotopic Heart Transplantation in Mice: The Spearhead of Immunology Research

Since the success of solid organ transplants, such as human kidneys, livers and hearts, from the 50s to the 60s in the last century, the field of organ transplantation has progressed rapidly. Mainly due to modifications in surgical operation techniques and improvements in immunosuppressive therapy regimes, organ survival time can now be greatly prolonged. This progress has also been dependent upon the availability of appropriate animal models for organ transplantation. Therefore, the mouse heart transplantation model has developed into an irreplaceable research model for solid organ transplantation, providing indelible contributions to the field. In this review, we will provide an overview of the technical developments in murine heart transplantation, as well as its historical and current role for alloimmune research. Further, we will describe its current fields of application and its scientific achievements before we discuss potential future applications.

Modified Two-Flap Palatoplasty With Leaving Lateral Periosteum and Application of Honey Pack : A Preliminary Study

According to our experience in Ciptomangunkusumo hospital, most cleft palate patients has wide gap. It makes the epithelialization of the lateral defect takes longer time ( 3- 4 weeks). In this study, the authors propose a modified technique to the two-flap palatoplasty by not elevating the lateral part of the periosteum with the flap, and then apply honey packs to cover the lateral defects. The technique modification and additional honey-soaked dressing are expected to hasten the epithelialization rate. Twelve consecutive patients with non-syndromic cleft palate (with or without cleft lip) are included in the study. They undergo the modified two-flap palatoplasty with the lateral periosteum left behind, covering the palatal bone and the utilization of Honey pack. The rate of epithelialization is then observed every 2 days after operation until full healing is achieved. Complete epithelialization was attained within 5 days in one patient ( 2,8 mm/day), within 7 days in 8 patients (2-2,5mm/day), and within 9 days in 3 patients (2,2-2,7mm/day). There were no surgical complications, such as hemorrhage or wound infection. The fistula of the palate was not found until the defect closed. Our technique hasten the rate of epithelialization. It may prevent the maxillary growth disturbances in the future because faster healing reduces scar formation and wound contraction.

Derivation of the carbon dioxide total column in the atmosphere from satellite-based infrared fourier-transform spectrometer IKFS–2 measurements: analysis and application experience

The paper discusses the use of a new version of the regression technique for derivation the total content of carbon dioxide in the atmosphere XCO2 (column-averaged dry-air mole fraction) from measurements of the infrared Fourier-transform spectrometer IKFS–2 installed on board Russian meteorological satellite Meteor-M No. 2. To evaluate the accuracy of satellite-based XCO2 estimates the retrospective comparison was made with data from ground-based spectroscopic measurements at Peterhof site of St. Petersburg State University as well as with aircraft measurements of the V. E. Zuev Institute of Atmospheric Optics (IOA) in the area of the Novosibirsk Reservoir conducted in 2019-2022. A brief description of the regression technique modifications is given made to improve the accuracy of satellite – based XCO2 estimates. In particular, to compensate for the effect of changes in the IKFS-2 characteristics during a long flight, the XCO2 estimates calibration is realized using ground - based XCO2 measurements at the NOAA Observatory on Mauna Loa volcano (island of Hawaii). After calibration and cloud scenes filtering, the discrepancy between satellite estimates and ground-based / aircraft measurements is characterized by root mean square deviation of ~4 ppm or 1% of the CO2 total content. In order to accelerate the adjustment of the regression technique, used for estimating XCO2, to IKFS-2 data on new satellites, it is reasonable to use XCO2 observations at the TCCON terrestrial network in addition to conventional contact measurements of CO2 concentrations. Along with this, it seems rational to use the cryogenic film thickness on the glass of the IKFS-2 photodetector, characterizing the state of the instrument, as additional predictor in the regression model.

Comparative Short-Term Outcomes of Double-Kissing Culotte and Culotte Techniques in Acute Coronary Syndrome from the Lower Silesia Culotte Bifurcation Registry.

Background/Objectives: The double-kissing (DK) culotte technique is a modification of the culotte technique that employs initial kissing balloon inflation after first stent implantation. The DK culotte technique may improve strut apposition and procedural outcomes; however, data on its efficacy and safety remain limited. This study aimed to investigate the short-term outcomes of bifurcation percutaneous coronary intervention (PCI) using the DK culotte technique compared with those of the culotte technique in patients with acute coronary syndrome (ACS). Methods: This two-center, observational, retrospective study included patients with ACS. Out of 12,132 screened patients, 117 and 122 underwent DK culotte and culotte PCIs, respectively, with 117 and 57 patients remaining after propensity score matching. The primary endpoint was 1-year target lesion failure (TLF), which included cardiovascular death, target vessel myocardial infarction or clinically indicated target lesion revascularization (TLR). Secondary endpoints included major adverse cardiac events (MACEs) comprising myocardial infarction, cardiac death, and TLR; contrast medium amount (mL); and cumulative radiation dose (mGy). Results: At 1 year, TLF occurred in 7% and 12% of the DK culotte and culotte groups, respectively (p = 0.17). No significant differences were observed in MACEs between the groups (13% DK culotte vs. 19% culotte; p = 0.12). Additionally, the DK culotte technique did not cause higher contrast medium usage or cumulative radiation dosage. Conclusions: No statistically significant differences were found in TLF and MACE reduction between ACS patients treated with the DK culotte technique and the culotte technique. The observed trend favoring the DK culotte needs further validation in prospective studies.

A critical update on endoscopic dacryocystorhinostomy.

Endoscopic dacryocystorhinostomy (endo-DCR) is becoming a workhorse in the management of distal lacrimal duct obstruction. It yields success rates comparable to external DCR, with the advantage of no external scars. However, it requires multidisciplinary expertise and many uncertainties in terms of proper indications, technique, and perioperative management still exist. Systematic review of the literature in the last 5 years using PubMed and Google Scholar. A total of 66 articles were included. Many technical modifications and surgical refinements have been proposed, but a formal comparison of the various techniques is hampered by methodological heterogeneity. The use of local anaesthesia and perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity even if the level of evidence remains weak. Endo-DCR offers satisfactory clinical outcomes even though there are many grey areas that need to be addressed in future high-quality studies.

Lumbocaval Shunt for Idiopathic Intracranial Hypertension: A Technical Report and Case Series

BACKGROUND AND OBJECTIVES: Neurosurgical management of idiopathic intracranial hypertension (IIH) can be challenging given high rates of revision associated with cerebrospinal fluid shunting. In this study, we present a technical report and early outcomes for lumbocaval shunt (LCS) placement in difficult-to-manage cases. METHODS: A literature search was performed for previous reports of LCS or lumboatrial shunt. Electronic medical records of patients who underwent placement of LCS for the treatment of IIH at a single institution were reviewed. Based on early experience and outcomes, our modified technique for LCS is described. RESULTS: Six patients (4 females, median age 36 years [IQR 31-43]) underwent placement of LCS between October 2023 and April 2024. LCS was completed in all cases without intraoperative complications. The median operative time was 88.5 minutes [IQR 79.5-158.8]. One patient developed low-pressure headaches that resolved after the addition of a shunt-assist device. Five of 6 patients reported improved headache at the last follow-up visit, with 4 of 5 patients reporting that their high-pressure headaches completely resolved (median time to the last follow-up of one month [IQR 1-2 months]). During the study period, one shunt revision was performed because of migration of the lumbar shunt into a suprafascial pocket. This led to modification of the surgical technique, specifically the inclusion of anchoring dips. CONCLUSION: LCS may represent an alternative shunting technique in difficult-to-manage patients with IIH. Further assessment of long-term outcomes is needed.

Impact of voltage variation on topography, hydrophobicity, and corrosion behavior of the CeO2-TiO2 nanocomposite coating on AM60B Mg alloy prepared by plasma electrolyte oxidation

Abstract A superhydrophobic oxide layer on AM60B magnesium alloy was created by using a plasma electrolytic oxidation (PEO) technique and subsequent surface modification. PEO was applied in an electrolyte with/without CeO2-TiO2 nanoparticles (NPs) by two different voltages of 350 and 450 V. Atomic force microscopy (AFM) and field emission scanning electron microscopy (FE-SEM) were used to evaluate the roughness and morphology of the surface. Water contact angles on the surface were measured to investigate the surface wettability. Potentiodynamic polarization tests in a 3.5 wt% NaCl solution were used to assess the corrosion resistance of the coating. Also, the FE-SEM images showed that increasing applied voltage, decreases the numbers and size of the pores on the surface. Results showed that applying PEO, increased the corrosion resistance of the bare AM60B because corrosion rate (C.R.) decreased from 1.523805 (bare AM60B) to 1.432107 mpy (PEO-450 V). Furthermore, using CeO2-TiO2 NPs effectively enhanced the corrosion resistance of the bare AM60B by decreasing the corrosion rate from 1.523805 to 1.286469 mpy.

Creating thresholds for success and ‘underachievement’: a critical policy history of public examinations in England

ABSTRACT In England, thresholds for success in public examinations taken by 15/16 year-olds play a major role in the education system. Definitions of what constitutes ‘success’ change over time and have an important impact on young people’s progression to further education, training, and employment. By taking a historical view of examination thresholds at 15/16 in England, we show that thresholds are not a mere reflection of societal or economic norms, nor are changes to them simply gradual adjustments or technical modifications. Using ideas from ‘critical policy sociology’ (see Savage, Gerard, Gale and Molla, 2021), we argue that thresholds can be understood as ‘temporary settlements’ (Gale 1999, p. 401) that are the product of four separate but interlocking policy contests around educational purposes, the importance of specific subjects, the role of education in the economy, and educational governance. Analysing and decoding the production of changing thresholds over long periods through these policy contests allows us to more clearly understand the contemporary situation (where thresholds have become very prescriptive) and to challenge the foundations of thresholds: creating space for different conceptions of success and failure.

Whole lung and sequential bronchoscopic lavage for pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that results from the accumulation of lipoproteinaceous material in the alveoli due to abnormal surfactant homeostasis. Since its introduction in the 1960s, whole lung lavage (WLL) has been the primary treatment for PAP. This review focuses on WLL, including its technique modifications, and sequential bronchoscopic lavage. Autoimmune PAP, which accounts for the majority of cases, occurs when antigranulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies lead to the deficiency of bioavailable GM-CSF. At present, there are no international guidelines or consensus statements for PAP treatment. Traditionally, therapeutic decisions are made based on the severity and type of PAP. Despite emerging data on GM-CSF-based therapies, WLL remains a central component in the therapeutic strategy for PAP. Although the technique of WLL has evolved over time, there is still no universally adopted, standardized protocol. However, key periprocedural aspects - such as preprocedural planning, patient evaluation, anesthetic technique, lavage protocol, and postprocedural care - remain essential to ensuring the safety and success of WLL.

Exploring Dense Breast Density in Mammography: A Comparative Analysis of Breast Cancer Risk.

Breast density is a strong predictor of breast cancer. However, the difference in risk between breast density categories C and D remains inadequately explored. Given the low occurrence of extremely dense breasts, this investigation is crucial because it may lead to modifications in screening techniques for those with these conditions. The objective of the study is to evaluate the difference in breast cancer risk among women undergoing mammography and biopsy at a tertiary referral hospital in Colombia, based on American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) results in categories of breast density C (heterogeneously dense) and D (extremely dense). Methods: This retrospective cross-sectional study recorded variables from the mammographic BI-RADS scale, as well as histological and clinical variables from digital medical records. A stratified analysis of lesion malignancy/benignity was conducted according to density category by mammography and histological findings. The association between mammographic breast density subclassification of dense breasts and the occurrence or not of pathology-defined malignancy was sought. Results: A total of 107 patients with breast density in categories C and D were included, with 88.7% having heterogeneously dense breasts. The frequency of breast cancer was 32%. Infiltrating ductal carcinoma was the most frequently diagnosed malignancy (N = 14). Ahigher BI-RADS category was correlated withbreast density grade D and malignancy. A statistically significant association (p <0.045, RR 1.95, CI: 1.12-3.50) was found when comparing breast density (categories C and D) with the risk of malignancy. The positive predictive value (PPV) varied across different BI-RADS categories (BI-RADS 4A 25% vs. 0%; p-value 0.005; BI-RADS 4B 50% vs 10.5%; p-value 0.032). Efforts and resources should be focused on patients with extremely dense breasts, emphasizing the importance of additional (individualized) screening. Breast density could change the PPV within each BI-RADS category. However, further studies are needed to define the risk associated with each breast density subcategory and within BI-RADS categories, as well as to assess the efficacy of additional screening in patients with extremely dense breasts.