Open Fashion Research Articles

외모관리 행동이 미용성형 후 메이크업관리 행동에 미치는 영향

Appearance management behavior needed for women to express their personality and beauty has recently changed people’s image in a very open and active fashion through plastic surgery and makeup. In fact, satisfaction with plastic surgery can also affect makeup care behavior. This study attempted to investigate women’s psychological satisfaction after aesthetic surgery and examine the influence of appearance management behavior on makeup care behavior after setting the hypothesis that satisfaction with plastic surgery would affect makeup care behavior. It tried to suggest a way to enhance satisfaction with such appearance management behavior and provide data which can be used for makeup care behavior after the surgical procedure. For this, a questionnaire survey was performed against adult women in their 20s or older, who had plastic surgery before. A total of 280 copies were collected and analyzed, using SPSS 25.0. To analyze subjects’ general characteristics, frequency analysis was conducted. To examine how the variables are related to each other, correlation analysis was performed. In addition, to verify the influence of appearance management behavior on satisfaction with aesthetic surgery and makeup care behavior, multiple regression analysis was carried out. Furthermore, simple regression analysis was conducted to examine the effects of satisfaction with aesthetic surgery on makeup care behavior, and the results found the followings: Correlation among appearance management behavior, satisfaction with aesthetic surgery and makeup care behavior was confirmed, and satisfaction with plastic surgery had a positive effect on makeup care behavior. It is anticipated that the study results would be available as basic data in suggesting a way to enhance satisfaction and appearance management behavior in an efficient manner.

Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up

To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level IV, case series, therapeutic.

Unraveling the complexities of programming neural adaptive deep brain stimulation in Parkinson's disease.

Over the past three decades, deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied in a continuous open loop fashion, unresponsive to changes in a given patient's state or symptoms over the course of a day. Advances in recent neurostimulator technology enable the possibility for closed loop adaptive DBS (aDBS) for PD as a treatment option in the near future in which stimulation adjusts in a demand-based manner. Although aDBS offers great clinical potential for treatment of motor symptoms, it also brings with it the need for better understanding how to implement it in order to maximize its benefits. In this perspective, we outline considerations for programing several key parameters for aDBS based on our experience across several aDBS-capable research neurostimulators. At its core, aDBS hinges on successful identification of relevant biomarkers that can be measured reliably in real-time working in cohesion with a control policy that governs stimulation adaption. However, auxiliary parameters such as the window in which stimulation is allowed to adapt, as well as the rate it changes, can be just as impactful on performance and vary depending on the control policy and patient. A standardize protocol for programming aDBS will be crucial to ensuring its effective application in clinical practice.

A mixed methods exploration of the parent perspective of talent development environments across a national multi-sport landscape

Parents are known to be important influencers in the talent development process but are often overlooked. Understanding the parent perspective may help National Governing Bodies and coaches improve their support for young talented athletes. This study aims to understand the parent perspective of the talent development experience across a national multi-sport landscape using mixed methods. Four hundred and eighty-five parents of pathway athletes completed the talent development environment questionnaire for parents (TDEQ-P), which included the opportunity for parents to respond in an open fashion. The results revealed several key relative strengths and weaknesses of the talent development environment. Areas identified for improvement included 1) Communication related to pathway understanding, planning, guidance, and feedback, 2) Individualised training, goal setting, and feedback, 3) Facilities, 4) Access to a specialist support network, in particular psychology support, 5) Engagement between coaches and, 6) Dual career management and engagement with educational institutions. The results also revealed evidence of context specific needs between performance level, sport type, and age group. The TDEQ-P may be an efficient and effective way coaches can access important feedback, improve communication, and build relationships with parents in sport.

Implementation of an enhanced recovery after surgery (ERAS) protocol for total abdominal hysterectomies in the division of gynecologic oncology: a network-wide quality improvement initiative.

Enhanced Recovery After Surgery (ERAS) protocols have been shown to decrease length of stay and postoperative opioid usage in colorectal and bariatric surgeries performed at large academic centers. Hysterectomies are the second most common surgical procedure among women in the United States. Hysterectomies performed in an open fashion, or total abdominal hysterectomies (TAHs), account for a large portion of procedures performed by gynecologic oncologists secondary to current oncology guidelines and surgical complexity. Implementation of an ERAS protocol for gynecologic oncology TAHs is one way in which patient outcomes may be improved. An ERAS protocol for gynecologic oncology surgeries performed in a community hospital was instituted with the goal to optimize patient outcomes preoperatively. The primary outcome of interest was to reduce patient opioid usage. Secondary outcomes included compliance with the ERAS protocol, length of stay, and cost. Thirdly, this study aimed to demonstrate the unique challenges of implementing a large-scale protocol across a community network. An ERAS protocol was implemented in 2018, with multidisciplinary input from the Departments of Gynecologic Oncology, Anesthesia, Pharmacy, Nursing, Information Technology, and Quality Improvement to develop a comprehensive ERAS order set. This was implemented across a 12-site hospital system network that consisted of both urban and rural hospital settings. A retrospective review of patient charts was performed to assess measured outcomes. Parametric and nonparametric tests were utilized for statistical analysis with p<0.05 denoting statistical significance. If the p value was >0.05 and <0.09, this was considered a trend toward significant. A total of 124 patients underwent a TAH utilizing the ERAS protocol during 2018 and 2019. The control arm consisted of 59 patients who underwent a TAH prior to the ERAS protocol intervention, which was the standard of care in 2017. After 2 years of implementation of the ERAS protocol intervention, we found that 48 % of the ERAS patients had minimal opioid requirements after surgery (oral morphine equivalent [OME] range 0-40) with decreased postoperative opioid requirements in the ERAS group (p=0.03). Although not statistically significant, utilization of the ERAS protocol for gynecologic oncology TAHs trended toward shorter hospital length of stay from 5.18 to 4.17days (p=0.07). The median total hospital costs per patient also showed a nonsignificant decrease in cost from $13,342.00 in the non-ERAS cohort and $13,703.00 in the ERAS cohort (p=0.8). A large-scale quality improvement (QI) initiative is feasible utilizing a multidisciplinary team to implement an ERAS protocol for TAHs in the division of Gynecologic Oncology with promising results. This large-scale QI result was comparable to studies that conducted quality-improvement ERAS initiatives at single academic institutions and should be considered within community networks.

The Best of Both Worlds

The minimal invasive surgery in Foot and Ankle is here to stay and its growth and strength is undeniable. During the 90s in the American continent, forefoot minimal invasive surgery was dominated by North American Podiatrist, during that time the now called “first generation MIS” for Hallux Valgus wasn´t well accepted by orthopedic foot and ankle surgeons. It was a controversial topic pointed out as a “blind with no fixation technique” that could not be predicted on its outcome. This was supported because of the lack of scientific studies regarding this MIS bunion´s correction and the fact that there were some publications and oral presentations putting it down because of its detrimental outcomes. In the 2000s and 2010s the orthopedic world started to look more seriously into this ideology and started to do a formal scientific work and resulted in this ultimate generation percutaneous Hallux Valgus correction with hardware fixation backed up with several papers with clinical and radiological outcomes. Proof of this is the threefold rise in publications on MIS that arouse from 10,127 in med nineties to 30,362 in 2015. At the same scenario, percutaneous metatarsal osteotomies that were done in despite of Metatarsophalangeal dislocation, found its contraindication on this new paradigm and must be done in an open fashion to reduce it when doing a percutaneous bunion, giving a place to hybrid surgery. Also Minimal Invasive Queilectomy for Hallux Rigidus yielded more second procedures than open surgery in some publications favoring this latter technique. Open surgery has been studied for many years reporting good to excellent outcomes in forefoot, midfoot, hindfoot and ankle. Wound Complications and faster recovery time are the main factors that pulled the indications for some open procedures to be done in a minimal invasive fashion like Achilles Rupture repair, arthroscopic ankle fusion, etc. But there are open techniques such as the Progressive collapsing foot deformity reconstruction, Cavus varus deformity reconstruction, tibial osteotomy for ankle deformities, tendon transfer for neurological pathologies, triple, or double arthrodesis, etc., that are mostly done with “traditional” surgery because of the power of addressing and fixing the problem that isolated minimal invasive procedures could not. Nevertheless, minimal invasive calcaneal osteotomy, arthroscopic arthrodesis, tendoscopy, arthroereisis, arthroscopic or percutaneous lateral ligament reconstruction are excellent complements for those open surgeries. Patient demands in cosmetic scars and very early return to more than moderate physical activity sometimes pushes the surgeon to choose a different procedure he or she are comfortable with, and this could jeopardize the results and elevates the complications possibility. The surgeon must decide on learning new techniques in the foot area that have more advantages for the patient benefit. The Foot and Ankle surgeon should be ready to consider both ways of thinking and being capable of performing either one procedure or sometimes both (hybrid surgery) accordingly to each one´s experience and expertise to be able to give the best resolution to mild, moderate or severe cases for the patients with the least risk of complications. It is our responsibility to evolve…

Toward a Super-COP? Timing, Temporality, and Rethinking World Climate Governance

Toward a Super-COP? Timing, Temporality, and Rethinking World Climate Governance

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC).

Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT. A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications. Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery (P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery. The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications. Level IV, case series.

Outcomes Following Endoscopic versus Open Carpal Tunnel Release—A Matched Study

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the world. Surgical treatment can be performed in an open or endoscopic fashion. To date, similar rates of complications for both approaches have been described. We sought to compare the results of endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR) in patients with CTS. Patients with a diagnosis of CTS undergoing open or endoscopic surgical management were identified between January 2010 and October 2020. The primary outcome of the study was nerve injury within 30 days of the procedure. Secondary outcomes included readmission, wound-related complications, hematoma, seroma formation, and cost. A total of 735,631 patients were identified as undergoing CTR. Following a 1:1 match procedure, 292,626 patient records were analyzed. Patients undergoing OCTR versus ECTR had an increased odds of readmission at 30 days (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.73-2.06), developing an infection (OR 1.59, 95% CI 1.41-1.80), and experiencing wound complications (OR 1.97, 95% CI 1.74-2.23). No significant difference in odds of developing a seroma (OR 1.17, 95% CI 0.83-1.65), hematoma (OR 1.15, 95% CI 0.95-1.39), or nerve injury (OR 1.18, 95% CI 0.98-1.43) was noted. The reimbursement cost of ECTR was significantly greater than OCTR ($310.60 ± $1639.57 vs. $237.69 ± $1488.93, P < 0.001). In the largest study to date on the surgical management of CTR, OCTR was seen to be associated with an increased odds of readmission, infection, and wound complications, but reduced costs for the procedure alone.

Pediatric cerebrovascular trauma: Incidence, management, and outcomes

BackgroundPediatric cerebrovascular trauma (CVT) is rare. There is an increasing use of endovascular management in vascular trauma. We studied the incidence, management, and outcomes of CVT in the pediatric population using the NTDB (National Trauma Data Bank). MethodsThe NTDB was queried for CVT in patients less than 18 years of age over a recent three-year period (2017–2019). Demographics, injury mechanism, type and location, Glasgow Coma Score (GCS), length of stay (LOS), surgical approach (open vs endovascular), and morbidity/mortality were evaluated. Statistical analysis included χ2 and student's t-tests or Fisher's exact tests where appropriate. ResultsOf 386,918 pediatric trauma cases, 1536 (0.4%) suffered 1821 CVT. Blunt trauma accounted for 69.3%. Patients were predominantly male (65.4%) and white (57.5%), with an mean age of 14 years. There were 998 (55%) carotid artery injuries, including 846 common/internal carotid and 145 external carotid. Other vessel injuries included 141 (11%) intracranial carotid, 571 (31%) vertebral artery and 252 (14%) jugular vein. Mean number of vessels injured was 1.2. Motor vehicle trauma was most common (49.3%) followed by firearm injury (21%). The mean GCS was 11, and mean total LOS was 11.3 days. Majority of interventions were performed in an open fashion (65.7%), whereas 29.7% were performed endovascularly. Stroke rate was 3.1%. Patients with multiple vascular injuries had an overall mortality of 29% (p<0.0001). ConclusionWhile not accorded as much importance as blunt injury, penetrating CVT comprises of 30% of injuries. Nearly 1/3rd of all cases needing surgical intervention were managed with endovascular techniques. Level of evidenceIII.

What happens after percutaneous cholecystostomy tube for acute calculous cholecystitis?

• PCT can be a temporary treatment for acute calculous cholecystitis. • High incidence of biliary complications after PCT placement calls for timely cholecystectomy. • Interval cholecystectomy is recommended after PCT for calculous cholecystitis. Acute cholecystitis is commonly treated with laparoscopic cholecystectomy, if feasible. However, critically ill patients can be managed with a percutaneous cholecystostomy tube (PCT) for biliary drainage. This is a temporizing measure and does not represent a final treatment. We aimed to compare the outcomes of performing an interval cholecystectomy vs. conservative management after PCT placement. We conducted a retrospective study of all patients with a PCT placed for acute calculous cholecystitis (ACC) at a single center from October 2010 to March 2015. Ninety-five patients (median age 79 years) underwent PCT placement for ACC. Only 26.3% of patients underwent interval cholecystectomy. The mortality rate within 6 weeks of ACC diagnosis was higher in the non-surgical group but this was not statistically significant. The number of re-admissions and complications of biliary disease was higher in the surgical group before undergoing interval cholecystectomy, specifically, choledocholithiasis (44% vs. 21.4%; p = 0.03). Patients who had an ICU admission [OR 0.21; 95% CI 0.07-0.66] or increased age [OR 0.94; 95% CI 0.89-0.98] were less likely to undergo interval cholecystectomy. Nine cholecystectomies were performed laparoscopic, 6 were converted to open and 10 were done in an open fashion. The complication rate in the first 30 days after cholecystectomy was 56%. Most complications occurred when surgery was performed in an open or converted to open technique (11/14=78.6%) vs. laparoscopic (3/14=21.4%). The relatively high incidence of biliary complications in the period between PCT placement and cholecystectomy calls for timely cholecystectomy in patients treated with PCT. When feasible, patients with a history of ACC should undergo interval cholecystectomy.

Robot-assisted kidney transplantation: Is it getting ready for prime time?

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.

Supporting the emergence of Indian design through design and innovation centres – A methodological approach

In this article a set of strategic interventions developed through the Erasmus + KA2 project entitled ‘Design and Innovation Capacity Building in India/DESINNO’ which is under implementation within the action ‘Capacity Building in the field of Higher Education’ are presented. The approach developed brings together an historical overview of design in India, an overview of Higher Educational Institutes (HEIs) and industry in relation to design in the country, a literature review of relevant emerging field in contemporary design, an overview of relevant sectorial reports from India and the European Union and fieldwork comprising of surveys and focus groups in India. This triangulation of the interventions chosen allows to move forward to the deployment of the strategy developed in three Indian HEIs. The maker movement, social innovation and grassroots innovation form a unity that is tailor made for the Strengths and Opportunities present in contemporary India. Design hubs, community makers spaces in HEIs, are the central pillar in this strategy. Additionally, the knowledge transfer to Indian academics and professional designers by European HEIs in an open and collaborative fashion aims to provide the necessary competences to support said design hubs.

Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)—a study protocol for a prospective randomized controlled trial

BackgroundA multitude of different diseases—benign and malign—can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications.MethodsThe presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues.DiscussionThe described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations.Trial registrationProspective trials registration at the German Clinical Trials register with the registration number DRKS00027865. Registration Date: January 24, 2022.

Exploring the hydrogen-bonding interactions in the piperazinylethanol substituted homoleptic zinc(II)-dithiocarbamate and its diimine 2,2′-bipyridyl and 1,10-phenanthroline adducts, and their DNA binding studies

Keeping in view the significance of H-bonding hydroxyethyl substituent in the supramolecular organization of the compounds of general formula Zn(S2CNR1R2)2, herein we report synthesis and characterization (1H/13C NMR, FTIR, UV–Vis spectroscopy, CV, elemental analysis and single crystal XRD) of piperazinylethanol substituted complex [Zn{S2CN(CH2)4N(C2H4OH)}2]2 (1) and its 2,2′-bipyridyl (2) and 1,10-phenanthroline (3) adducts. Inferred from XRD data, these compounds show a variety of coordination geometries, i.e., Zn1-center (τ = 0.668) in (1) is more inclined towards trigonal-bipyramidal environment than the Zn2-center (τ = 0.567), whereas (2) and (3) exhibit distorted octa- and tetra-hedral geometries, respectively. Unlike the others, complex (2) co-crystallized with an uncoordinated 2,2′-bipyridyl ligand showing more stable trans-conformation of the N-atoms. Supramolecular data reveal pivotal role of the H-bonding interactions in the crystal packing, especially in (1) where (hydroxyethyl)OH···OH(hydroxyethyl) interaction sustains 3-D network. The interaction propagates in infinite open chain fashion and the network secures undulating topology. Adducts (2) and (3) also feature undulating topologies, however, OH···N H-bonding interaction plays the role to sustain 2- and 1-D networks, respectively. Other secondary bonding interactions, like CH···S, CH···π(aromatic), CH···O and π···π stacking etc. contribute to transform these 1- and 2-D architectures into 3-D aggregates. Compared to closely related systems, these compounds show enhanced H-bonding potential with less hydroxyethyl substituents per molecule, possibly due to the presence of sterically flexible piperazine ring. Further, their DNA-binding capability was assessed through multiple techniques (like UV–vis spectroscopy, CV and viscometry), which revealed promising DNA binding potential for these compounds.

The surgical management of complicated peptic ulcer disease: An EAST video presentation.

Peptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations. A combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy. Surgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction. Video procedure and technique, not applicable.

Endoscopic Gluteus Medius Repair Replicates Open, Knotless Repair With Similar Cyclic Loading Properties: A Cadaveric Study

PurposeTo compare the repair strength, gap formation, and mode of failure between endoscopic and open double-row gluteus medius repairs in a cadaveric model.MethodsSix pairs of fresh-frozen human cadavers were used in this study. Gluteus medius tears were created in an open fashion and then repaired with either open or endoscopic techniques. Specimens were manually preloaded to 5 N, then cycled between 20-50 N for 150 cycles s. Then, a ramp to/s. Specimens were then returned to 10 N and ramped to failure at 1 mm/s. Gap formation and strengths of the construct were compared for the 2 techniques.ResultsBiomechanical testing resulted in no significant differences in ultimate load (P = .86) or gap formation (P > .10) between groups. Ninety-two percent of specimens failed near the muscle origin on the ilium.ConclusionsThis study shows that both open and endoscopic gluteus medius repairs are stronger than the muscle–bone interface in a cadaveric model and loaded biomechanically in tension between the ilium origin and femoral insertion. Further, endoscopic technique is able to replicate open, knotless gluteus medius repair technique in terms of gap formation in physiologic (i.e., subfailure) cyclic loading.Clinical RelevanceGluteus medius tendinopathy is an increasingly common recognized etiology of lateral hip pain. When tears occur, debate exists over whether open or endoscopic repair procedures are optimal. Double-row endoscopic gluteus medius repair with knotless suture anchors may be an alternative to open repair.

Surgical approach does not influence changes in circulating immune cell populations following lung cancer resection

IntroductionThe multimodal management of operable non-small cell lung cancer (NSCLC) continues to evolve rapidly. The immune milieu allowing for immunotherapeutic benefit can be affected by multiple parameters including clinicopathologic and genetic. Surgery induced physiological changes has received attention for modulating and affecting post-operative oncotaxis and immunosuppression. Here, we sought to investigate how surgical stress influences phenotype of peripheral blood mononuclear cells (PBMCs) in patients with NSCLC who underwent lobectomy. MethodsBlood was prospectively collected from patients with Stage IA-IIIA NSCLC undergoing lung resection between 2016 and 2018. Samples were obtained pre-operatively, 24 h and 4 weeks after surgery. PBMCs were isolated and subject to high-dimensional flow cytometry, analyzing a total of 115 cell populations with a focus on myeloid cells, T cell activation, and T cell trafficking. We further evaluated how surgical approach influenced post-operative PBMC changes, whether the operation was conducted in an open fashion with thoracotomy, or with minimally invasive Video Assisted Thoracoscopic Surgery (VATS). ResultsA total of 76 patients met the inclusion criteria (Open n = 55, VATS n = 21). Surgical resection coincided with a decrease in T lymphocyte populations, including total CD3+ T cells, CD8+ T cells, and T effector memory cells, as well as an increase in monocytic myeloid-derived suppressor cells (mMDSC). Post-operative changes in PBMC populations were resolved after 4 weeks. Surgical-induced changes in immune populations were equivalent in patients undergoing open thoracotomy and VATS. DiscussionSurgical stress resulted in transient reduction in T cells and T effector memory cells, and increase of mMDSC following resection in NSCLC patients. The immune profile modulation was similar regardless of surgical approach. These findings suggest that surgical approach does not seem to affect mononuclear cell lines obtained from peripheral blood. Thus, the decision regarding surgical approach should be patient centered, rather than based on post-operative treatment response optimization.

Proximal Phalanx Osteotomy in Percutaneous Correction of the Lesser Toe Deformities: A Cadaver Study

Category:Lesser ToesIntroduction/Purpose:The correction of lesser toe deformities has been traditionally performed in an open fashion. With minimal-invasive foot surgeries becoming increasingly popular, correction of lesser toe deformities via percutaneous soft-tissue procedures and osteotomies is frequently performed. The aim of this study was to evaluate the site of percutaneous proximal phalanx osteotomy of the lesser toes in relation to the metatarsophalangeal joint line when performed without fluoroscopy guidance.Methods:In this experimental cadaver study, the metatarsophalangeal joints of the lesser toes of 20 cadaver samples (=80 toes) were palpated. A plantar skin stab incision was made just distal to the joint line without fluoroscopic control. Plantar closing osteotomies of the proximal phalanx were performed with a Shannon burr. Adorsoplantar view was taken with fluoroscopy. The location of the osteotomy and the relative distance from the metatarsophalangeal joint line was evaluated.Results:The majority (78/80; 97.5 %) of the osteotomies were localized in the metaphyseal region. No osteotomy violated the metatarsophalangeal joint.Conclusion:Percutaneous osteotomy of the proximal phalanx of the lesser toes guided by palpation without using the image intensifier is a safe procedure and does not violate the metatarsophalangeal joint.

Robotic-guidance allows for accurate S2AI screw placement without complications.

The study design is retrospective, multi-surgeon, single-center review. The objective is to evaluate complication rates, revision rates, and accuracy grading for robotic-guided S2 alar-iliac (S2AI) screws. Sixty-five consecutive patients underwent S2AI fixation (118 screws) as part of a posterior spine fusion using robotic-guidance. Screws were placed percutaneously in 14 cases and 51 were placed in an open fashion by three board-certified spine surgeons using the Mazor core technology robotic systems (Mazor X, n = 42; Mazor XSE, n = 23). Medical charts were retrospectively reviewed for revisions and complications. All patients were followed for 90days or greater. Postoperative CT scans were obtained in 22 of the 51 patients, allowing for 46 screws to be reviewed by an independent neuroradiologist who graded the screws for accuracy. There were no intraoperative or postoperative complications associated with S2AI screw placement. There were no revisions found to be related to the S2AI screw placement. All 46 screws evaluated with postoperative CT scans were reported as being at the highest level of accuracy, grade A, with a breach distance of 0mm (no breach). The robotic-guided technique for S2AI screw placement is a reliable method to achieving pelvic fixation with low complication and revision rates. In addition, a high degree of accuracy can be achieved without relying on visible and tactile landmarks needed for the freehand technique or the additional radiation associated with fluoroscopic-guidance.