Operative Procedures Research Articles

Preoperative nonalcoholic steatohepatitis and resolution of metabolic comorbidities after bariatric surgery

BackgroundMost patients undergoing bariatric surgery demonstrate elements of the metabolic syndrome (MetS) and can therefore be diagnosed with metabolically unhealthy obesity (MUO). Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) as hepatic manifestations of the MetS occur in many patients with obesity, but their leverage on postoperative improvement to Metabolic Health (MH), defined as absence of any metabolic comorbidity, remains unclear. ObjectivesThe aim of this study was to assess the influence of liver health status, operative procedure, and sex on postoperative switch from a MUO to an MH phenotype. Secondary objective was weight loss to MH. SettingUniversity Hospital, Germany. MethodsPatients who underwent either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at our obesity surgery center were included in this retrospective study. Liver biopsy was taken and evaluated for presence of NAFLD/NASH. For diagnosis of MH, blood pressure and laboratory values referring to the MetS were assessed preoperatively and at 3, 6, 12, and 24 months’ postoperatively. ResultsOne hundred thirty-three patients (73% female) with a mean body mass index of 52.0 kg/m2 and mean age of 43 years were included in this study. A total of 55.6% underwent RYGB and 44.4% underwent SG. NAFLD was found in 51.1% of patients and NASH in 33.8%. All patients were diagnosed MUO at baseline. Postoperatively, 38.3% patients (n = 51) switched to a MH condition. Mean time to MH was 321 days and mean excess body mass index loss to MH was 63.8%. There were no differences regarding liver health status, operative procedure, or sex. ConclusionsBariatric surgery can resolve MUO independent of liver health status, operative procedure, and sex. However, patients should be closely monitored to ensure sustainable long-term outcomes following the switch to the MH condition.

The Impact Of Endorphin Massage On The Efficient Production Of Postpartum Breast Milk In TPMB Sulastri, Pagelaran District, Pringsewu Regency In 2024.

Initiating breastfeeding within the first day of delivery has been shown to decrease the likelihood of newborn mortality. It is specifically demonstrated to provide exclusive protection against diarrhea, respiratory infections, and pneumonia ASI. The project seeks to investigate endorphin massage's impact on smoothness development in postpartum women at TPMB Sulastri, S.ST., M.Kes in 2024.ASI stands for Automatic Speech Recognition. This research employs a quasi-experiment design utilizing a pretest-posttest control group strategy. The sample included of 14 participants in the intervention group and 14 participants in the control group. Purposive sampling techniques were employed. The instrument utilizes Standard Operating Procedures (SOP) and checklist sheets. A three-day Endorphin massage treatment was administered and assessed using the Mann-Whitney test. The study found that 50% of individuals had a moderate frequency of meal intake. The utilization rate of non-hormonal contraceptives was 71.4%. The weight of newborns does not exceed 100% of the BBLR. The gestational age at the time of labor is 100% accurate. The mean milk output of the intervention group was 2.6 before and 7.5 after. The mean of the control group was 2.5 before and 5.2 after. The endorphin massage significantly impacted the efficient production of breast milk in postpartum moms. This was evidenced by a p-value of 0.000 (< 0.05) and a positive Correlation Coefficient value of 0.88, indicating a highly robust association between the two variables. Ultimately, endorphin massage has a significant impact on facilitating the efficient production of breast milk in mothers throughout the postpartum period. It is desirable for lactating postpartum women to regularly engage in endorphin massage to ensure the continuous and unobstructed flow of breast milk during the entire two-year duration of breastfeeding.

Vancomycin Soaking to Reduce Intraoperative Contamination by Cutibacterium acnes During the Latarjet Procedure

Background: Postoperative infection after the Latarjet procedure, ranging from 1% to 6%, can compromise the functional outcome of young athletes. Cutibacterium acnes is a main pathogen as a consequence of an intraoperative contamination. Purpose: To evaluate intraoperative contamination with C. acnes and the effectiveness of the local application of vancomycin during the Latarjet procedure. Study Design: Cohort study; Level of evidence, 2. Methods: This was a single-center study including 75 patients (mean age, 26 years; range, 15-55 years) operated on for anterior shoulder instability with the primary open Latarjet procedure; they underwent the same protocol of skin preparation and preoperative prophylactic antibiotics. Three groups of 25 patients were created and divided sequentially, without the results of each group being known before the end of the study: group A (5 mg/mL of vancomycin), group B (20 mg/mL of vancomycin), and group C (control group with no vancomycin). Swab samples of the coracoid were taken before sectioning the coracoid process (time 1) and after its preparation (time 2). The coracoid was then wrapped in gauze impregnated with different concentrations of vancomycin, except for group C. A final sample (time 3) was taken before screwing the bone block onto the glenoid. All samples were cultured for 21 days, and patients underwent clinical and radiological follow-up for 6 months. Results: The C. acnes contamination rates at times 1, 2, and 3 were 25%, 44%, and 45%, respectively, without significant difference. There was no significant difference between groups A and B with respect to the number of positive cultures at each time point. Of 9 positive cultures at time 1, all were still positive at time 3 in group A, whereas 3 of 5 were negative in group B (P = .027). The rate of C. acnes at time 3 in the control group was higher than that in the 2 other groups (68% vs 44% for group A and 20% for group B; P = .003). Body mass index was the only prognostic factor for a C. acnes–positive culture (26.05 ± 3.39 vs 23.34 ± 2.33; P = .018). No clinical infection was reported at the 6-month postoperative follow-up. Conclusion: The rate of C. acnes contamination ranged from 25% to 68% during the open Latarjet procedure in young athletes. Vancomycin reduced the bacterial contamination when it was used at high concentrations in a gauze wrap on the coracoid. The type of C. acnes detected and its clinical implications remain to be studied.

Emergency Anesthesiology Encounters, Care Practices, and Outcomes for Patients with Firearm Injuries: A 9-Year Single-Center US Level 1 Trauma Experience.

Firearm injuries cause significant morbidity and mortality. Patients with firearm injuries require urgent/emergency operative procedures but the literature incompletely describes how anesthesia care and outcomes differ between high acuity trauma patients with and without firearm injuries. Our objective was to examine anesthesia care, resource utilization, and outcomes of patients with acute firearm injuries compared to nonfirearm injuries. We conducted a retrospective cross-sectional study of patients ≥18 years admitted to a regional Level 1 trauma center between 2014 and 2022 who required operative management within the first 2 hours of hospital arrival. We examined clinical characteristics, anesthesiology care practices, and intra- and postoperative outcomes of patients with firearm injuries compared to patients with nonfirearm injuries. Over the 9-year study period, firearm injuries accounted for the largest yearly average increase in trauma admissions (firearm 10.1%, blunt 3.2%, other 1.3%, motor-vehicle crash 0.9%). Emergency anesthesiology care within 2 hours of arrival was delivered to 4.7% of injured patients (2124; 541 firearm [25.4%] and 1583 [74.5%] nonfirearm). Patients with firearm injuries were younger (30 [23-40] years vs 41 [29-56] years; P < .0001), male (90% vs 75%; P < .0001), direct admissions from scene (78% vs 62%; P < .0001), had less polytrauma (10% vs 22%; P < .0001), arrived after hours (73% vs 63%; P < .0001), and received earlier anesthesiology care (0.4 [0.3-0.7] vs 0.9 [0.5-1.5] hours after arrival; P < .0001). Patients with firearm injuries more often received invasive arterial (83% vs 77%; P < .0001) and central venous (14% vs 10%; P = .02) cannulation, blood products (3 [0-11] vs 0 [0-7] units; P < .0001), tranexamic acid (30% vs 22%; P < .001), as well as had higher estimated blood loss (500 [200-1588] mL vs 300 [100-1000] mL; P < .0001), and were transferred to the intensive care unit (ICU) more frequently (83% vs 77%; P < .001) than patients with nonfirearm injuries. Intraoperative mortality was comparable (6% firearm vs 4% nonfirearm) but postoperative mortality was lower for patients with firearm injuries who survived the intraoperative course (6% vs 14%; P < .0001). Comparatively, more patients with firearm injuries were discharged to home, or to jail (P < .001). Over the study period, anesthesiologists increasingly cared for patients with firearm injuries, who often present outside of daytime hours and require urgent operative intervention. Operating room readiness and high-intensity resuscitation capacity, such as access to hemostatic control measures, are critical to achieving intraoperative survival and favorable postoperative outcomes, particularly for patients with firearm injuries.

Executive Summary of Standard Operating Procedures for Society for Vascular Medicine (SVM) publications.

Executive Summary of Standard Operating Procedures for Society for Vascular Medicine (SVM) publications.

Minimally Invasive Glaucoma Surgery (MIGS) recommendations in Clinical Practice Guidelines for open angle glaucoma and MIGS procedures: A scoping review.

Introduction: To assess the recommendations of open angle glaucoma Clinical Practice Guidelines (CPG) addressing Minimally Invasive Glaucoma Surgery (MIGS) or MIGS procedures CPG. Methods: A scoping review of CPG was conducted, based on an ongoing systematic review (CRD42024510656). A systematic literature search of CPG was carried out in November 2023, with an update in January 2024. CPG published in the last 8 years, full text available and addressing MIGS were selected. CPG details and recommendations concerning MIGS were extracted. Results: 13 CPG addressing MIGS were selected (8 recovered from databases and 5 from registers). Four health Technology Assessments were assessed but recommendations were not considered. Finnish and Swedish guidelines, published in 2024, and Japanese guidelines, published in 2023, are English versions of their native language guidelines, but none of them make specific recommendations about MIGS. The Spanish Glaucoma Society - Advanced Glaucoma guideline (2023) describes the available techniques but does not make recommendations about MIGS. The European Glaucoma Society (2023) guideline only makes recommendations for 4 devices and the National Institute for Health and Care Excellence Interventional procedures guidance makes recommendations both for specific procedures and devices. Conclusion: MIGS is a relevant topic that has not been adequately addressed in terms of updated evidence, available procedures, and recommendations in open angle glaucoma CPG or MIGS procedures CPG.

Risk assessment of general FPSO supply system based on hybrid fuzzy fault tree and Bayesian network

One of the major risks to the operation of a FPSO (Floating, Production, Storage and Offloading) is collision of supply vessels. Experiences have shown that collisons of supply vessel take place frequently, although the consequences are limited. The offshore oil&gas industry has established relevant design standards and operational procedures, which are proven to be effective in reducing this risk. As the risk assessment becomes increasingly applied, there is a need to quantify the likelihood of supply vessel collisions especially duing the early design/project stage when historical incident data does not exist. This paper proposees a method for estimating the likelihood of supply vessel collision based on fault tree analysis (FTA), Bayesian network (BN), hybrid theory and fuzzy theory. In liew of using historicval data, this method combines the fuzzy logic with expert heuristics to determine the basic events(BEs). The triangular fuzzy membership functions and a hybrid theory were adopted to define factors that lack data or had no data in the events. To account for the imprecise information of human error, a scheme is devised to use the fuzzy fault probability(FFP) based on the hybrid theory, or a hybrid fuzzy fault tree analysis (HFFT). The algorithm transforms the FT into a BN with a conditional probability table (CPT). This new method was demonstrated in an example of a FPSO, and the results were has been validated through case studies and accident reports. A sensitivity analysis was also conducted to illustrate key parameters.

Pigeons' (Columba livia) intertemporal choice in binary-choice and patch-leaving contexts.

Typical approaches to study self-control present subjects with a simultaneous choice between a larger-later (LL) reinforcer and a smaller-sooner (SS) reinforcer. In contrast, in patch-leaving tasks, subjects choose between staying at a patch for an SS (or LL) reinforcer and leaving for an LL (or SS) reinforcer. Previous studies show that blue jays, monkeys, humans, and rats prefer the SS reinforcer in binary-choice tasks, whereas the same subjects prefer the LL reinforcer in equivalent patch-leaving tasks. The current study systematically replicated this research using pigeons. Six pigeons responded in a binary-choice task and in two patch-leaving tasks in which staying led to an LL (Patch-L) or SS (Patch-S) reinforcer. Across conditions, the SS reinforcer delay varied from 5 to 55 s; the LL reinforcer delay was always 60 s. In binary-choice conditions, subjects preferred the SS reinforcer. In Patch-L and Patch-S conditions, subjects preferred the LL and SS reinforcer, respectively, reflecting a bias to stay at the patch. This bias persisted when the stay response was more effortful and when the delays to both reinforcers were equal. This may reflect a species-specific win-stay bias and the differential consequences of staying (which led to a stimulus signaling food) versus leaving (which led to a stimulus never associated with food). Thus, we propose a conditioned-reinforcement account of intertemporal choice in patch-leaving contexts. We suggest several avenues for further investigations of the mechanisms underlying intertemporal choice in different contexts and question the economic equivalence of the operant and patch-leaving procedures. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Open Data-Driven Decision Making: Observations from COVID-19 Minimal Essential Data, Canton Zürich, Switzerland.

This research delves into the relationship between open data and decision making, drawing insights from the utilization of Minimal Essential Data (MED) during the COVID-19 pandemic in Canton Zürich, Switzerland. It examines observations and lessons learned, emphasizing the pivotal role of open data in response to an emergency. Through a case study approach, this article sheds light on the practical implications and observed strategies in publishing open data from digital public health surveillance software. While it is arguable that open data has the potential to enhance data quality in the context of a public health emergency, our findings indicate that it is firstly essential that a Minimal Essential Dataset (MED) is defined and publicly published, an open data publication platform and procedure are secondly in place (ideally following FAIR data principles), and thirdly, that regular data quality reviews are conducted.

European Association of Hospital Pharmacists (EAHP) guidance on the pharmacy handling of in vivo gene therapy medicinal products

Gene therapy is becoming increasingly prevalent, with new gene therapy medicinal products (GTMPs) being approved for use every year. Hospital pharmacists are expected to prepare and dispense these products, but...

Spatial Patterns of Tourism: Towards Legally-Based Tourism Village Regulations Based on Physical Carrying Capacity Analysis

Lowita Beach was a tourist area in Suppa District, Pinrang Regency, with 11 tourist attractions. The annual increase in visitors to Lowita Beach can compromise tourist comfort and damage the area's natural habitat. This is the basis for researchers to analyse the Physical Carrying Capacity (PCC) of Lowita Beach. This study aimed to determine the characteristics of tourist activities, assess the physical carrying capacity of the area, and formulate the role of tourist villages in managing the Lowita Beach area. The research approach used was research and development, as initiated by Borg and Gall: the calculation of Physical Carrying Capacity (PCC), area parameters, and the number of tourists. The study population comprised 93 tourists who visited the Lowita Beach area. Data was collected through the completion of questionnaires, interviews, measurements, and field observations. A quantitative-descriptive approach was used for data analysis. The Physical Carrying Capacity (PCC) analysis reveals that Lowita Beach's ideal capacity is 1 visitor per day, yet it currently hosts an average of 35 visitors daily, significantly surpassing this threshold. This overcapacity indicates that the beach is experiencing environmental strain and underscores the need for management strategies to align visitor numbers with sustainable limits. In conclusion, despite the physical carrying capacity (PCC) of Lowita Beach being 17 visitors per day, the present daily visitor count suggests that the beach is currently facing overcrowding, albeit not to a significant extent. Hence, it is necessary to implement policy interventions from the tourist villages of Tasiwalie and Wiringtasi, which should include the establishment of standardized operating procedures and fostering collaboration among stakeholders, in order to ensure sustainable tourism management at Lowita Beach.

Robot-assisted mitral valve surgery may be supported by patient-specific planning aid in port placement

Robotic-assisted mitral valve surgery is gaining renewed popularity in the global surgical community. Appropriate patient-specific planning is pivotal for the safety and effectiveness of this procedure. One main step in this perspective is represented by the choice of placement of four ports in the right chest, for the introduction of robotic arms. Individual anatomical features (e.g., chest morphology and position of the mitral valve inside the chest) may determine inadequate surgical exposure, conversion to open procedure, or refusal for the technique. Currently, and contrary to robotic-assisted procedures in other surgical specialties, there is no dedicated approach or tool for patient-specific planning aimed at formally addressing these issues preoperatively. Herein, we present a dedicated, comprehensive method entailing: a homemade algorithm for rib segmentation (deep learning approach) and identification of intercostal spaces / candidate port entry sites; semiautomatic definition of a target working volume (mitral valve); definition of dedicated Performance Measure J* based on each potential triad of thoracic ports entry sites. We propose the dedicated J* parameter to better indicate the optimal patient-specific entry port solution than other parameters (h_e, ic, CCI and E). Prospective clinical studies should be based on the J* parameter. We hypothesize that this approach, dedicated to the requirements of robotic-assisted mitral valve surgery, may enhance the safety and the diffusion of this surgical strategy.

Solid waste dumpsite leachate and contiguous surface water contain multidrug-resistant ESBL-producing Escherichia coli carrying Extended Spectrum β-Lactamase (ESBL) genes

Dumpsites generate leachates containing bacteria that may carry antibiotic resistance genes, such as extended spectrum β-lactamase (ESBL). However, the contribution of dumpsite leachates in the environmental spread of ESBL genes has not been investigated in greater detail. This study aimed to quantify the impact of Ajakanga dumpsite leachate on the spread of ESBL genes through surface water. The susceptibility of Escherichia coli isolated from dumpsite leachate and the accompanying surface water to selected antibiotics was assessed by the standardized disc diffusion method. The isolates were evaluated for phenotypic ESBL production using the double disc synergy test (DDST). The detection of ESBL genes in the isolates was carried out using a primer-specific polymerase chain reaction (PCR). Escherichia coli isolates from leachate (n = 26/32) and surface water (n = 9/12) expressed ESBL phenotype. The ESBL-producing isolates showed the highest level of resistance to the 3rd generation cephalosporin antibiotics: cefotaxime (100%), cefpodoxime (97%), ceftazidime (97%), with low resistance observed to imipenem (6%) and azithromycin (3%). All the isolates were multidrug-resistant, showing resistance to three or more classes of antibiotics. All the ESBL-producing E. coli obtained carried blaCTX−M, 21/35 (60%) carried blaTEM while none of the isolates bore blaSHV. This study found that ESBL-producing Escherichia coli from dumpsite leachate and nearby surface water had identical resistance signatures indicating the relatedness of the isolates, and that dumpsite leachate could contribute to the transfer of ESBL-producing bacteria and their genes to receiving surface water. This study has necessitated the need for a review of the guidelines and operational procedures of dumpsites to forestall a potential public health challenge.

Surgical Management of Complicated Abdominal Tuberculosis: The First Systematic Review-New Treatments for an Ancient Disease and the State of the Art.

Background: Abdominal tuberculosis comprises all forms of tuberculosis that involve the gastrointestinal tract. Controversies exist regarding the surgical approach and timing and type of intervention for complicated forms of abdominal tuberculosis. The aim of this systematic review is to define the rate of surgical treatment, the type of surgical procedures performed and the role of minimally invasive surgery in the management of abdominal tuberculosis. Methods: The literature in MEDLINE, Scopus and Google Scholar and forward and backward citations for studies published between database inception and July 2022 were searched without language restrictions. All prospective and retrospective studies were included. The electronic database search yielded 2440 records. Additionally, eight records were identified through snowball searching. Following duplicate removal (45 duplicates found), 2403 records were screened for titles and abstracts. After screening for titles and abstracts and exclusion criteria, 38 reports were included for systematic review, 27 retrospective studies and 11 prospective studies. Data extracted included the general and demographic characteristics of the studies, diagnostic methods used, clinical presentation, site of involvement and details on surgical treatment. Results: In total, 2870 patients with a diagnosis of abdominal tuberculosis were included, and 1803 (63%) underwent a surgical procedure. The majority of patients underwent an open surgical procedure (95%). The most commonly performed procedures were adhesiolysis (21%) and small bowel resection with primary anastomosis (21%). Conclusions: The results of this review suggest that whenever surgery is required, there is a tendency to perform open surgical procedures in patients with complicated abdominal tuberculosis, both in emergency and elective settings, despite advances in minimally invasive surgery. The study protocol was registered on PROSPERO (CRD42022354322).

Impact of omission of routine blood monitoring of stable patients living with HIV during the coronavirus pandemic.

The British HIV Association (BHIVA) guidelines were amended during the coronavirus (COVID-19) pandemic, allowing for less frequent monitoring of routine bloods. We assessed the impact of this on patient outcomes. Between April 2020 and March 2021, routine blood appointments at our HIV clinic were replaced by virtual consultations in 'stable' people living with HIV (PLWH), defined using standard operating procedure (SOP) criteria. All had an undetectable HIV viral load (VL) (<50 copies/mL). Demographic, HIV clinical information, and antiretroviral treatment (ART) data were collated using the electronic patient record (EPR). Blood results from before (baseline) and after (follow-up) the omitted appointment were analysed for each parameter. In all, 791/2395 PLWH were scheduled to have blood tests omitted; 381 were excluded for reasons including not fitting the SOP criteria or presenting to clinic early, and 410 were included in analysis. The demographics of the group were consistent with our whole HIV cohort. HIV VL became detectable in 8/410 individuals (1.95%, range 51-730 copies/mL). VL resuppressed in 6/8 after a median of 29 days. VL remained detectable in two individuals, both of whom remain in care. Routine blood monitoring revealed baseline and follow-up blood parameters that were largely within normal range. Four out of 12 parameters had statistically significant changes but were not considered clinically significant; 59/410 (14.4%) changed ART, most commonly for simplification. For the majority of stable PLWH included in our evaluation, the omission of routine blood monitoring during the pandemic did not have a negative impact on HIV suppression or blood monitoring outcomes. ART switch was uncommon.

Impact of Procedure Risk vs Frailty on Outcomes of Elderly Patients Undergoing Emergency General Surgery: Results of a National Analysis.

The direct association between procedure risk and outcomes in elderly patients who undergo emergency general surgery (EGS) has not been analyzed. Studies only highlight the importance of frailty. A comprehensive analysis of relevant risk factors and their association with outcomes in elderly patients who undergo EGS is lacking. We hypothesized that procedure risk has a stronger association with relevant outcomes in elderly patients who undergo EGS compared with frailty. Elderly patients (age >65 years) undergoing EGS operative procedures were identified in the NSQIP database (2018 to 2020) and stratified based on the presence of frailty calculated by the Modified 5-Item Frailty Index (mFI-5; mFI 0 nonfrail, mFI 1 to 2 frail, and mFI ≥3 severely frail) and based on procedure risk. Multivariable regression models and receiving operative curve analysis were used to determine risk factors associated with outcomes. A total of 59,633 elderly patients who underwent EGS were classified into nonfrail (17,496; 29.3%), frail (39,588; 66.4%), and severely frail (2,549; 4.3%). There were 25,157 patients in the low-risk procedure group and 34,476 in the high-risk group. Frailty and procedure risk were associated with increased mortality, complications, failure to rescue, and readmissions. Differences in outcomes were greater when patients were stratified according to procedure risk compared with frailty stratification alone. Procedure risk had a stronger association with relevant outcomes in elderly patients who underwent EGS compared with frailty. Assessing frailty in the population of elderly patients who undergo EGS without adjusting for the type of procedure or procedure risk ultimately presents an incomplete representation of how frailty impacts patient-related outcomes.

Influence of Socioeconomic Deprivation on Surgical Outcomes for Patients With Sigmoid Diverticulitis in France

Objectives: To evaluate the relationship between socioeconomic deprivation and postoperative outcomes in patients who underwent colonic resection for sigmoid diverticulitis (SD). Background: The potential impact of socioeconomic inequalities on the management of SD has been scarcely studied in the literature. Considering other gastrointestinal pathologies for which lesser access to optimal treatment and poorer survival have been shown, we hypothesize that deprivation could be associated with outcomes for SD. Methods: This multicenter retrospective study was conducted at 41 French hospitals between January 1, 2010, and August 31, 2021. The main outcome was the occurrence of severe postoperative complications on postoperative day 90, according to the Clavien-Dindo scale (≥3). The European Deprivation Index was used to approximate deprivation for each patient. Multiple imputations by a chained equation were performed to consider the influence of missing data on the results. Results: Twenty percent of the 6415 patients operated on had severe postoperative complications at 90 days. In the multivariate regression analysis, increasing age, male sex, American Society of Anesthesiologists score ≥3, conversion to laparotomy or upfront open approach, surgical procedures, and perioperative transfusion were independent risk factors for severe postoperative complications. After adjusting for age, sex, body mass index, American Society of Anesthesiologists score, emergent setting, blood transfusion, indications for surgery, surgical approach, and procedures, the probability of severe postoperative complications increased with socioeconomic deprivation (P=0.026) by day 90. Conclusions: This study highlights the potential influence of socioeconomic deprivation on the surgical outcomes of SD. Socioeconomic deprivation should be considered as a risk factor for severe postoperative complications during the preoperative assessment of the patient’s medical conditions.

Assessing the impact of climate change on aircraft engine performance during different flight phases (take-off and cruise) and the environmental consequences

PurposeClimate change significantly impacts global temperatures, posing challenges to various sectors, including aviation. The purpose of this study is to assess the impact of climate change on aircraft engine performance during different flight phases (take-off and cruise) and the environmental consequences.Design/methodology/approachThis study examines the effects of rising temperatures on aircraft engine performance using real-time data from a Boeing 787-8 equipped with GEnx-1B engines, which are collected via Flight Data Recorder of the engines and were analyzed for the take-off and cruise phases on the ground. Exhaust gas temperature (EGT), fuel flow and take-off weights were evaluated.FindingsThe analysis revealed a significant increase in EGT at the cruising altitude of 38,000 ft during the summer months compared to expected standard atmospheric values. This increase, averaging over 200 °C, is attributed to global warming. Such elevated temperatures are likely to accelerate the degradation of turbine components, resulting in increased fuel consumption: higher EGT signifies inefficient engine operation, resulting in more fuel burned per unit thrust; early engine aging: elevated temperatures accelerate wear and tear on turbine components, potentially reducing engine lifespan and increasing maintenance costs and enhanced atmospheric pollution: incomplete combustion at high EGTs generates additional emissions, contributing to local air quality concerns.Practical implicationsThe research findings have practical implications for understanding the potential operational challenges and environmental impacts of climate change on aircraft engine performance. This lets us explore mitigation strategies and adapt operational procedures to ensure sustainable regional aviation practices.Originality/valueThis research enhances environmental consequences by assessing the impact of climate change on aircraft performance.

Laparoscopic ablation for liver malignancies: initial experience at a Scandinavian high volume HPB center

BackgroundAblation is an effective, parenchymal-sparing treatment for primary liver cancer and liver metastases. The purpose of this study was to report our initial experience with laparoscopic microwave ablation regarding postoperative complications, rate of conversions to open procedure, and technical efficacy.MethodsThis was a quality improvement project carried out at a tertiary care center in Denmark. Patients ≥ 18 years old with liver malignancies, not available for percutaneous ablation, and treated with ultrasound-guided laparoscopic ablation were included.ResultsFrom March 2023 to December 2023, 39 patients were referred for laparoscopic ablation after a multidisciplinary team conference. Of these, two procedures were converted to open procedures due to adhesion and tumor progression. Three patients rejected the sharing of medical information, two procedures were canceled and in one case the strategy was changed perioperatively. Therefore, 32 procedures in 31 patients were available for analysis. Complete ablation was evaluated after 1 month and was achieved in 100% of the procedures. None of the patients died, and no complications were reported in 21 cases (65.6%). Most patients with complications had a grade 1 complication based on the Clavien–Dindo classification, which among others included abdominal and shoulder pain, atrial fibrillation, and subcutaneous hematoma. Two patients had a complication grade 2 (wound infection and decompensated cirrhosis) and one had a grade 4b (sepsis due to pneumonia and urinary tract infection). The median Comprehensive Complication Index was 12.2 (interquartile range 8.7–24.2). Furthermore, univariable logistic regression showed that ≥ 2 tumors treated were associated with a higher risk of complications (odds ratio 6.37, 95% confidence interval [1.20;33.85], p-value = 0.0297).ConclusionUltrasound-guided laparoscopic microwave ablation of liver malignancies is feasible and safe with little risk for complications, a high technical efficacy, and a low rate of conversions to open procedures.

An Academic Analysis of Digital Transformation: A Comprehensive Review of Literature and Business Strategies

The idea of digital transformation has an impact on many different facets of business. The goal of this study is to examine how digital transformation affects businesses, industries, and society as a whole, with a particular emphasis on business models, operational procedures, and customer experience. To examine the definitions, components, pillars, and important facets of digital transformation, this study uses a literature review methodology. The review's findings show that using digital technology to modernize corporate processes and improve productivity, responsiveness, and creativity is included in the concept of digital transformation. The components of digital transformation are also described in this study, including business models, digital platforms, employee experience, customer experience, and operational procedures within the organization. The customer experience, business models, and operational procedures of the organization are the three primary pillars of digital transformation. In addition, there are five essential components of digital transformation: value, data, customers, competition, and innovation. In a connected and quickly evolving business environment, digital transformation is becoming more and more significant, and firm executives need to have a long-term vision to take advantage of the potential.