Operative Exposure Research Articles

What's New in Spine Surgery.

What's New in Spine Surgery.

Institutional Experiences with Transfemoral Compared to Transcarotid Stenting

Transcarotid artery revascularization (TCAR) is a new surgical technique that is gaining popularity over the transfemoral method (TF-CAS) as the preferred strategy to deliver a carotid stent. This investigation was performed to evaluate the real-world perioperative and long-term outcomes of both techniques at the health system level. A retrospective review of prospectively maintained carotid revascularization databases were performed at 2 high-volume TCAR centers in the United States to extract consecutive TF-CAS and TCAR procedures. The characteristics and outcomes associated with these 2 modalities were compared at the preoperative and perioperative points by univariate methods. The Kaplan-Meier methodology was utilized to calculate the long-term stroke and death trends. From 2008-2021, 1,058 carotid stents were implanted at our institutions, consisting of 750 TCARs and 308 TF-CAS procedures. Patients undergoing TF-CAS were older (68.2±0.6 vs. 73.1±0.3years, P<0.01) and unhealthier by Charlson Comorbidity Index (4.9±0.1 vs. 5.5±0.1, P<0.01). Additionally, TF-CAS patients had more high-risk anatomic characteristics, such as restenosis after previous carotid surgery (27.0% vs. 9.5%, P<0.01), previous ipsilateral neck surgery (38.8% vs. 11.5%, P<0.01), irradiated ipsilateral field (20.4% vs. 4.5%, P<0.01), and a contralateral carotid occlusion (10.4% vs. 4.6%, P<0.01). The incidence of symptomatic lesions was the same (40.1% vs. 36.9%, P=0.35). Within the operating room, TCAR outperformed TF-CAS with respect to operative time (83.2±2.6 vs. 64.3±0.9min, P<0.01), radiation exposure (769.9±144.3 vs. 232.7±19.1mGys, P<0.01), fluoroscopic time (17.8±1.1 vs. 4.5±0.1min, P<0.01), and contrast volume (75.2±2.4 vs. 22.6±0.4mLs, P<0.01). In the 30-day perioperative period, ipsilateral stroke (2.8% vs. 2.3%, P=0.65), contralateral stroke (1.0% vs. 0.1%, P=0.07), and death (1.0% vs. 1.2%, P>0.99) were similar between modalities. None of these endpoints, including a composite of stroke and death (4.8% vs. 3.6%, P=0.38), reached statistical significance. Additionally, we found no differences with respect to stroke-free survival between modalities during follow-up by Kaplan-Meier analysis (P=0.30). In this combined experience from 2 large health systems, TCAR was associated with less intraoperative complexity, as measured by operative time, radiation exposure, and contrast volume. Although stroke and death seemed to be less frequent in patients undergoing transcervical stenting, this did not reach statistical significance.

Agency banking business and operators’ risk of exposure to criminal victimisation in Ibadan, Nigeria

Despite the growing popularity of the agency banking business in Nigeria, a major problem confronting its operators is criminal victimisation. Thus, this study examined the risk of exposure of agency banking operators in Ibadan city to criminal attacks. Routine activity theory was deployed as the conceptual framework. Data were elicited from 11 operators of the business who were victims of criminal attacks and 20 of their counterparts who were yet to be victimised, using key informant and in-depth interview methods. Results showed that operators of agency banking business were being targeted by lone criminals and gangs of criminals using violent and non-violent tactics. Scamming through fake SMS credit/debit transaction alerts was the most common type of criminal victimisation suffered by people involved in the business. A combination of factors was responsible for their vocational-related victimisation. It is imperative for operators of agency banking business to invest in physical security appliances, such as CCTV surveillance system, protective barriers, and alarm devices.

Minimally Invasive Transpedicular Screw Fixation: Review of 152 Cases in a Single Institution. Steep or Shallow Learning Curve?

In this study, we analyze our institutional experience and personal impressions using minimally invasive spine surgery (MISS) to describe our learning curve and how experience influenced different parameters of the surgical procedure. The study was conducted prospectively and included the first consecutive 152 patients treated with MISS techniques. Patient demographics, surgical data, length of hospital stay, and clinical outcome were reviewed. The cohort was divided into consecutive quarters. Comparison between the quarters and timeline analysis were made to assess the learning curve. Only percutaneous transpedicular screw fixation was performed in 65 cases, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in 70 cases, and vertebral body replacement in 4 cases. The average blood loss was 113.3, 115, 106.6, and 107.1 mL for each quarter. The average operative time was 155.0, 143.2, 134.5, and 133.8 minutes for the four quarters, whereas the average radiation exposure time was 105.4, 85.3, 46.2, and 45.2 seconds. Differences in the operative time and radiation exposure time between the first to third and the first to fourth quarters were statistically significant. Some advantages of MISS techniques could be observed with the very first cases and were not related significantly with the surgeon's experience with MISS. With the acquisition of more experience, some disadvantages of MISS techniques such as longer operative time and longer X-ray exposure can be substantially reduced. Surgical experience, familiarity of the team with the MISS instrumentation, and good patient selection are crucial for achieving all the benefits of MISS.

The role of expert focus echocardiography during the COVID-19 pandemic.

BackgroundFocus Echocardiography has routinely been used to offer quick diagnosis in critical care environments, predominantly by clinicians with limited training. During the COVID‐19 pandemic, international guidance recommended all echocardiography scans were performed as focus studies to limit operator viral exposure in both inpatient and outpatient settings. The aim of this study was to assess the effectiveness of eFoCUS, a focus scan performed by fully trained echocardiographers following a minimum dataset plus full interrogation of any pathology found.MethodsAll diagnostic echocardiograms, performed by fully trained echocardiographers during an 8‐week period during the first UK COVID‐19 wave, were included. The number of images acquired was compared in the following categories: admission status, COVID status, image quality, indication, invasive ventilation, pathology found, echocardiographer experience, and whether eFoCUS was deemed adequate to answer the clinical question.ResultsIn 87.4% of the 698 scans included, the operator considered that the eFOCUS echo protocol, with additional images when needed, was sufficient to answer the clinical question on the request. Echocardiographer experience did not affect the number of images acquired. Less images were acquired in COVID‐19 positive patients compared to negative/asymptomatic (38 ± 12 vs. 42 ± 12, p = .001), and more images were required when a valve pathology was identified.ConclusioneFoCUS echocardiography is an effective protocol for use during the COVID‐19 pandemic. It provides sufficient diagnostic information to answer the clinical question but differs from standard focus/limited protocols by enabling the identification and interrogation of significant pathology and incidental findings, preventing unnecessary repeat scans and viral exposure of operators.

Sequential Indoor Use of Pesticides: Operator Exposure via Deposit Transfer from Sprayed Crops and Contaminated Application Equipment

Dermal transfer of pesticide residues to human skin due to contact with treated crops, treated surfaces, or contaminated surfaces is an important route of exposure for operators, workers and possibly for bystanders and residents. However, information on dermal transfer data is limited and mainly available for workers. The aim of the present study has been to generate both dermal exposure and transfer data related for operators involved in sequential tasks of mixing/loading and application of pesticides in a southern EU zone greenhouse. Exposure measurements were based on the principles of the whole-body dosimetry (WBD) method involving the use of cotton coveralls and gloves as dosimeters. Six field trials were conducted in three tomato greenhouses, on the island of Crete, Greece. The study results showed that the contribution of existing pesticide deposits on the treated crops, i.e., from an application conducted earlier the same day, was in the range of 8–16% for the application task and 0.9–18% for the mixing/loading task in relation to the measured total exposure to this pesticide during a short-term sequential application. The results of this study have been incorporated in the GAOEM (Greenhouse Agricultural Operator Exposure Model) included in the updated EFSA Guidance on the assessment of exposure of operators, workers, residents and bystanders in risk assessment of plant protection products. The low values of the pesticide amount penetrating the coverall (actual dermal exposure) in all cases highlight and confirm the need for the use of appropriate personal protective equipment (PPE) for operator safety.

Pesticide Exposure in Fruit-Growers: Comparing Levels and Determinants Assessed under Usual Conditions of Work (CANEPA Study) with Those Predicted by Registration Process (Agricultural Operator Exposure Model).

Knowledge of pesticide exposure levels in farmers is necessary for epidemiological studies and regulatory purposes. In the European pesticide registration process, operators’ exposure is predicted using the Agricultural Operator Exposure Model (AOEM), created in 2014 by the European Food Safety Authority based on studies conducted by the pesticide industry. We compared operators’ exposures during treatment days in the apple-growing industry under non-controlled working conditions and AOEM-predicted values. The dermal exposure of thirty French apple-growers from the CANEPA study when applying two fungicides was measured using body patches and cotton gloves. For each observation, the corresponding exposure was calculated by means of the AOEM, using data recorded about the operator, spraying equipment and personal protective equipment (PPE) used. A significant linear correlation was observed between calculated and measured daily exposures. The model overestimated the daily exposure approximately 4-fold and the exposure during application 10-fold. However, exposure was underestimated during mixing/loading for 70% of the observations when the operator wore PPE. The AOEM did not overestimate exposures in all circumstances, especially during mixing/loading, when operators handle concentrated products. The protection provided by PPE appeared to be overestimated. This could be due to the optimal working conditions under which the “industrial” studies are conducted, which may not be representative of real working conditions of operators in fruit-growing.

Particle Size, Mass Concentration, and Microbiota in Dental Aerosols

Many dental procedures are considered aerosol-generating procedures that may put the dental operator and patients at risk for cross-infection due to contamination from nasal secretions and saliva. This aerosol, depending on the size of the particles, may stay suspended in the air for hours. The primary objective of the study was to characterize the size and concentrations of particles emitted from 7 different dental procedures, as well as estimate the contribution of the nasal and salivary fluids of the patient to the microbiota in the emitted bioaerosol. This cross-sectional study was conducted in an open-concept dental clinic with multiple operators at the same time. Particle size characterization and mass and particle concentrations were done by using 2 direct reading instruments: Dust-Trak DRX (Model 8534) and optical particle sizer (Model 3330). Active bioaerosol sampling was done before and during procedures. Bayesian modeling (SourceTracker2) of long-reads of the 16S ribosomal DNA was used to estimate the contribution of the patients’ nasal and salivary fluids to the bioaerosol. Aerosols in most dental procedures were sub-PM1 dominant. Orthodontic debonding and denture adjustment consistently demonstrated more particles in the PM1, PM2.5, PM4, and PM10 ranges. The microbiota in bioaerosol samples were significantly different from saliva and nasal samples in both membership and abundance (P < 0.05) but not different from preoperative ambient air samples. A median of 80.15% of operator exposure was attributable to sources other than the patients’ salivary or nasal fluids. Median operator’s exposure from patients’ fluids ranged from 1.45% to 2.75%. Corridor microbiota showed more patients’ nasal bioaerosols than oral bioaerosols. High-volume saliva ejector and saliva ejector were effective in reducing bioaerosol escape. Patient nasal and salivary fluids are minor contributors to the operator’s bioaerosol exposure, which has important implications for COVID-19. Control of bioaerosolization of nasal fluids warrants further investigation.

Surface Navigation and the Influence of Navigation on MIS Surgery.

Study Design:Literature review.Objectives:To review the evidence for surface-based navigation in minimally-invasive spine surgery (MIS), provide an outline for its workflow, and present a wide range of MIS case examples in which surface-based navigation may be advantageous.Methods:A comprehensive review of the literature and compilation of findings related to surface-based navigation in MIS was performed. Workflow and case examples utilizing surface-based navigation were described.Results:The nascent literature regarding surface-based intraoperative navigation (ION) in spine surgery is encouraging and initial studies have shown that surface-based navigation can allow for accurate pedicle screw placement and decreased operative time, fluoroscopy time, and radiation exposure when compared to traditional fluoroscopic imaging. Surface-based navigation may be particularly useful in MIS cervical and lumbar decompressions and MIS lumbar instrumentation cases.Conclusions:Overall, it is possible that surface-based ION will become a mainstay in the armamentarium of enabling technologies utilized by minimally-invasive spine surgeons, but further studies are needed assessing its accuracy, complications, and cost-effectiveness.

A Critical Scoping Review of Pesticide Exposure Biomonitoring Studies in Overhead Cultures.

The exposure of operators, workers, residents and bystanders to pesticides is of high potential concern. Yet, reports on pesticide residues in the environment and near treated fields often spark debates if such findings might indicate a health risk. Although the underlying models are considered conservative, there are only limited field data on systemic exposure available. As a first step to improve the situation, we conducted a scoping review of state-of-the-art pesticide exposure biomonitoring studies in operators, workers, residents or bystanders. In contrast to existing reviews, we focused on target cultures of potential high pesticide exposure such as tree-grown produce, vine or hops. The search was conducted in Web of Science, Scopus and PubMed. Out of 17 eligible articles, a total of 11 studies met our search criteria, and 6 of them quantified the systemic exposure of humans. The analysis revealed that exposure was mainly driven by application of pesticides and reentry work, resulting in a higher exposure of operators and workers than of residents and bystanders. In nearly all cases, the systemic exposure was below the relevant toxicological reference values. The studies were subsequently analyzed to identify key criteria for a reliable design of a biomonitoring study on pesticide exposure.

Accuracy and Precision of the Computed Tomographic Angiography Perforator Localization Technique for Virtual Surgical Planning of Composite Osteocutaneous Fibular Free Flaps in Head and Neck Reconstruction

Virtual surgical planning (VSP), computer aided design/computer aided modeling, and 3-dimensional printing technology have been shown to improve surgical accuracy and efficiency in head and neck reconstruction. However, persisting criticism of the technology is that it does not adequately address the soft tissue-related aspects of reconstructive surgery. Prior publication on the computed tomographic angiography (CTA) perforator localization technique has demonstrated how soft tissue planning can be incorporated directly into existing VSP workflows. The aim of this study is to prospectively assess the accuracy, precision, negative predictive value (NPV), and positive predictive value (PPV) of the CTA perforator localization technique for VSP of osteocutaneous fibular free flaps. A prospective observational study in a consecutive cohort of subjects undergoing VSP of osteocutaneous fibular free flaps at Mayo Clinic between 2018 and 2020 was completed. All cutaneous perforators from the peroneal system of the selected donor leg were identified preoperatively through a previously reported CTA tracing method and registered into the VSP. Perforators were classified as primary or secondary based on whether the perforators were targeted for use in the final reconstructive plan. Perforator measurements obtained from the VSP were cross-referenced with intraoperatively obtained measurements of actual perforator locations to calculate accuracy, precision, NPV, PPV, sensitivity, and specificity of the CTA localization technique. Sixty consecutive subjects were enrolled in the study. A total of 141 perforators were identified preoperatively on CTA and 145 perforators were identified on operative exposure. One perforator identified on preoperative CTA was not identified on surgical exposure (false positive perforator). Six perforators were identified on operative exposure alone without recognition on preoperative CTA (false negative perforators). The accuracy of CTA perforator identification was 96.52%. Median precision of perforator localization was 0.3cm (standard deviation 0.40) between CTA and operatively identified locations. PPV of the technique was 99.29% and NPV was 90.00%. The CTA localization technique for identifying and incorporating cutaneous perforator locations into VSP of osteocutaneous fibular free flaps is a reliable, accurate, and precise technique to employ in the modern paradigm of guided surgery for head and neck reconstruction.

Reduction of Occupational Radiation Exposure During Endovascular Treatment of Peripheral Artery Disease Using Radiation Absorbing Drapes

A chronic exposure to low dose radiation, as encountered in endovascular procedures, may impact the health of surgeons and radiologists over a timespan of several months to a lifetime. This study evaluates the feasibility and efficacy of a radiation absorbing sterile drape (RADPAD) to reduce operator exposure during the endovascular treatment of obstructive peripheral artery disease (PAD). Between February 2016 and September 2017, patients with PAD who received percutaneous transluminal angioplasty, stent placement, remote endarterectomy, or a combination thereof were included in this nonrandomized study. Patients were equally divided over a study cohort (with RADPAD) and a control cohort (without RADPAD). The unshielded body dose (E) of the staff was measured via electronic dosimeters placed at a chest height of the first operator (FO), second operator (SO), and sterile nurse (SN). A virtual maximum operator (MO) dose was constructed, yielding the highest dose per fluoroscopy run for either of the operators. Simultaneously, the dose area product (DAP) and C-arm settings for each fluoroscopy run were extracted. Staff exposures of the study cohort and control cohort were compared in terms of relative exposure (E/DAP). A secondary analysis involved an analysis of the individual fluoroscopy runs using a multivariate generalized linear mixed effect model. In total, 49 patients were included in this study. The use of RADPAD was technically feasible. Significant reductions of relative exposure were observed when comparing the study cohort with the control cohort. The relative exposure of the FO was reduced with 66.5% (1.82 vs. 0.61μSv/Gycm2, P<0.001), the relative exposure of the SO with 68.3% (0.55 vs. 0.17μSv/Gycm2, P=0.02), and the relative exposure of the MO with 65.8% (2.06 vs. 0.71μSv/Gycm2, P<0.001). Dose levels of SN were too low to draw conclusions under the current sample size. The multivariate generalized linear mixed effect model showed a significant correlation between absolute exposure of the MO and the use of the RADPAD (odds: 0.51, P<0.001). Usage of a radiation absorbing drape (RADPAD) during endovascular treatment of PAD results in statistically significant reduction in a relative operator dose while presenting no drawbacks. The use of these drapes is advised in future peripheral endovascular procedures.

Encapsulation of the glyphosate herbicide in mesoporous and soil-affine sorbents for its prolonged release

The increase in herbicide consumption, in particularly glyphosate, is causing considerable health and environmental concerns, due to its possible carcinogenic effects. Indeed, its widespread and intensive use promotes its diffusion in the surrounding environment. Additionally, the operator's exposure to the herbicide is not negligible.

Laparoscopic resection of pediatric interaortocaval large paraganglioma

Paragangliomas (PGL) are extremely rare tumors, especially in children. While minimally invasive surgical techniques are well established in adult patients, the evidence in children is extremely limited. PGL have a rich blood flow and are located around large vessels; thus, operative exposure and resection are often difficult due to proximity to major vascular structures including renal vessels, vena cava, and aorta. In particular, surgery for interaortocaval large PGL is extremely challenging. In this report, we presented a case of a child with hormonally active interaortocaval large PGL that was resected laparoscopically. A 14-year-old girl was transferred to the emergency room due to acute chest pain and vomiting after falling from a vaulting box. At presentation, her blood pressure was 218/137 mmHg and enhanced computed tomography of her abdomen revealed a 6.5-cm hypervascular tumor with intratumoral hemorrhage in the interaortocaval area. The patient's plasma catecholamine and 24-h urinary catecholamine level were found to be elevated. 131 I-MIBG scan showed increased uptake in the tumor. The definitive diagnosis of PGL was made and we conducted elective laparoscopic excision of the retroperitoneal tumor. Careful and meticulous dissection was needed to separate the tumor from the surrounding vessels and tissues using a sealing device. Intraoperative hypertension was controlled using phentolamine, and the surgeon closely communicated with the anesthesiologist intraoperatively. Complete resection of the tumor was achieved laparoscopically. Total blood loss was 175 mL and the operating time was 422 min. Six months later, she remained well with no evidence of recurrence. The laparoscopic approach gave excellent exposure and observation of the tumor's relationship to surrounding structures. Our findings suggest that laparoscopic tumor removal for interaortocaval large PGL is a feasible and safe procedure in children with the improvement of laparoscopic surgical skills and devices.

Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis.

ObjectiveAs exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.MethodsData Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ 2, Fisher's exact, and independent t tests.ResultsOf 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps (n = 15, 44.1%) and free mucosal grafts (n = 11, 32.4%). Rigid reconstruction was uncommon (n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise (p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis (p < 0.001), larger tumor size (p = 0.001), and operative exposure of orbital fat (p < 0.001) and extraocular muscle (p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone (p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia.ConclusionMost outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.

Impact of the incorrect use of lead drapes on staff and patient doses in interventional radiology

To evaluate the usefulness of commercially available scatter reduction drapes in mitigating staff exposure in interventional radiology and the potential harmful effects of drape malpositioning in terms of exposure levels to both patients and staff. An anthropomorphic phantom was irradiated on an angiography device under three scenarios: no drape and correct and incorrect drape positioning. Different levels of incorrect drape positioning relative to the field-of-view (FOV) were evaluated: slight, mild and severe. Real-time dosimeter systems (positioned on the operator’s eye, chest and thyroid) were used to evaluate accumulative doses and dose rates. Different obstruction levels were evaluated and compared to the observer’s perception. Additionally, patient exposure was evaluated for all scenarios using a dose area product (DAP). Up to a mild obstruction, by using the drape a dose reduction of up to 86% was obtained while a severe obstruction produced a 1000% increase in exposure, respectively for all dosimeter positions compared to the use of no drape. A similar order of magnitude was observed for patient exposure. Good agreement was obtained for the observer perception of the FOV obstruction up to 25% of the FOV; for larger obstructions, an overestimate of the obstruction was observed. Patient lead drapes can reduce staff doses in interventional radiology procedures even when mildly malpositioned and obscuring the FOV. Special attention to protective drape positioning is necessary, since the severe obstruction of the FOV results in a large increase in both operator and patient exposure.

Controlling Woody Weed Chinese Elm (Celtis sinensis Pers.) with Stem-Implanted Herbicide Capsules.

Chinese elm [Celtis sinensis Pers.] is an emerging environmental weed naturalised throughout the coastal and riparian (creek-banks, river margins, and streams) regions of eastern Australia. Throughout this introduced range, its management is limited to the application of synthetic herbicides and mechanical clearing operations (terrain and soil type permitting). The current mechanisms of chemical control (basal bark spraying, stem-injection, and cut-stump applications) often result in collateral damage to non-target native species (such as Eucalyptus spp. and Casuarina cunninghamiana Miq.) through herbicidal drift, runoff or leaching into adjacent habitats. This has raised concerns regarding the suitability of synthetic herbicides in ecologically sensitive (e.g., riparian zones, rainforest margins, and woodlands) or low-value habitats, thereby promoting significant developments in the fields of integrated weed management. This study investigated the effectiveness of a novel stem-implantation system for controlling woody weed species in the context of a conserved habitat. A replicated trial (n = 315) was established among a naturally occurring population of C. sinensis. This trial involved the mapping, measurement, and treatment of this invasive species with five encapsulated synthetic herbicides, as well as an untreated control and benchmark treatment (diesel + AccessTM). A significant effect (p < 0.05) on plant vigour and functional canopy was discerned for each assessment period following trial establishment. The highest incidence of mortality was observed among the individuals treated with glyphosate (245 mg/capsule), aminopyralid and metsulfuron-methyl (58.1 and 37.5 mg/capsule) and picloram (10 mg/capsule), achieving a similar response to the basal bark application of diesel and AccessTM (240 g/L triclopyr, 120 g/L picloram, and 389 g/L liquid hydrocarbon). This was also evidenced by a rapid reduction in functional canopy (i.e., no or little living leaf tissue) from three weeks after treatment. Unlike their industry counterparts, these encapsulated herbicides are immediately sealed into the vascular system of the target species by a plug. This significantly minimises the possibility of environmental or operator exposure to synthetic compounds by providing a targeted, readily calibrated herbicide application.

Differing radiation exposure in scrub technicians and rotating staff in cardiac catheterization laboratory: occupation matters

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiation exposure of cardiac catheterization lab personnel is an evolving area of concern, due to long term, repetitive exposure causing deterministic and stochastic effects(1,2). Current radiation protection measures are based on increasing distance, shielding from fluoroscopy source and depend on primary operator behavior(3) Effective dose(ED) in micro Sieverts( μSv) as a measure of individual absorbed radiation dose provides feedback as to occupational exposure and risks. Dosimeter badges worn over equipment measure ED correlating with radiation exposure of areas unprotected by standard lead apron such as head, neck, lens and upper limbs. (4) Most studies focus on primary operator exposure (5,6,7), overlooking non physician staff comprising scrub technicians working as assistants to primary operator physicians, and rotating staff involved in peri-procedural care of patients. Purpose This study aimed to find out ED acquired by scrub technicians(ED.S) and rotating staff(ED.R) in interventional cardiology and invasive electrophysiology procedures, utilizing external dosimeters worn over lead aprons. Methods We prospectively collected radiation data over forty six invasive Cardiology procedures from 15th March 2021 to 1st June 2021 comprising fourteen diagnostic coronary and graft angiograms, seventeen combined diagnostic and interventional cardiology procedures, nine sole percutaneous coronary interventions and six electrophysiology procedures. Nine staff members: two female and seven male members participated as scrub technicians and rotating staff, provided with external dosimeter badges. ED was obtained by logging in dosimeter badges into pre calibrated monitors. Results Significantly high mean ED was acquired by rotating staff as compared to scrub technicians, mean ED.R:21.04 μSv( SD: +/-39.64) and mean ED.S: 7.54 μSv( SD:+/- 17.23), this three fold difference in radiation exposure was statistically significant with a p-value of 0.03. This was consistent across procedure groups, with rotating staff acquiring higher ED compared to their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. Statistically significant differences in radiation exposure of both staff groups were demonstrated in diagnostic and interventional cardiology procedures, with p-values of 0.04 and 0.01 respectively.(See Table) Conclusion This small, single center study highlights occupational role as a significant factor in varying radiation exposure amongst non-physician staff . Higher ED was attributed to rotating staff duties involving proximity and mobility around fluoroscopy source and patient, devoid of protective lead shields. Based on these findings, avoiding fluoroscopy use while staff performs duties involving proximity to patient such is mandatory. Other essential measures should include accessory left sided leads shields, mandatory protective lens and head shields for rotating staff. Abstract Table

Quadrilateral plate fractures of the acetabulum: Classification, approach, implant therapy and related research progress.

The quadrilateral plate (QP) is an essential structure of the inner wall of the acetabulum, an important weight-bearing joint of the human body, which is often involved in acetabular fractures. The operative exposure, reduction and fixation of QP fractures have always been the difficulties in orthopedics due to the special morphological structure and anatomical features of the QP. Fortunately, there have been many effective methods and instruments developed for QP exposure, reduction and fixation by virtue of the combined efforts of numerous orthopedists. At the same time, each method presents with its own advantages and disadvantages, resulting in different prognoses. It is necessary to have a thorough understanding of the anatomy, radiology and fixation techniques of the QP in terms of patient prognosis optimization. In this paper, the anatomical features, definition and classification of QP, operative approach selection, implant internal fixation methods and efficacy were reviewed.

Aerosol generation during general anesthesia is comparable to coughing: An observational clinical study.

ABSTRACTBackgroundIntubation, laryngoscopy, and extubation are considered highly aerosol‐generating procedures, and additional safety protocols are used during COVID‐19 pandemic in these procedures. However, previous studies are mainly experimental and have neither analyzed staff exposure to aerosol generation in the real‐life operating room environment nor compared the exposure to aerosol concentrations generated during normal patient care. To assess operational staff exposure to potentially infectious particle generation during general anesthesia, we measured particle concentration and size distribution with patients undergoing surgery with Optical Particle Sizer.MethodsA single‐center observative multidisciplinary clinical study in Helsinki University Hospital with 39 adult patients who underwent general anesthesia with tracheal intubation. Mean particle concentrations during different anesthesia procedures were statistically compared with cough control data collected from 37 volunteers to assess the differences in particle generation.ResultsThis study measured 25 preoxygenations, 30 mask ventilations, 28 intubations, and 24 extubations. The highest total aerosol concentration of 1153 particles (p)/cm³ was observed during mask ventilation. Preoxygenations, mask ventilations, and extubations as well as uncomplicated intubations generated mean aerosol concentrations statistically comparable to coughing. It is noteworthy that difficult intubation generated significantly fewer aerosols than either uncomplicated intubation (p = .007) or coughing (p = 0.006).ConclusionsAnesthesia induction generates mainly small (<1 µm) aerosol particles. Based on our results, general anesthesia procedures are not highly aerosol‐generating compared with coughing. Thus, their definition as high‐risk aerosol‐generating procedures should be re‐evaluated due to comparable exposures during normal patient care.Implication StatementThe list of aerosol‐generating procedures guides the use of protective equipments in hospitals. Intubation is listed as a high‐risk aerosol‐generating procedure, however, aerosol generation has not been measured thoroughly. We measured aerosol generation during general anesthesia. None of the general anesthesia procedures generated statistically more aerosols than coughing and thus should not be considered as higher risk compared to normal respiratory activities.