Background:Ankle impingement is common in athletes, especially in running, jumping, and cutting activities. We present 2 clinical cases of impingement, anterior (AAI) and posterior (PAI), plus subfibular, demonstrating the utility of ankle arthroscopy and hindfoot endoscopy techniques.Indications:AAI presents with pain at terminal dorsiflexion, tenderness over the anterior joint, and pain with passive hyperdorsiflexion. PAI presents with pain on repetitive plantarflexion, tenderness over the posterior talar process, and pain with passive hyperplantarflexion. Surgical indications include persistent pain or functional limitations refractory to conservative treatment. Contraindications include severe arthritis, poor vascular status, or a compromised soft tissue envelope.Technique Description:For AAI, the patient is slightly lateral with the thigh in a foam-lined leg holder. Minimal traction is applied through an ankle stirrup attached to a noninvasive sterile distractor. Standard anteromedial and anterolateral portals are created, with accessory portals made to access the submalleolar spaces. Impinging soft tissue and bony spurs are resected using a radiofrequency wand, shaver, and/or bur, followed by arthroscopic confirmation of resolution of impingement. For hindfoot endoscopy, the patient is prone with the involved ankle off the operative table end. Standard portals are posterolateral and posteromedial. The crural fascia is identified and released with a radiofrequency wand. The flexor hallucis longus is identified and is the most medial extent of any dissection to avoid neurovascular injury. Impinging structures are identified and resected using small joint instruments.Results:AAI arthroscopy has shown improvements in the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale, Foot Functional Index, and dorsiflexion. The reported overall complication rate is 4%, with the most common being transient neurapraxia, superficial infection, and disturbed wound healing. PAI hindfoot endoscopy improves AOFAS scores and reduces time to return to play compared with open procedures. There is a reported 6% complication rate with transient sensory nerve symptoms, Achilles pain, and portal thickening being the most common.Discussion/Conclusion:Anterior and posterior ankle impingements are common in athletes and present with limited function, decreased range of motion, and localized pain. When conservative treatment fails, ankle arthroscopy and hindfoot endoscopy are effective surgical options that provide pain relief, modest improvement in range of motion, faster return to play, and low complication rates.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Physician-modified endograft for repairing iatrogenic innominate artery injury: A case report and literature review.

Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic working-height recommendations in orthopaedic surgery remains limited. Methods: A simulated left total knee arthroplasty (TKA) was divided into twelve critical surgical steps and analysed across four commonly used surgeon positions (A-D). Two conditions were compared: uncorrected working height (N) and working height corrected according to Canadian Centre for Occupational Health and Safety (CCOHS) recommendations (C). Joint angles were measured from standardized photographs using Kinovea software, and postural load was quantified with the Rapid Entire Body Assessment (REBA) method. Two trained evaluators conducted three independent assessments, yielding 288 REBA scores. Results: Mean REBA scores decreased across all surgeon positions following ergonomic correction, with statistically significant reductions observed in positions A, B, and D. When pooled across all position-step combinations (n = 48), the mean reduction was 0.92 REBA points (95% CI 0.50-1.33; p < 0.001). Notably, 27 of the 48 position-step comparisons exceeded the minimal detectable change threshold. The largest reductions occurred during force-intensive surgical steps, including bone cutting, drilling, and implant impaction. Conclusions: Adjusting working height in accordance with CCOHS ergonomic recommendations reduces surgeons' postural load during TKA. These findings support the integration of evidence-based ergonomic adjustments into routine orthopaedic surgical practice.

Safeguarding Against Falls From the Operating Room Table During Emergence From Anesthesia: A Simple Strategy.

A quasigroup is a pair ( Q , * ) where Q is a non-empty set and * is a binary operation on Q such that for every ( u , v ) ∈ Q 2 there exists a unique ( x , y ) ∈ Q 2 such that u * x = v = y * u . Let q be an odd prime power, let 𝔽 q denote the finite field of order q , and let ℛ q denote the set of non-zero squares in 𝔽 q . Let ( a , b ) ∈ 𝔽 q 2 be such that { a b , ( a - 1 ) ( b - 1 ) } ⊆ ℛ q . Let 𝒬 a , b denote the quadratic quasigroup ( 𝔽 q , * a , b ) where * a , b is defined by x * a , b y = x + a ( y - x ) if y - x ∈ ℛ q , x + b ( y - x ) otherwise . The operation table of a quadratic quasigroup is a quadratic Latin square. Recently, it has been determined exactly when two quadratic quasigroups are isomorphic and the automorphism group of any quadratic quasigroup has been determined. In this paper, we extend these results. We determine exactly when two quadratic quasigroups are isotopic and we determine the autotopism group of any quadratic quasigroup. In the process, we count the number of 2 × 2 subsquares in quadratic Latin squares.

Introduction: The study aimed to prospectively compare the lateral and the modified tilted supine position in patients undergoing trochanteric fracture fixation using dynamic hip screws regarding the procedural difficulties and the radiologic outcomes. Materials and Methods: This randomized controlled trial recruited 64 patients with peritrochanteric fractures; 30 in group A, where patients were placed in a supine position on the operative table and 34 in group B, where patients were placed in a lateral position. Our outcome measure were the setting-up time, operating time, any operative difficulties, preoperative blood loss, postoperative wound drainage, and the amount of blood transfused. Hemoglobin levels before and at 48 hours after surgery, delay in wound healing or infection, and duration of hospital stay were noted. Radiologically, the amount of displacement, femoral neck-shaft angle (NSA), tip-to-apex distance (TAD), and modified Parker Index Ratio (PIR) were measured and reported. Patients were followed up for a minimum of 2 years. Results: The mean setting-up time was significantly shorter in the lateral position group (B). The mean fluoroscopy time was significantly longer among the supine position group (A). However, the total operative time was similar in both groups. The mean NSA in the anteroposterior view was similar in both groups. The disparity between the diastasis in both AP and lateral views was substantially higher among group B. Both groups had close PIR in both AP and lateral views and TAD at final follow-up. Conclusions: This study demonstrates that the lateral position provides shorter setting-up, fluoroscopy and operative times for peritrochanteric fracture fixation (AO types 31A1 and 31A3) using a dynamic hip screw. This highlights its potential to enhance surgical success and patient recovery. Level of Evidence: Level I.

On 1 January 2025, the revised Italian classification of economic activities, Ateco 2025, entered into force. To implement it for both statistical and administrative purposes, an automated procedure recodes enterprises according to the new scheme. This process relies on a mapping and operational correspondence table that automatically resolves one-to-many cases between Ateco 2022 and Ateco 2025. This research work is intended to describe the process of development of the above-mentioned tool including: i) the application of an automatic matching algorithm that compares the text strings headings and inclusion notes of the two classifications Ateco 2022 and Ateco 2025, ii) the analysis of the SEA Survey of Economic Activities results and iii) the involvement of classification experts. Results have shown that, in the absence of any kind of information describing the economic activity at individual level, the developed tool is very useful to make a preliminary large scale recoding of registers and archives of enterprises maintained by various bodies.

Effectiveness and Validity of Informed Consent in Patients Undergoing Surgery in Cameroon: A Prospective Survey.

Introduction Tilting an operating room table, though frequently needed to optimize surgical exposure, is associated with an increased risk of falls. While safety straps mitigate the risk of a fall should the patient start to slide, few tools can predict settings in which falls are likely to occur. The purpose of this study was to develop and validate a predictive biomechanical model for degree of table tilt associated with patient movement and risk of falling. Methods A model incorporating patient's body mass index (BMI) was designed to predict the maximum angle a table could be tilted before patient movement occurred. The model was developed using SolidWorks computer simulation and validated with 19 unrestrained, non-anesthetized volunteers. Movement on the table was self-reported and observed by the researchers as the table was tilted laterally and in reverse Trendelenburg (RT). Volunteers were categorized by BMI (“normal”: 18.5–24.9, “overweight”: 25–29.9, “obese”: &gt;29.9). Fit of the model was assessed using mean square error, and predicted angles were compared to experimental outcomes using the Student’s t -test ( P &lt; 0.05). Results In both the overweight and obese BMI groups, no significant difference was noted between predicted and experimental angles. In volunteers with a normal BMI, the model underestimated the lateral angle, but accurately predicted RT. Overall, lateral angles were smaller than RT. Conclusions This model can predict patient sliding in the operating room, though it underestimates the maximum angle of slipping in the lateral direction among those with a normal BMI. Larger studies are needed for validation and feasibility of implementation.

Ventilation systems in operating rooms have high importance, as they simultaneously are important for patient and personnel safety. However, conventional ventilation systems laminar air flow and mixing ventilation show disadvantages, e.g., the first leads to discomfort of the staff because of high draught risks and the latter improves lateral transport of contaminations. In this study, a concept that introduces additional air inlets for local horizontal ventilation in the vicinity of the operation table combined with these conventional systems is tested in experiments. The impact on the removal of bacteria originating from the surgical staff and surgical smoke that is emitted during electrosurgical procedures with surrogate particles as well as thermal comfort of the staff and heat flux of the patient were experimentally assessed in a full-scale research operating room. It was shown that the concentrations of contaminations were reduced by more than one order of magnitude for surgical smoke and two orders of magnitude for airborne germs in the proximity of the local air inlet, compared to reference cases without local ventilation. Moreover, a risk of cross-contamination from the surgical micro-environment to the peripherical area was formed due to the horizontal airflow. The heating system of the patient simulators surface consumed 13 % more power for LAF and 29 % for TMV compared to the reference cases, increasing the risk of perioperative hypothermia. The thermal comfort of the surgical staff was not significantly affected by the local ventilation system.

This paper addresses the problem of optimizing transaction performance in relational databases used in warehouse management systems. In response to the growing demands for scalability and efficient data processing in high-load environments, the research aims to evaluate the impact of structural configurations—particularly indexing and partitioning—on the execution speed of key business operations. PostgreSQL was selected as the experimental platform due to its advanced optimization capabilities and wide industrial adoption. The study employs a relational data model comprising eight interrelated tables representing a typical warehouse system, including products, categories, suppliers, stock balances, and disposal records. Three architectural configurations of the main operational table (warehouse stock) were developed, including default indexing and combinations of partitioning and composite indexing on warehouse and product identifiers. Each configuration models a distinct approach to database optimization under intensive transactional load. To assess performance objectively, the pgbench benchmarking tool was used with multithreaded workloads and fixed-duration tests. Four core operations—stock availability check, product transfer between warehouses, goods intake, and inventory disposal—were implemented as SQL procedures simulating real-world scenarios. Each test scenario yielded performance metrics in terms of transactions per second, enabling comparative evaluation of all configurations. The proposed methodology allows for a systematic assessment of how architectural decisions influence relational database performance in transaction-heavy systems. The experiment provides a foundation for further research involving larger datasets, alternative partitioning schemes, or comparative evaluation with other DBMS platforms and hardware setups. The work holds practical significance for professionals involved in database architecture, performance optimization, and the development of scalable warehouse management solutions.

Drained peatlands are a substantial contributor to global anthropogenic greenhouse gases despite the relatively small areas they occupy. In New Zealand, drained Organic Soils (former peatlands) under cropland and grazed grasslands disproportionately contribute to emissions, but outdated mapping and limited measurements result in large uncertainties. To progress our understanding of the magnitude of these emissions and potential for mitigation, we compiled existing measurements from New Zealand and default emission factors from the IPCC along with updated soil mapping to develop a comprehensive national assessment. Using the IPCC 2013 Wetland Supplement (WS), Tier 1 default emission factors, total CO 2 equivalent (CO 2 e) drained Organic Soil emissions were 3.86 Mt yr⁻¹, equivalent to 6.5 % of the country’s net emissions. This was similar to the estimate derived from the mean of New Zealand-specific annual CO 2 e emissions (3.61 Mt yr⁻¹). However, there are insufficient measurements from which to develop robust Tier 2 emission factors, and the range of CO 2 e estimates based on existing data (3.06–4.69 Mt yr⁻¹) reinforces the need for more distributed measurements. The estimated CO 2 e contribution to national emissions increased to 6.34 Mt yr⁻¹ (or 11 % of net emissions) when peaty-mineral soils were included in the calculations. Carbon-rich soils with a peaty surface horizon that do not meet the technical definition of Organic Soils are increasingly recognised as a potential source, but we have even less data quantifying their emissions to determine appropriate emission factors. We evaluated the potential for emissions mitigation through rewetting Organic Soils by running scenarios representing different areal rates of annual rewetting over the next ten years using WS default emission factors. Cumulative emissions avoided by rewetting 500–3000 hectares per year from 2026 until 2035 ranged from 0.53 to 1.25 Mt of CO 2 e. Despite the barriers to practical implementation of peatland rewetting in New Zealand, the opportunity for emissions reductions is substantial. Further work is needed to refine emission factors, improve spatial activity data, and develop operational water table management capability to realise the potential in climate mitigation.

The electro-hydraulic operating table is a vital component in contemporary surgical systems, responsible for supporting the patient’s body throughout various procedures. Ensuring the structural strength and stability of the bed frame is critical for maintaining patient safety and enhancing procedural success. This study investigates the mechanical performance of key substructures within the bed unit, namely the cranial support structure, dorsal frame, pelvic base, and lower limb support frame. A static structural analysis was conducted using SOLIDWORKS Simulation software, incorporating load distribution data based on a 280 kg patient. Results revealed maximum stress values of 14.888 N/mm² (cranial support), 105.621 N/mm² (dorsal frame), 2.495 N/mm² (pelvic base), and 81.185 N/mm² (lower limb support). All stress values were below the yield strength of aluminum casting (220 N/mm²), indicating structural safety. The findings suggest that the current frame design is mechanically reliable and suitable for clinical deployment under specified load conditions.

BackgroundThe effectiveness of a 15° left-lateral tilt for alleviating the inferior vena cava (IVC) compression caused by a gravid uterus has been questioned. This study assessed the benefits of conducting pre-spinal anesthesia IVC-abdominal aorta ultrasound examinations and utilizing the IVC to abdominal aorta (IVC/Ao) ratio as a guide for post-spinal anesthesia positioning.Methods200 parturients undergoing cesarean section were randomized 1:1 into an ultrasound-guided and a control group (groups U and C, respectively). The parturients in group C were positioned with a 15° left-lateral tilt, while those in group U had the operating table tilted to achieve the maximum IVC:Ao diameter, as determined by preoperative ultrasound, which indicated the maximum IVC:Ao diameter. The primary endpoint was the incidence of hypotension in parturients, defined as the period from the completion of intrathecal drug injection (time A) to when they were placed in the supine position (time B). Secondary outcomes included total vasopressor use, umbilical cord blood parameters (such as the pH and base excess values of the umbilical artery) immediately after birth, and Apgar scores at 1 and 5 min for the neonate.ResultsThe incidence of hypotension from the end of spinal anesthesia until the supine position was lower in group U (60.8%, n = 79) compared to group C (80%, n = 80) for the parturients included in the statistical analysis (risk difference = −0.192 (95% CI −0.325 to −0.050), p = 0.010). Furthermore, the usage of the vasoactive drug, metaraminol, in group U was lower than in group C [1 (0, 1.5) vs. 1 (0.5, 1.5)], with a mean difference of 0.283 (95% CI 0.044 to 0.522), p = 0.012.ConclusionConducting an IVC-abdominal aorta ultrasound examination before spinal anesthesia in parturients and using the IVC/Ao ratio to guide post-spinal anesthesia positioning reduced the incidence and frequency of hypotension as well as the dose of vasopressors required after surgery.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=166587, identifier ChiCTR2200059888.

Epidaurus is world famous as a well-preserved ancient theatre with good acoustics. The daily tourists are informed that it was connected to the medical sanctuary behind it. In the museum below the theatre, you can clearly see that this 'sanctuary' was a highly specialized super hospital. The instruments on display document surgical expertise on joints, muscles, internal organs and the brain. Epidaurus Medical Centre was from the 3rd century BC and a few hundred years later the Mediterranean world most specialized hospital. In addition to injuries from war, sports and oldage, medical and mental illnesses could also be treated here. Outside the very large hospital and the hotel for the relatives, a space was set up with at theatre to entertain patients and relatives. The popular genres of music, dance and reprise theatre (4th century classical comedies and tragedies) were shown here. International music and sports competitions for the entire Greek-speaking Mediterranean world took place here too thanks to large and persistent sponsorships for the super hospital. At the same time, the medical understanding of 'recovery' at the time contained a series of aesthetic experiences of a visual, aural and rhythmic nature, which could be fully achieved within a theatre space: The operated or weakened body had during medical treatment to be exposed to the singing and dancing body to ensure safe healing and complete recovery. Using the example of Epidaurus, my paper will analyse the relationship between the two bodies - the medical and the artistic - the latter's healthy function for the former. What scientific thinking and experience was behind it? In addition – attending a performance at Epidaurus you have at the same time the most beautiful view of the Greek Peloponnesian landscape. As an audience you can at the same time concentrate and relax, take the landscape in.

BackgroundCleaning procedures for the anesthesia workspace can generate substantial reductions in Staphylococcus aureus (S. aureus) transmission and all-cause surgical site infections (SSIs), including for the anesthesia machine. In this study, we evaluated their practicality and safety.MethodsA total of seven volunteer anesthesiologists were briefly trained (two-minute video) regarding the implementation of surface disinfection and triangular (one emitter at the head and on each side of the operating room table) ultraviolet-C (UV-C) cleaning procedures. Volunteers were each randomized to three cleaning trials involving surface disinfection cleaning or surface disinfection cleaning plus two minutes of triangular UV-C treatment. The total time and efficacy of each cleaning procedure were measured along with the risk for inadvertent UV-C and ozone exposure.ResultsThe mean (standard deviation (SD)) surface disinfection wiping time was 2.1 (1.5) minutes. The mean (SD) surface disinfection wiping efficacy among the seven participants was 1.13 (0.15), where 1 = some and 2 = full cleaning. The mean (SD) marginal increase for UV-C augmentation of surface disinfection wiping was 10.5 (2.1) minutes. The mean (SD) for UV-C dose delivery was 73.25 (21.85) mJ/cm2 for the anesthesia machine and 32.76 (15.55) for the anesthesia cart, with delivery ≥ 27.01 (0.15) mJ/cm2. There was zero ozone generation or inadvertent UV-C exposure.ConclusionsEvidence-based anesthesia machine surface disinfection and triangular UV-C cleaning procedures are practical. Two minutes of triangular UV-C is a reasonable approach for the augmentation of surface disinfection that was largely ineffective, even despite training. These study results support a negligible risk for inadvertent UV-C or ozone exposure.

either sex, American Society of Anesthesiologists (ASA) grade I and II, aged between 20 and 55 years, scheduled for planned head and neck oncosurgery, were included in the study.It is a prospective, nonrandomized study conducted from January to December 2020.Patients with peripheral vascular disease, autonomic dysfunction, chronic pain disorder, or allergy to drugs used in the study were excluded from the study.On the day of surgery, after taking the patient on the operation table, all routine monitors were attached: an electrocardiogram (ECG), noninvasive blood pressure (NIBP), and pulse oximeter (SpO 2 ).PI was measured by Masimo Radical-7 SET pulse oximeter, and the probe was attached on the index finger contralateral to the side of the blood pressure cuff to get uninterrupted PI monitoring.All data were recorded by faculties of anesthesiology.Preinduction values of PI, HR, and mean arterial pressure (MAP) were noted.

The rotation and projection of the nasal tip are fundamental factors in determining surgical success. The tongue-in-groove (TIG) technique is performed by securing the medial crura to the septum to control nasal tip rotation and projection. Unlike the traditional TIG technique, the membranous TIG variation involves creating a pocket between the two layers of the membranous septum and placing the caudal septum into this pocket. The aim of this study is to evaluate the long-term effects of the membranous TIG technique on nasal tip rotation and projection in patients undergoing closed rhinoplasty. Fifty-two patients who underwent closed rhinoplasty using the membranous tongue-in-groove technique between January 2021 and February 2024 were retrospectively analyzed. Preoperative, postoperative operating table, short-term, and long-term postoperative photographs were evaluated. The nasolabial angle and nasal tip projection ratio were recorded. All patients included in the study were female. The age range was between 19 and 37 years, with a median age of 25. The mean preoperative, postoperative operating table, short-term, and long-term rotation values were 100.58±10.64, 116.19±7.67, 113.73±7.50, and 108.49±8.41, respectively (p<0.001). The mean preoperative, postoperative operating table, short-term, and long-term goode ratios were 0.61±0.05, 0.77±0.05, 0.68±0.05, and 0.64±0.05, respectively (p<0.001). Rotation loss was more pronounced in the long term, whereas projection loss more pronounced in the short term. The membranous TIG technique is an effective method for stabilizing nasal tip rotation and projection. Additional supportive techniques should be explored to maintain long term LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background: The practice patterns for patient positioning, surgical techniques, and challenges faced by ophthalmologists during eye surgery on patients with kyphosis in India are yet unknown.Methods: A cross-sectional online survey was conducted through Google Forms amongst practicing ophthalmic surgeons over two months and communicated across email lists and social media networks of state and regional ophthalmological associations of India in 2022.Results: Fifty-two ophthalmologists responded (mean age 48.6 ± 8.5 years, 71.2% males), mostly from teaching hospitals in urban areas of eastern India. Overall, 1279 cases of kyphosis were reported to have been operated upon. The majority had 30-50° of kyphosis. Peribulbar or retrobulbar anesthesia was equally preferred with an ophthalmic operating table for positioning. Almost equal numbers of surgeons operate sitting superiorly or temporally. More than half the respondents (57.7%) reported no difficulty or complications, and 71.2% did not alter their settings while performing phacoemulsification. The majority of the remainder had problems due to the high level of the patient’s head, microscope oculars raised beyond their comfort level, and having to adjust their posture with every movement of a restless patient. Reaching the foot pedal while sitting or operating it while standing posed challenges. Surgeons commonly reported backache, neck pain, exhaustion, stiffness, tiredness, and mental stress. Conclusions: Our study provides an Indian perspective on managing intraocular surgery in kyphotic patients with special requirements. Innovative solutions for positioning the patient and proficient surgeons can lead to the successful accomplishment of ocular surgery in such challenging patients.

This paper reinterprets the figure of Briseis in Homer's Iliad as a powerful archetype of constrained beauty and post-traumatic survival. Traditionally framed within the male heroic narrative, Briseis has been reduced to a voiceless prize-her beauty both praised and possessed, yet never her own. Through classic sources and modern cultural parallels, this editorial explores how beauty, when aestheticized under violence and captivity, becomes a double-edged symbol: it both elevates and silences the sufferer. Briseis exemplifies this paradox, where her appearance becomes currency in the economy of war, while her suffering is softened into an ornament. This tension resonates with modern experiences-from war photography to reconstructive surgery-where beauty remains a potent but problematic framework for interpreting trauma. Drawing on contemporary texts such as The Silence of the Girls and Autobiography of a Face , the article highlights how female survivors of violence and injury navigate identity reconstruction in ways that resist the expectations imposed upon them. The paper argues that Briseis's survival, long overshadowed by her subjugation, can be reclaimed as a narrative of endurance, not passivity. Briseis becomes a symbol for clinicians, writers, and readers grappling with the ethics of beautifying pain. Her myth challenges us to consider how the authors represent and respond to suffering: can the authors witness pain without aestheticizing it? Can survival be beautiful without being ornamental? As the authors confront trauma in modern contexts-on operating tables, in literature, or cultural memory-Briseis reminds us that true resilience lies not in being idealized, but in being heard.