Day Of Surgery Research Articles

Successful management of drug-resistant rhizobium radiobacter endophthalmitis: A case report.

To report a unique case of post-cataract surgery endophthalmitis caused by Ceftazidime-resistant Rhizobium radiobacter, successfully managed with timely vitrectomy and intravitreal Levofloxacin. A healthy 73-year-old man underwent phacoemulsification and posterior chamber intraocular lens implantation in his left eye. Postoperative ocular examination (OE) one day after the surgery revealed no specific findings. However, on postoperative day 6, he presented with a painful and red left eye. Diagnosed with postoperative endophthalmitis on day 8 at another hospital, he received IVI of Ceftazidime and Vancomycin before being urgently referred to our hospital on the same day. Early vitrectomy and anterior chamber irrigation were performed timely when he arrived on day 8, with cultures identifying Ceftazidime-resistant Rhizobium radiobacter, sensitive to Levofloxacin. Repeated IVI of Levofloxacin (500 mcg/0.1 ml) ensued on post-cataract operative days 13 and 18. Six months post-cataract surgery, the corrected distance visual acuity of the left eye stabilized at 20/33, and OE remained stable. Early vitrectomy and vitreous culture prove effective in managing postoperative endophthalmitis in drug-resistant Rhizobium radiobacter. IVI of Levofloxacin, though rare, proved to be effective in treating Ceftazidime-resistant and Levofloxacin-sensitive pathogens in our case.

Short- and Intermediate-Term Morbidity Following Total Pelvic Exenteration in Colorectal Cancer.

Total pelvic exenteration (TPE) for clinical T4b colorectal cancer (CRC) is associated with significant morbidity. Short (0-30days)- and intermediate (31-90days)-term temporal analysis of complication onset is not well described, yet needed, to better counsel patients considering TPE. A retrospective cohort study of consecutive patients with primary or recurrent clinical T4b pelvic CRC undergoing open TPE between 2014 and 2023 was conducted. Clinicopathologic variables were collected for each patient. Postoperative morbidity was classified according to the Clavien-Dindo (CD) grade system and stratified by time of onset within 90days of surgery. Pearson's Chi-square test, Fisher's Exact test, and the Mann-Whitney U test were used to compare primary vs recurrent patient groups, and logistic regression assessed predictors of postoperative morbidity. Statistical analysis was performed using R with two-sided significance set at <0.05. Twenty-seven patients were identified of which 24 (88.9%) were male with a median age of 60.4years (interquartile range [IQR]: 56.3-70.5). Seventeen (63.0%) patients had primary disease and 10 (37.0%) had recurrent CRC. Twenty-three (85.2%) patients experienced at least one complication within 90 days of surgery, but no mortality was observed. Ten (37.0%) patients experienced a CD ≥ 3 event, of which 40% took place beyond 30days. The most common complication overall was anemia requiring transfusion, while the most common major complication was pelvic abscess. No clinicopathologic variables analyzed were predictive of major postoperative complication within 90days of TPE. TPE for clinical T4b CRC carries a high risk of postoperative morbidity in both the short- and intermediate-term after surgery, with a significant proportion of complications occurring after 30days. Given the magnitude of operation, an extended recovery with high risk for complications is common. Although a single-center series, this annotated postoperative complication profile may assist patients and clinicians when reviewing informed consent for TPE.

A rare case of thoracoscopic management of post operative chylous neck fistula

Background: Thoracic duct injury is commonly iatrogenic. It can present as chylothorax, chylous neck fistula or rarely as chylopericardium. Injury to the main thoracic duct, rarely closes spontaneously while a chylothorax after lung resection rarely requires operative intervention as the leak is through the tributaries of the main duct. Chyle fistula can lead to high morbidity due to fluid loss causing nutritional deficiency and immunosuppression with mortality up-to 50%. Methods: A 37 years old male was referred to our hospital with left supraclavicular malignant swelling which was a spindle cell tumor for which his local neck exploration and the excision of tumor was done. Patient had iatrogenic thoracic duct injury in the neck and developed a chylous neck fistula on post operative day 2, with output of 1200- 1400 ml chyle per day in drain. We did a video assisted thoracoscopic ligation of thoracic duct just at its entry point in right hemithorax between azygous vein and aorta. Results: Patient had an uneventful post operative recovery with complete stoppage of chyle leak in the neck. Conclusions: Conservative management of chyle leak is rarely successful and has high incidence of morbidity and mortality due to nutrition loss. VATS introduced in early 90’s has been applied in the management of chyle leak also. Injury to the main thoracic duct rarely closes spontaneously and surgical management in the form of thoracoscopic thoracic duct ligation is the treatment of choice.

Laparoscopic Pudendal Nerve Release at the Level of Sacrospinous Ligament.

Pudendal nerve release can be managed by the laparoscopic approach for pudendal nerve entrapment. This is a case report of a stepwise demonstration of the technique with narrated video footage. A 71-year-old woman, gravid 7, parity 3, abortion 4, live births 3 vaginal delivery, complained of pain while sitting. She had been having vaginal and vulvar pain on the left side for 3years. At vaginal examination, she had pain over the sacrospinous ligament with palpation. Tinel's sign (+) on the left side. Left side pudendal nerve block relieves pain for 1h. Using a laparoscopic approach for a left pudendal nerve release at the level of sacrospinous ligament, the dissection started at the level of medial to the infundibulopelvic ligament, after visualization of obliterated umbilical artery and obturator nerve and vessels, dissection continued deeper to the pelvic floor visualizing the obturator internus muscle, then pudendal nerve and vessels are identified and the coccygeus muscle and sacrospinous ligament are observed. The sacrospinous ligament is cut all the way to the entrance of Alcock's canal. The operation was finished without any complication and the patient was discharged after the operation day. Pain decreased on her postoperative examination. Follow-up visits will be continued at 3 and 6 months. Laparoscopic pudendal nerve release is reproducible, effective, safe, and has a steep learning curve method for the management of pudendal nerve entrapment.

BHSeP2 Light and heavy weight mesh comparison for incisional hernia repair

Abstract Introduction Incisional hernia or surgical hernia is quite a common occurrence in large operative wounds. Prosthetic mesh repair is imperative to tackle its high risk of recurrence. Conventional mesh (heavy weight) is considered thicker than is probably sufficient, with a volley of contradictory data regarding the outcomes of the light weight and the heavy weight mesh in incisional hernia repair. Objective To compare light and heavy weight mesh for foreign body sensation in the repair of incisional hernia. Materials and methods To proceed with this randomized controlled trial at the Surgical Unit III, Dept. ofSurgery, Lahore General Hospital, Lahore 260 patients based on inclusion criteria were selected from S-III ward. Then they were randomly and equally divided in two groups. Where group A was having light weight mesh (weight ≥35–&amp;lt;70 g/m2) repair and group B had a heavy weight mesh (≥140 g/m2) used in repair. At 7th post OP day, feeling of foreign body was noted. Then follow up for recurrence till 3 months. Results With light weight mesh feeling of foreign body was significantly low. (Light Weight Mesh: 14.6%vs. Heavy Weight Mesh: 36.9%, P-value = 0.000). Conclusion The lightweight meshes have benefits over the heavy weight mesh for incisional hernia repairs for having a reduced foreign body sensation.

Anorectal malformation with rectoperineal fistula in males treated with a posterior rectal advancement anoplasty (PRAA) - report of early outcomes.

A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described which incised only within the limits of the sphincteric ellipse and eliminated an anterior rectal dissection, thus avoiding any possibility of a urethral injury. This report provides longer term postoperative outcomes after PRAA. Method A retrospective, single institution study was performed examining male patients with a rectoperineal fistula between 1/2020-12/2023. PRAA was done only if the rectoperineal fistula was located within the anterior extent of the sphincteric ellipse, which was true for all patients encountered during this study period. We assessed post-operative outcomes, length of stay, time to first feeding, and early stooling patterns. Results Eighteen patients underwent PRAA at a median age of 5.4 months (range 1 day-8 months) with median follow up of fourteen months (range 4-40). Seven patients (39%) were repaired within the first month of life. Thirteen (72%) were repaired primarily and five (28%) had a diverting ostomy placed before referral. There were no instances of wound dehiscence, rectal prolapse, or urethral injury. Two (11%) patients developed an anal stricture requiring dilation or Heineke-Mikulicz anoplasty. All patients resumed feeds on post operative day one. Median discharge was on post operative day one (range 1-6). Fifteen (83%) were utilizing laxatives at their most recent follow up. Conclusions The PRAA avoids any potential urethral injury or perineal dehiscence, has a low rate of anal stenosis (11%), and appears to be applicable to all male patients with a rectoperineal fistula. The technique allows for early return to diet and discharge and can be safely done in the neonatal period or in a delayed fashion without the need for a stoma.

Validation and Recalibration of a Model for Predicting Surgical-Site Infection After Pelvic Organ Prolapse Surgery.

The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery. This study utilized a previously validated model for predicting post-POP surgery SSI within 90days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database. Discriminatory performance was assessed via the c-statistic and calibration was assessed using calibration curves. Methods of recalibration in the large and logistic recalibration were used to update the models. The PHD contained 420,277 POP procedures meeting the inclusion criteria and 1.6% resulted in SSI. The NSQIP dataset contained 62,553 POP surgeries and 1.4% resulted in SSI. Discrimination of the original model was comparable with that seen in the initial validation (c-statistic = 0.57 in PHD, 0.59 in NSQIP vs 0.60 in the original Medicare data). Recalibration greatly improved model calibration when evaluated in NSQIP data. A previously developed model for predicting SSI after POP surgery demonstrated stable discriminatory ability when externally validated on the PHD and NSQIP databases. Model recalibration was necessary to improve prediction. Prospective studies are needed to validate the clinical utility of such a model.

Platelet-rich plasma protects hippocampal neurons and memory functions in a rat model of vascular dementia.

Platelet-rich plasma (PRP) is a promising biomaterial rich in bioactive growth factors, offering potential as a therapeutic agent for various diseases. However, its effectiveness in central nervous system disorders like vascular dementia (VaD) remains underexplored. This study investigated the potential of PRP to mitigate VaD progression in vivo. A rat model of VaD was established via bilateral common carotid artery occlusion and hypovolemia operation. Rats were randomly assigned to receive either PRP or platelet-poor plasma (PPP)-the latter being a byproduct of PRP preparation and used as a reference standard-resulting in the groups designated as 'operated group (OP)+PRP' and 'OP+PPP', respectively. PRP or PPP (500 μl) was administered intraperitoneally on the day of the operation and postoperative days 2, 4, 6, and 8. Cognitive function was assessed using the Y-maze, Barnes maze, and passive avoidance tests. On postoperative day 8, hippocampal samples were subjected to histological and semi-quantitative analyses. OP exhibited significant memory decline compared to controls, while the 'OP+PRP' group showed notable improvement. Histological analysis revealed increased neuronal loss and neuroinflammation in OP hippocampi, mitigated in 'OP+PRP'. Semi-quantitative analysis showed decreased expression of brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin receptor kinase B (TrkB) in OP, restored in 'OP+PPP' and further in 'OP+PRP'. These results highlight PRP's protective effects against VaD-induced hippocampal damage and cognitive impairment, partially attributed to BDNF/TrkB pathway upregulation.

Frailty Is Strongest Need Factor among Predictors of Prehabilitation Utilization for Total Hip or Knee Arthroplasty in Fee-for-Service Medicare Beneficiaries.

Prehabilitation may have benefits for total hip arthroplasty (THA) and total knee arthroplasty (TKA), given an aging population with multimorbidity and the growth of value-based programs that focus on reducing postoperative costs. We aimed to describe prehabilitation use and examine predictors of utilization in fee-for-service Medicare beneficiaries. This retrospective cohort study using the Medicare Limited Data Set included fee-for-service Medicare beneficiaries who were ≥ 66years old and who underwent inpatient elective THA or TKA between January 1, 2016, and September 30, 2021. We assessed predictors of receiving preoperative physical therapist services within 90days of surgery (prehabilitation) using a mixed-effects generalized linear model with a binary distribution and logit link. We report adjusted odds ratios (ORs). Of 24,602 THA episodes, 18.5% of patients received prehabilitation; of 38,751 TKA episodes, 17.8% of patients received prehabilitation. For both THA and TKA, patients with medium or high (vs low) frailty were more likely to receive prehabilitation (OR = 1.72-2.64). Male (vs female) patients, Black (vs White) patients, those with worse county-level social deprivation, those with dual eligibility, and those living in rural areas were less likely to receive prehabilitation before THA or TKA (OR = 0.65-0.88). Patients who were ≥ 85years old (vs 66-69years old) and who underwent THA were also less likely to receive services (OR = 0.84). Additionally, there were geographic differences in prehabilitation utilization and increased utilization in more recent years. The need factor of frailty was most strongly associated with increased prehabilitation utilization. The variation in utilization by predisposing factors (eg, race) and enabling factors (eg, county-level social deprivation) suggests potential disparities. The findings describe prehabilitation use in a large cohort of fee-for-service Medicare beneficiaries. Although services seem to be targeted to those at greater risk for adverse outcomes and high spending, potential disparities related to access warrant further examination.

Evaluation of zirconia implants in fibula and deep circumflex iliac artery flaps: a prospective 1.5-year follow-up study.

Follow-up results of modern zirconia implants inserted in fibula free and deep circumflex iliac artery (DCIA) flaps with fixed dentures are scarce. This study aimed to evaluate crestal bone changes and the survival rate of zirconia implants for up to 1.5 years of prospective follow-up. Ten patients with six fibula and four DCIA flaps underwent reconstruction in the lower and upper jaws using vascularized composite flaps and were treated with zirconia implants. Peri-implant bone resorption was measured using radiographic images that were taken immediately after implant surgery (T1) and after three (T2), 12 (T3), and 18 months (T4). Between the day of operation and T3, a significant increase in distance was recorded for the fibula flaps. After occlusal loading (T2) of 41 zirconia implants for up to 1.5 years, no significant bone loss in each flap was observed overall. An overall survival rate of 96.56% was reported. When comparing both composite flaps, no significant difference in periimplant bone levels was measured between the same timepoints. For fixed dentures, modern zirconia implants can be used in the DCIA and fibula flaps, however further long-term data is necessary.

Maximizing the Total Profit of Combined Systems with a Pumped Storage Hydropower Plant and Renewable Energy Sources Using a Modified Slime Mould Algorithm

This paper examines the effectiveness of a pumped storage hydropower plant (PSHP) when combined with other plants. System 1 examines the contribution of the PSHP to reducing fuel costs for thermal power plants. System 2 examines the optimization of operations for power systems with energy storage and uncertain renewable energies to maximize total profit based on four test system cases: Case 1: neglect the PSHP and consider wind and solar certainty; Case 2: consider the PSHP and wind and solar certainty; Case 3: neglect the PSHP and consider wind and solar uncertainty; and Case 4: consider the PSHP and wind and solar uncertainty. Cases 1 and 2 focus on systems that assume stable power outputs from these renewable energy sources, while Cases 3 and 4 consider the uncertainty surrounding their power output. The presence of a PSHP has a key role in maximizing the system’s total profit. This proves that Case 2, which incorporates a PSHP, achieves a higher total profit than Case 1, which does not include a PSHP. The difference is USD 17,248.60, representing approximately 0.35% for a single day of operation. The total profits for Cases 3 and 4 are USD 5,089,976 and USD 5,100,193.80, respectively. Case 4 surpasses Case 3 by USD 10,217.70, which is about 0.2% of Case 3’s total profit. In particular, the PSHP used in Cases 2 and 4 is a dispatching tool that aims to achieve the highest profit corresponding to the load condition. The PSHP executes its storage function by using low-price electricity at off-peak periods to store water in the reservoir through the pumping mode and discharge water downstream to produce electricity at periods with high electricity prices using the generating mode. As a result, the total profit increases. A modified slime mould algorithm (MSMA) is applied to System 2 after proving its outstanding performance compared to the jellyfish search algorithm (JS), equilibrium optimizer (EO), and slime mould algorithm (SMA) in System 1.

From Ancient Rituals to Modern Rhinoplasty: A Historical Evolution of Nasal Reconstruction

Background and aims: As surgical practices continue to evolve, the origins of these techniques and their respective indications are often lost over time, while in other cases they remain fundamental to modern utility. Rhinoplasty is a prime example of an operative intervention that has been heavily influenced by cultural beauty standards throughout different eras and civilizations to improve both aesthetics and functionality. By recognizing the historical context and evolution of this procedure, its modern-day application that integrates both form and function is better understood. This study aims to delineate the development of rhinoplasty from its genesis onward and demonstrate how the influences of different civilizations, eras, and cultural beliefs have shaped what the rhinoplasty is today. Methods: We performed a narrative review of various articles pertaining to ancient and modern contributions to the rhinoplasty. Articles were selected based on relevance and significance to the evolution of the procedure in a given era, highlighting pioneers and revolutionaries in the field. MESH terms, including but not limited to, “ancient rhinoplasty,” “evolution of the rhinoplasty”, and “modern-day rhinoplasty” were searched on PubMed, Google Scholar, and other major literature databases. Key sources included medical journals, historical texts, and surgical reports, supplemented by systematic reviews of existing literature. Results: Twenty-three sources were taken into consideration and categorized based on time periods. Their notable contributions, surgical innovations, and clinical impacts were expanded upon. Our analysis also explores the cultural implications of rhinoplasty and influential beauty standards across history, and how these have carried over to the present day. In a similar fashion, technical procedures were critiqued on whether they have withstood the test of time and their responsiveness to the aesthetic status quo. Finally, our analysis shows how the varied historical indications for rhinoplasty, whether functional or cosmetic, have persisted into modern practice. Conclusions: The historical evolution of rhinoplasty reveals more than mere advancements in surgical technique, as it reflects broader cultural values that influence its utilization. By examining its history, we gain valuable insight into how ancient practices have progressed through the middle ages, renaissance, and early modern period, continuing to shape the field of plastic surgery in the present day.

Inhibition of disinfection byproducts formation and microbial stress responses by Cu-Al/coconut shell activated carbon biofiltration: The key role of Al species

The effects of biological activated carbon treatment using CuAl bimetallic modified coconut shell activated carbon (CAAC) were investigated on the formation of disinfection by-products (DBPs) and microbial stress responses with unmodified granular coconut shell activated carbon (GAC) as a reference. In the long-term biological filtration process, the formation potentials of trihalomethanes and haloacetic acids in the effluent of CAAC filter (ACW) was reduced by 63.58 % compared to the effluent of GAC filter (CW). After the 6th day of biofilter operation, the dissolved organic carbon concentration of ACW rapidly decreased to around 1.03 mg/L and was consistently lower than that of CW. Under the enhanced biological flocculation by Al species, the extracellular polymeric substances (EPS) on the CAAC surface exhibited higher content and stronger flocculation efficiency, making the biofilm denser and more difficult to detach into ACW. In addition, the developed biofilms on CAAC surface promoted the biodegradation of organic compounds including DBPs precursors. Interestingly, the coexistence of Cu and Al mitigated the stimulatory effect of Cu, resulting in less intracellular reactive oxygen species and EPS. Our findings revealed that as a biofilter carrier filler, CAAC can effectively improve water quality and continuously control the risk of DBPs in the subsequent transmission and distribution process. More importantly, the introduction of Al species can provide new ideas to promote the realistic application of various modified treatment materials that are stressful to microorganisms.

Apixaban versus enoxaparin to prevent venous thromboembolism in post-operative patients with gynecologic cancers at an urban academic medical center

ObjectiveA recent clinical trial demonstrated that the use of apixaban was safe and equal to enoxaparin (LMWH) in post-operative gynecologic oncology patients. This study aimed to determine if these findings are applicable in a diverse patient population at a single site urban academic medical center. MethodsThis was a retrospective cohort study of patients who underwent an exploratory laparotomy for confirmed or presumed gynecologic cancer from the years 2017–2023 at a single-site urban academic medical center. Venous thromboembolism (VTE) prophylaxis with LMWH was standard practice at our institution up until January 2021 after which apixaban became standard for post-operative prophylaxis in our division. Baseline demographic and clinical characteristics of patients receiving apixaban post-operatively were compared to the population previously receiving enoxaparin. The primary outcome was a VTE event within 90days of surgery. Secondary outcomes included major and minor bleeding events. ResultsTwo hundred fifteen patients met inclusion criteria, of which 65 were discharged on enoxaparin and 150 were discharged on apixaban. Baseline characteristics in terms of age, race/ethnicity and BMI found no significant difference between the two groups. Rates of any VTE event within 90 days of surgery were similar for apixaban and LMWH (3.33 % vs. 4.61 %, p = 0.6). Secondary outcomes demonstrated that the rate of a major bleeding event in apixaban group was 1.31 % and LMWH group was 3.08 %, (p = 0.38). Minor bleeding events in the apixaban group were comparable to the LMWH group (10.60 % vs 10.16 %, p = 0.5). ConclusionsIn this real world, urban setting, for women undergoing laparotomy for gynecologic cancer, apixaban as post-operative VTE prophylaxis showed no increase in VTE events and appeared safe with no increase in bleeding events compared to LMWH. This study adds to the literature demonstrating that apixaban is safe and effective for VTE prophylaxis in our gynecologic oncology patients.

Influence of hormonal factors, number of sexual partners, surgical intervention on gastrointestinal and urogenital microbiota of patients endometriosis

Endometriosis is associated with gastrointestinal (GI) and urogenital (UG) microbial dysbiosis in patients with endometriosis (P-EOSIS). Sexual partner exposure may contribute to microbial dysbiosis but has not been studied in P-EOSIS. We hypothesized that sexual partner number, hormonal and surgical therapy would affect GI/UG microbial dysbiosis in P-EOSIS. Urine, fecal and vaginal swabs from control (n = 15) and P-EOSIS (n = 33) were collected on the day of surgery (DOS) and ∼1-3 weeks post-surgical intervention (PSI). Control and P-EOSIS were grouped based on hormonal therapy (HT) to determine the effect of HT on microbial profiles, Control (HT n = 8; no HT n = 7) and P-EOSIS (HT n = 18; no HT n = 15). Samples underwent DNA extraction and sequencing of the V4 region of 16S rRNA gene. Sequences were processed using QIIME2 and amplicon sequence variants (ASV) were analyzed for microbial differences. Pearson's and Spearman correlation analyses determined associations among microbial features and sexual partner exposure. P-EOSIS had microbial dysbiosis characterized by unique GI/UG bacteria and altered microbial richness and diversity. Hormonal and surgical intervention in P-EOSIS restored GI microbial diversity. Increased sexual partner exposure decreased GI/UG microbial diversity. P-EOSIS who had 10 or more sexual partners had greater microbial dysbiosis compared to 4-6 partners. Surgical intervention negatively correlated with sexual partner numbers and GI/UG microbial abundance. Increased sexual partner exposure may enhance microbial dysbiosis in P-EOSIS and diminish the effectiveness of HT and surgical interventions.

Obturator prostheses with intramucosal retention system in patients with maxillectomy.

To evaluate the intramucosal retention system in patients' masticatory efficiency and quality of life in this case series. A total of 3 individuals with maxillectomy were included for rehabilitation with a complete obturator prostheses with an intramucosal retention system(OPI). The complete obturator prostheses was made for 60days, and electromyography assessments and bite force were applied before, after 30, 60, and 90days of surgery and prostheses installation. The University of WashingtonQuality of Life Questionnaire (UW-QoL) and the Obturator Functional Scale (OFS) were also administered at baseline and in the same follow-up periods. The electromyography was evaluated on both sides of the masseter, temporalis, and buccinator muscles while chewing hard and soft food. The maximum bite force was recorded in the central incisors and both sides of the first molar region. Bite force values increased in the first molar region, and muscular electrical activity remained constant. Items related to the taste and swallowing of the UW-QOL impacted. Most OFS questionnaire data responses indicated that patients improved in swallowing liquid foods and appearance. The rehabilitative capacity improves masticatory efficiency and QoL in adults maxilectomized and rehabilitated with OPI analysis in the study. Further clinical studies should be encouraged to determine the effectiveness of this retentive system.

Acute Kidney Injury Post Hip Fracture Surgery: Local Quality Improvement Project and Review of Literature.

The aim of the study is to identify the potential risk factors for postoperative AKI in hip fracture patients. Using our local neck of femur (NOF) registration data, patient details were selected using inclusion and exclusion criteria. Electronic records of patients were assessed retrospectively, including blood results, radiological investigations, clinical documentation, and drug charts. The time period was from the start of January 2022 to the end of June 2022. All patients > 50 years old with NOF fractures underwent operative management from January 2022 to June 2022. 1. Pathological fractures. 2. Non-operative management. 3. Died directly postoperative. Two hundred and fifty patients underwent hip fracture surgery at our hospital in 6 months (January 2022-June 2022) (Cemented procedures were 133 [53%], while fixation procedures were 117 [47%]).Female patients were 174 (70%), and male patients were 76. The average age was 83.4 years, and the number of operations done over the weekend (Friday-Sunday) = 123 (49%).The incidence of postoperative AKI was 56 (22.4%). Forty-five of the fifty-six cases were stage one (80.4%), while seven cases (12.5%) were stage 2.The studied risk factors for postoperative AKI were cemented procedures (61% of postoperative AKI incidence), female gender (66%), time from admission to operation (>24 hours = 33%), day of operation (operations done Friday/Saturday/Sunday = 55%), and postoperative antibiotics (71%). We need strategies to reduce the incidence of postoperative AKI, like AKI alert on laboratory results, IV fluid prescription preoperatively since the arrival of patients to the ED, avoiding/stopping nephrotoxic medications on admission, regular review of postoperative renal function tests and fluid balance, especially in high-risk patients, increase nursing staff and junior doctors on wards over weekends, and we need to review our policy of giving postoperative IV antibiotics.

Modeling, Control and Validation of a Three-Phase Single-Stage Photovoltaic System

The central inverter topology presents some advantages such as simplicity, low cost and high conversion efficiency, being the first option for interfacing photovoltaic mini-generation, whose shading and panel orientation studies are evaluated in the project planning phase. When it uses only one power converter, its control structures must ensure synchronization with the grid, tracking the maximum power generation point, appropriate power quality indices, and control of the active and reactive power injected into the grid. This work develops and contributes to mathematical models, the principles of formation of control structures, the decoupling process of the control loops, the treatment of nonlinearities, and the tuning of the controllers of a single-stage photovoltaic system that is integrated into the electrical grid through a three-phase voltage source inverter. Using the parameters and configurations of an actual inverter installed at the power plant CRESP (Reference Center for Solar Energy of Petrolina), mathematical modeling, implementation, and computational simulations were conducted in the time domain using MatLab® software (R2021b). The results of the currents injected into the grid, voltages, active powers, and power factor at the connection point with the grid are presented, analyzed, and compared with real measurement data during one day of operation.

Intrastromal graft of anterior lens capsule. A substitute for Bowman layer graft transplantation for keratoconus.

The shortage of donor corneas limits Bowman layer transplantation for keratoconus. In this study, we evaluate the clinical outcome of porcine anterior lens capsule (xenograft) transplantation in the corneal stroma of a rabbit model as substitute for Bowman layer graft that is used in stromal transplantation for advanced keratoconus. Transplantation of porcine anterior lens capsule in the corneal stroma was performed in four New Zealand white rabbits through the creation of a stromal pocket. Corneal transparency, central corneal thickness, and topographic characteristics of corneas were evaluated at different time points: pre- (0) and post- (7, 14, 21, and 28) operative days. Additionally, at the end of the study histopathological findings were evaluated. In comparison to pre-operative day, transplantation of an anterior lens capsule preserved corneal transparency, central corneal thickness, and topographic characteristics remained constant throughout the study period. Histopathological analysis revealed the presence of the anterior lens capsule as a fully integrated lamellar graft without adverse effects in host stroma. The anterior lens capsule may be useful as a graft for intrastromal corneal trasplantation. Similarly to Bowman layer, anterior lens capsule has mechanical characteristics that facilitate corneal transplantation. In post-transplanted corneas the preservation of transparency, as well as the effect on corneal thickness, and topographic characteristics support the possibility of using anterior lens capsule as a substitute for Bowman layer graft.

Does intubation while observing the glottis with a fiberoptic scope reduce postoperative sore throat?

IntroductionIn oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11–55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube. However, the extent to which this technique causes postoperative complications is unknown compared to traditional technique. The aim of this study was retrospectively to determine the effect of postoperative sore throat following nasotracheal intubation by tip of the tube is visualized by fiberoptic scope.MethodAnesthesia records of the adult patients with nasotracheal intubation were checked. Patients underwent oral maxillofacial surgery from January 2021 until March 2023. Facilitated with rocuronium, nasotracheal intubation was performed using the traditional or observative method by fiberoptic scope with a 4.8 mm outer diameter. Intubation was performed with a cuffed 6.5–8.0 mm ID nasotracheal tube. The following variables were recorded: gender, age, height, weight, ASA classification, anesthesia time, duration of intubation, tube size, intubation attempts, fentanyl and remifentanil. The postoperative sore throat and the incidence of hoarseness were recorded at operative day and at the day after operative day, and the time to recovery.ResultA total of 104 cases (traditional fiberoptic intubation n = 51, observative fiberoptic intubation n = 53) were enrolled in this retrospective study. There were no significant differences in clinical characteristics and anesthetic data. There was not significant difference in incidence of postoperative sore throat, hoarseness and recovery between the two groups (P = 0.61, 0.44, 0.90). For subjects reporting postoperative sore throat (n = 30), there was not a significant difference in VAS means at operative day and at the day after operative day between the two groups (P = 0.81, 0.91).ConclusionWe found that postoperative sore throat and recovery were not influenced by observative fiberoptic scope for nasotracheal intubation.