Operation Of Choice Research Articles

A decade of AGO QS-Mamma – Adherence to the Recommendations of The AGO Breast Committee for Diagnosis and Treatment in EBC in Routine Therapy in Germany

Introduction: The cure for Early Breast Cancer (EBC) is increasing over the last decades due to the improvement of diagnosis and therapy. Individualization of cancer treatment in EBC requires constant optimization by implementing current guidelines. The AGO (working group gynecologic oncology) QS-Mamma initiative, a quality assurance program (QS) of the AGO Breast Committee, was introduced to provide insight in guideline adherence in real world practice in Germany. We evaluated 10 years of QS-Mamma data to identify gaps and trends implementing those guidelines. Methods: QS-Mamma is a retrospective sample survey providing a representative overview of the treatment landscape for the treatment of breast cancer in Germany. The last six cohorts were analyzed over a period of ten years. Across all cohorts, an average of 264 centers documented a total of n=4,577 patients with EBC. Results: Testing for BRCA mutations in triple-negative patients increased significantly. Breast conserving surgery has been standard of care since the start of data collection; choice of surgical procedure depends primarily on tumor size and nodal status according to the patient´s preference, if possible. Axillary intervention has shifted towards SLNE or targeted axillary procedures in patients with negative preoperative nodal staging. Neoadjuvant systemic therapy (NAST) in operable EBC is established. Anthracycline administration in the adjuvant setting decreases. We noted an uptake on using platinum-containing CTx in TNBC, corresponding to AGO recommendations. Dual HER2 blockade is established in HER2 positive EBC with increased risk of relapse. Changes in guidelines are reflected in real-world data. Conclusion: Guideline adherence in breast cancer care is high and new treatments and diagnostic options are implemented promptly. Finally, escalation and de-escalation of treatment is depending on individual tumor characteristics resulting in the individual risk of recurrence. Guidelines should be flanked by real-world evidence to ensure and survey their impact.

Prospects of cold plasma in enhancing food phenolics: analyzing nutritional potential and process optimization through RSM and AI techniques

Consumption of plant-based food is steadily increasing and follows an augmented trend owing to their nutritive, functional, and energy potential. Different bioactive fractions, such as phenols, flavanols, and so on, contribute highly to the nutritive profile of food and are known to have a sensitivity toward higher temperatures. This limits the applicability of traditional thermal treatments for plant products, paving the way for the advancement of innovative and non-thermal techniques such as pulsed electric field, microwave, ultrasound, cold plasma, and high-pressure processing. Among these techniques, cold plasma would be an operative choice in plant-based applications due to their higher efficacy, greenness, chemical exclusivity, and quality retention. The efficiency of the plasma process in ensuring the bioactive potential depends on several factors, such as feeding gas, input voltage, exposure time, pressure, and current flow. This review explains in detail the optimization of process parameters of the cold plasma technique, ensuring greater extractability or retention of total phenols and antioxidant potential. Response surface methodology (RSM) is one of the common techniques involved in the optimization of these course factors. It also covers the convention of artificial intelligence-based methods, such as artificial neural networks (ANN) and genetic algorithms (GA), in evaluating the data on process parameters. The review critically examines the strengths of each optimization tool in determining the optimal process parameters for maximizing phenol retention and antioxidant activity. The ascendancy of these techniques was mentioned in the studies regarding fruit, vegetables, and their products, and they can also be applied to other food products.

Surgical treatment for intractable constipation: selection of procedure and perioperative management

When chronic constipation develops to the stage of intractable constipation, the symptoms of constipation in patients are severe and persistent, and drug treatment is often ineffective, so surgical treatment is often considered. The clinical manifestations of patients with intractable constipation are variable, and the underlying pathophysiological changes involve various abnormal and dysfunctional anatomical structure of colorectal and pelvic floor, which are different. For the surgical treatment of intractable constipation, accurate preoperative classification diagnosis is very important, and it is necessary to formulate an exact and effective surgical plan to avoid untargeted empirical treatment. The key to maintain long-term good results after surgery is to carry out comprehensive and scientific preoperative evaluation and the correct choice of individual operation. In recent years, thanks to the progress of basic research and clinical diagnosis and treatment of intractable constipation, as well as the improvement of minimally invasive surgical techniques and perioperative management, the safety and effectiveness of surgical treatment have been significantly improved. Based on the research progress at home and abroad and the authors' clinical experience, this paper focuses on the contents of preoperative accurate assessment, scientific selection of surgical methods and perioperative intestinal microecological therapy, so as to provide references for clinical practice in the same field.

A Network-Based Study of the Dynamics of Aβ and τ Proteins in Alzheimer’s Disease

Due to the extreme complexity of Alzheimer’s disease (AD), the etiology of which is not yet known, and for which there are no known effective treatments, mathematical modeling can be very useful. Indeed, mathematical models, if deemed reliable, can be used to test medical hypotheses that could be difficult to verify directly. In this context, it is important to understand how Aβ and τ proteins, which, in abnormal aggregate conformations, are hallmarks of the disease, interact and spread. We are particularly interested, in this paper, in studying the spreading of misfolded τ. To this end, we present four different mathematical models, all on networks on which the protein evolves. The models differ in both the choice of network and diffusion operator. Through comparison with clinical data on τ concentration, which we carefully obtained with multimodal analysis techniques, we show that some models are more adequate than others to simulate the dynamics of the protein. This type of study may suggest that, when it comes to modeling certain pathologies, the choice of the mathematical setting must be made with great care if comparison with clinical data is considered decisive.

Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer

IntroductionDefects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60. MethodsA retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure. ResultsFrom 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% versus 4.2%, P < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% versus 25%, P < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% versus 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45). ConclusionsThese findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.

Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence

BACKGROUND Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. METHODS In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. RESULTS One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results (P &lt; 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P &lt; 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049–14.458, P &lt; 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090–4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216–5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313–4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203–7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. CONCLUSION The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.

A Flexible Electrochemical/Thermochemical Operation to Improve Carrier Release of H2 and Counter Catalyst Instability

Formic acid is being actively pursued as a secure and potentially effective liquid organic hydrogen carrier (LOHC). Given its capability to store hydrogen through chemical bonds, it necessitates catalysis by efficient and durable catalysts for both storage and release processes. However, there remains a lack of comprehensive understanding regarding the mechanisms involved in formate dehydrogenation and catalyst deactivation.In my presentation, I delve into the exploration of the solution-phase formate dehydrogenation mechanism over Pd(111) and the significant role of operating potential in influencing both dehydrogenation activity and potential deactivation mechanisms. Notably, the operating potential plays a critical role in determining the mechanisms of both dehydrogenation and deactivation during formate dehydrogenation catalysis. Various steps involve charge-transfer processes, and their associated barriers and energies exhibit a strong dependence on the catalyst's work function or potential under reaction conditions. Through implicit solvent and constant-potential density functional theory (DFT) calculations, we observe that under the proposed conditions, formate tends to accumulate on the surface, occupying a substantial portion of it in a tightly bound oxygen-down configuration. This accumulation not only obstructs numerous surface sites but also escalates the activation energy for the process, suggesting that formate might significantly contribute to catalyst deactivation over time. Our analysis of the potential dependency of potential rate-limiting steps provides valuable insights into the prospect of adjusting this parameter, aiming at optimizing the reaction's activation energy and deepening our comprehension of the time-dependent deactivation effects observed experimentally. Additionally, I contrast these operational decisions with conventional thermal conversion pathways, serving as a benchmark for enhancing operational and conversion efficiency. The ultimate objective is to evaluate the hydrogen production rate concerning potential (U), temperature (T), and surface coverage, thereby examining the intricate interplay between thermochemical and electrochemical processes.Furthermore, I also highlight the role of the Pd phase in influencing dehydrogenation. For instance, Pd2+ tends to weaken formate binding and enhance H adsorption relative to Pd0, potentially counteracting formate-based catalyst poisoning. Illustrated in Figure 1, the thermal operation mode is represented by the vertical red line (at the PZC of Pd), whereas the room temperature electrochemical route is depicted by the horizontal blue line. The figure underscores that electrochemical conversion routes can significantly enhance dehydrogenation activity by several orders of magnitude, regardless of the maintained temperature. Moreover, activity can be further fine-tuned at these potentials by elevating the operating temperature.Hence, my research offers a qualitative description of the interplay between operating reaction conditions and operating voltage. Additionally, the dehydrogenation mechanism is slated for further investigation, taking into account the effect of support, composition, and associated phase changes as influenced by the operating potentials. Figure 1. A heatmap for the variation of dehydrogenation rate constants against the operational choices of temperature and the electrode potential. the thermal mode of operation is denoted by the vertical red line (at the PZC of Pd), while the room temperature electrochemical route is shown via the horizontal blue line. Figure 1

BN SO42 - Our experience of Emergency Laparoscopic Fundoplication in a DGH

Abstract Background Emergency presentation of hiatal hernias can be life-threatening and is associated with high morbidity and mortality rates. Elective Laparoscopic hiatus and paraoesophageal hernias are commonly performed with fundoplication. However, emergency cases are often repaired without an anti-reflux procedure. We present our experience of emergency Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication in a District General Hospital (Russells Hall Hospital, RHH). Method 6 cases of diagnosed hiatus/ paraoesophageal hernia that underwent Emergency fundoplication from 2019-2024. Results The mean age of the patients was 74 (56-83). All patients had a pre-op CT scan to confirm the diagnosis. 4 patients (66%) had a Type 3 Hiatus hernia and 2 (33%) had a Type 2 classic paraosephageal hernia. All patients underwent Emergency Laparoscopic Hiatus / Para oesophagal hernia repair with fundoplication. 2 patients required mesh for the repair. The mean length of stay was 5 days (3-7). There were no intra or post-op complications and on follow up 1 patient had a recurrence of symptoms after 1 year requiring redo fundoplication. Conclusion The choice of operation is mainly based on the patient’s clinical condition, the complexity of the hernia and the surgeon’s experience. Our experience at RHH shows that Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication is safe and feasible in patients with emergency presentation.

Surgical strategy for metastatic spinal tumors based on Spine Instability Neoplastic Score and patient-reported outcomes: JASA multicenter prospective study.

Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0-6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0-9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient's background and the plan for postoperative adjuvant therapy.

Understanding gravitationally induced decoherence parameters in neutrino oscillations using a microscopic quantum mechanical model

In this work, a microscopic quantum mechanical model for gravitationally induced decoherence introduced by Blencowe and Xu is investigated in the context of neutrino oscillations. The focus is on the comparison with existing phenomenological models and the physical interpretation of the decoherence parameters in such models. The results show that for neutrino oscillations in vacuum gravitationally induced decoherence can be matched with phenomenological models with decoherence parameters of the form Γ ij ∼ Δ m 4 ij E -2. When matter effects are included, the decoherence parameters exhibit a dependence on the varying matter density across the Earth layers. This behavior can be explained by the nature of the coupling between neutrinos and the gravitational wave environment, as suggested by linearised gravity. On a theoretical level, these different models can be characterised by a different choice of Lindblad operators, with the model with decoherence parameters that do not include matter effects being less suitable from the point of view of linearised gravity. Consequently, in the case of neutrino oscillations in matter, the microscopic model does not agree with many existing phenomenological models that assume constant decoherence parameters in matter. Nonetheless, we identify the KamLAND experimental setup as particularly well-suited to establish the first experimental constraints on the model parameters, namely the neutrino coupling to the gravitational wave environment and its temperature, based on a prior analysis using the phenomenological model.

Review/Perspective: Incidence and treatment of CSF leaks/dural tears (DT) occurring during anterior cervical surgery.

The incidence of cerebrospinal fluid (CSF) leaks/dural tears (DT) occurring during anterior cervical diskectomy and fusion (ACDF) are typically relatively low. However, this frequency markedly increases when anterior corpectomy and fusion (ACF) are performed to address ossification of the posterior longitudinal ligament (OPLL). The reported frequencies of CSF leaks/DT occurring during elective ACDF (i.e. exclusive of trauma), ranges from 0.24% to 1.7%. Notably, this incidence substantially rises for multilevel ACF addressing anterior OPLL, markedly varying from 3.4 - 44.7%. The classical risks of anterior cervical CSF leaks/DT with anterior cervical surgery may be minimized utilizing an operating microscope. For OPLL, careful evaluation of preoperative non-contrast CT studies is critical, especially to document whether any of the 3 signs of dural penetrance is present. Here, posterior operative choices should be strongly considered in the presence of sufficient lordosis and/or a Positive K Line (+ K Line) as this will avoid an anterior cervical CSF leak/dural fistula. Alternatively, for patients with kyphosis and a Negative K Line (- K Line), preoperative anticipation and planning to treat an intraoperative anterior CSF leak/DT (i.e. direct anterior primary dural graft repair with 7-0 Gore-Tex sutures, microdural staples, microfibrillar collagen, wound-peritoneal shunt, and lumbar drain or lumboperitneal shunt) are essential in the course of performing direct anterior OPLL resection. The incidence of anterior cervical CSF leaks/DT is relatively low (i.e. range 0.24 - 1.7%) where ACDF is performed for disc disease/spur/spondylosis exclusive of OPLL. However, where ACF is performed for multilevel OPLL, the risk of CSF Leaks/DT is substantially higher (i.e. range 4.3-44.7%).

Novel morphological classification of left atrial appendage using 3-dimensional printer -rock, paper and scissors-

Abstract Background The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019 only for patients who are at the high risk of bleeding events. It is known that the LAA diameter of Asians is larger than that of non-Asians. Furthermore, the LAA of the Japanese are more complicated, compared to the Western. Whereas the four classifications from previous reports are widely used in the world, the classification differs with different physicians in the real-world practice. Purpose We aimed to identify the relationship between morphological features of LAA and clinical events such as ischemic stroke in Japanese patients. Methods All LAAC cases in our institution performed between February 2020 and December 2023 were retrospectively analyzed. The three-dimensional printing of LAA was generated from cardiovascular computed tomography imaging data. The shapes of the LAA were classified into 3 morphological types: (1) The LAA with bi lobe was defined as "Scissors" type; (2) The one with complicated peripheral branches was "Paper" type; (3) The simple one was "Rock" type. We examined the between the risk of cardioembolic stroke and the morphological features of the LAA. The left atrial appendage was classified by two cardiologists, and when they made different choices, we used the operator's choice. Results The cohort consisted of 116 patients, excluding 22 patients without CT scans. Of those, 30 (26%), 38 (33%) and 48 (41%) patients were divided into the Rock, Scissors and Paper types, respectively. All groups were identically matched for comorbidities. Table shows the patient characteristics and the results of univariate and multivariate analysis. There were 51 (44%) patients who had a history of cardioembolic stroke (18% vs. 30% vs. 53%; Rock vs. Scissors vs. Paper types, p-value = 0.05). In the multivariate analysis, the Paper type is the potential risk factor of cardioembolic stroke (p-value = 0.01). In addition, of those, 36 (31%), 32 (28%), 28 (24%) and 20 (17%) patients were divided into the Chicken wing, Cactus, Cauliflower and Windsock types, respectively. The four types were not associated with prior cardioembolic stroke events (18% vs. 25% vs. 55%; Chicken wing vs. Cactus vs. Cauliflower vs. Windsock types, p-value = 0.83). The match rate of cardiologists’ choice was 86.2% for the new classification and 44.8% for the classical classification. Conclusions The morphological features of LAA by three-dimensional printing was significantly related to cardioembolic stroke in this population. Patients with Paper type LAA were significantly more likely to have had a history of cardioembolic stroke. These results could have a relevant impact on the antithrombotic management of patients who are at the high risk of embolic and bleeding events and, moreover, LAAC could be the best option for these patients.

All-loop Heavy-Heavy-Light-Light correlators in N = 4 super Yang-Mills theory

We study Heavy-Heavy-Light-Light (HHLL) correlators HHO2O2 in N = 4 super Yang-Mills theory with SU(N) gauge group at generic N. The light operator O2 is the dimension two superconformal primary in the stress tensor multiplet and H is a general half-BPS superconformal primary operator with dimension (or R-charge) ∆H. We consider the large-charge ’t Hooft limit, where ∆H→∞ with fixed ’t Hooft-like coupling λ≔∆HgYM2. We show that the L-loop contribution to the HHLL correlators in the leading large-charge limit is universal for any choice of the heavy operator H, given as λL∑ℓ=0LΦℓΦL−ℓ with an SU(N) colour factor coefficient, where Φ(ℓ) is the ladder Feynman integral, which is known to all loops. The dependence on the explicit form of the heavy operator lies only in the colour factor coefficients. We determine such colour factors for several classes of heavy operators, and show that the large charge limit leads to minimal powers of N. For the special class of “canonical heavy operators”, one can even resum the all-loop ladder integrals and determine the correlators at finite λ. Furthermore, upon integrating over the spacetime dependence the resulting integrated HHLL correlators agree with the existing results derived from supersymmetric localisation. Finally, as an application of the all-loop analytic results, we derive exact expressions for the structure constants of two heavy operators and the Konishi operator, finding intriguing connections with the integrated HHLL correlators.

Liquid solvent direct air capture’s cost and carbon dioxide removal vary with ambient environmental conditions

Emission trajectories produced by integrated assessment models increasingly suggest that gigatonnes of carbon removal will be required to stabilize atmospheric greenhouse gas concentrations at safe levels. This can be accomplished using the direct air capture of carbon dioxide, among other technologies. Process models of these systems assume that they would operate at standard ambient temperature and pressure, when capture rates vary with ambient conditions, including temperature, relative humidity, and other factors. Here, we build an open-source model of a liquid solvent direct air capture technology and analyze its capture performance as a function of hourly varying ambient environmental conditions across Canada. We find that, in the cool climate considered, capture performance is degraded due to both varying environmental conditions and the intermittent operation that could result. Our findings can be used to calibrate policy and investment decisions, and to support engineers in making operational design choices.

Valence quark PDFs of the proton from two-current correlations in lattice QCD

Following previous works on that topic, we consider Euclidean hadronic matrix elements in position space of two spatially separated local currents on the lattice, in order to extract the x dependence of parton distribution functions (PDFs). The corresponding approach is often referred to by the term . In this work we will consider valence quark PDFs of an unpolarized proton. We adapt the previously established formalism to our choice of operators. The calculation of the two-current matrix elements requires the evaluation of four-point functions. The corresponding calculation is carried out on a nf=2+1 gauge ensemble with lattice spacing a=0.0856 fm and pseudoscalar masses mπ=355 MeV and mK=441 MeV. The four-point functions have been evaluated in a previous project. The lattice data is converted to the MS¯ scheme at a scale μ=2 GeV and improved with respect to lattice artifacts. We use a common model as fit ansatz for the lattice data in order to extract the PDFs. Published by the American Physical Society 2024

Two-year 3D gait outcomes following in-situ pinning or modified Dunn procedure in children with slipped capital femoral epiphysis

BackgroundSlipped Capital Femoral Epiphysis (SCFE) is femoral head slippage off the femoral neck through the physis occurring in children aged 8–16 years. Surgical intervention is required in all paediatric cases and there is no universal agreement on choice of surgical procedure. Research questionWhat are the two-year 3D gait outcomes in children with SCFE who have undergone in-situ pinning (PIN) or modified Dunn procedure (MDP) compared with normative reference values? Methods17 children with SCFE who had undergone PIN (n=7, slip severity mild to moderate) or MDP (n=10, slip severity moderate to severe) surgical procedures prospectively underwent a 3D gait analysis post-surgery (2∙0 ± 0∙5 years). Ten age-matched children were also recruited to provide normative reference values. The conventional gait model was modified to incorporate Hara hip equations and Lerner pelvic tracking methods. Gait Profile Scores, Gait Variable Scores, kinematics, kinetics and spatiotemporal data were calculated for each group. ResultsOverall gait pattern, determined by the Gait Profile Score, indicated that both SCFE groups differed from the normative reference group (PIN 6∙6 ± 2∙5⁰, MDP 6∙2 ± 2∙0⁰ vs. 4∙0 ± 1∙3⁰ norm, p<0∙05). Normalised walking speed was reduced in the MDP group (0∙40 ± 0∙04) compared to the normative reference group (0∙46 ± 0∙06; p=0∙032). SignificanceGait patterns of children with SCFE treated with PIN was more markedly altered than that of children with SCFE treated with MDP, despite having lower SCFE severity. Increased external hip rotation observed in the PIN group may be a pre-cursor for osteoarthritis in adulthood. Therefore the use of the corrective MDP which normalises hip rotation may be beneficial for reducing functional impairments.

Enhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery - Status quo of implementation in Europe

ObjectivesEnhanced Recovery After Surgery (ERAS) is a multimodal care pathway to enhance recovery after surgery that is well established in various surgical disciplines. In pediatric cardiac surgery, implementation of ERAS protocols remains inconsistent. We conducted a survey of active European pediatric cardiac surgical centers to assess the current state of ERAS concepts and the current practice in perioperative pediatric cardiac care. DesignProspective, 79-item, web-based cross-sectional survey. SettingWeb-based survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC). ParticipantsAnesthesiologists of European pediatric cardiac surgical centers. InterventionsNone Measurements and Main resultsOut of a total of 98 centers, 50 responded. Eight responses were excluded due to incomplete survey forms or non-European location, leaving 42 responses (42,9%) for statistical analysis. Sixteen of the 42 centers (38,1%) follow an ERAS concept. Only 3 (7,1%) have formalized and detailed the ERAS concept in a written document, covering the entire perioperative period, while 13 (31%) have formalized it solely for the intraoperative period.Regarding regional and local anesthesia, 13 (31%) centers regularly practice regional anesthesia blocks, and 11 (26,2%) centers utilize wound infiltration by the surgical team. ConclusionThis European survey revealed that implementation of ERAS concepts in pediatric cardiac surgery is generally low, with considerable heterogeneity in clinical practice regarding the timing of extubation, the choice of surgical procedures triggering on-table extubation, the choice of anesthetic drugs and the use of regional anesthesia. More coordinated efforts are needed to implement ERAS concepts in pediatric cardiac surgery and harvest the benefits of ERAS concepts for the pediatric cardiac population.

Performance analysis of selected database management systems

The article presents the results of performance tests of database management systems. In order to conduct the tests, an application running in Java environment and using an ORM tool such as Hibernate for communication with the database was used. The tests were carried out for test scenarios such as CRUD operations, join queries, aggregate functions, and filter conditions in queries. The DBMSes used for testing were MySQL, PostgreSQL and H2. Performance analysis looked at the execution time of operations, RAM usage and CPU load. Additionally, tests were carried out for different sizes of user groups using the application. PostgreSQL proved to be the best choice for complex operations.

SP2.3 - Environmental and non-technical factors influence surgical trainees involvement in laparoscopic appendectomy in Northern Italy: a propensity score matching and survey based multicenter analysis

Abstract Aims Laparoscopic appendectomy (LA) is an index procedure for surgical residents (R). The trends of R involvement in LA can be a quality benchmark for residency programs. The impact of clinical and non-clinical factors on such trends is still undisclosed. We aimed to investigate the prevalence of LA performed by R in the largest Italian educational network and explore the decision-making behind R involvement in LA. Methods We extracted data from the RESIDENT-1 (R1) multicenter trial registry and performed a propensity score matching (PSM) analysis to identify clinical and environmental differences according to the operator, surgeons(S) vs R. Additionally, to explore environmental and non-technical factors influencing the choice of the primary operator, we administered a survey to S and R in the R1 network. Results We enrolled 653 LA from October 2019 to October 2022, 234 (35.89%) were performed by R. We compared 231 per group after PSM. In academic hospitals and dedicated emergency surgery units LA were more frequently approached by R (57.14%vs26.84%, 51.08%vs19.05% p&amp;lt;0.001, respectively). The survey showed discrepant perspectives, R prioritize clinical factors, as the presence of complicated disease (25.53%vs.8.33%, p&amp;lt;0.015), whilst non-technical and environmental factors such as year of residency (63.1%vs.44.7%,p=0.05) and punctuality (47.2%vs.23.4%,p=0.041) were more important for S. Both groups agreed that a perioperative feedback system would improve the process of R involvement in LA. Conclusion Our study report a low rate of LA performed by R in northern Italy, primarily influenced by non-clinical factors. Furthermore, dedicated pathways and a well-structured perioperative teaching method could optimize the teaching process.

A novel multi-state reinforcement learning-based multi-objective evolutionary algorithm

Multi-objective evolutionary algorithms (MOEAs) are widely employed to tackle multi-objective optimization problems (MOPs). However, the choice of different crossover operators significantly impacts the algorithm's ability to balance population diversity and convergence effectively. To enhance algorithm performance, this paper introduces a novel multi-state reinforcement learning-based multi-objective evolutionary algorithm, MRL-MOEA, which utilizes reinforcement learning (RL) to select crossover operators. In MRL-MOEA, a state model is established according to the distribution of individuals in the objective space, and different crossover operators are designed for the transition between different states. Additionally, in the process of evolution, the population still exhibits inadequate convergence in certain regions, leading to sparse areas within the regular Pareto Front (PF). To address this issue, a strategy for adjusting weight vectors has been devised to achieve uniform distribution of the PF. The experimental results of MRL-MOEA on several benchmark suites with a varying number of objectives ranging from 3 to 10, including WFG and DTLZ, demonstrate MRL-MOEA's competitiveness compared to other algorithms.