Operative Steps Research Articles

Proposal for a uniform protocol and checklist for cadaveric courses for surgeons with special interest in open abdominal wall reconstruction.

Over the last decade, there has been a rapid rise in the development and refinement of abdominal wall repair (AWR) techniques. Numerous cadaveric AWR training courses have been set up with the goal of helping practicing surgeons learn and incorporate them into their surgical repertoire. Some maybe excellent but their quality and consistency are unknown. The aim of this article is to present a stepwise cadaveric dissection template and checklist to standardize all training on open AWR courses and to help course organizers benchmark the quality of their program. This article is based on both the authors experience as faculty and course leads of cadaveric AWR courses, and the published anatomical and operative literature. The authors represent the training committee of the European Hernia Society, and the AWR subcommittees of the British Hernia Society and Association of Coloproctology of Great Britain & Ireland. A standardized stepwise approach for the cadaveric training of the most recognized procedures for open AWR, including retrorectus repair, posterior and anterior component separation techniques, is presented. Considerations on delegate selection, pre-course material and testing, course structure, and cadaveric models is also provided. Time and financial resources for surgeons to attend courses to learn and hone the skills required for safe effective AWR is limited. Ideally all courses should deliver up to date consistent training of the highest quality. One step to achieve this is by developing a standardized approach to ensure delegate understanding of the operative steps and key anatomical features.

Development of an indirect ELISA based on the VP1 protein for detection of antibodies against water buffalo Hunnivirus

Buffalo hunnivirus (BufHuV) is an important pathogen, which can cause diarrhea in water buffaloes, and as yet, there are no vaccines and drugs for its prevention and control. Here we studied the immunogenicity and predicted the three-dimensional structure of the BufHuV VP1 protein, in order to establish a rapid and efficient serological assay for detection of its antibodies in the host. The N-terminal truncated gene, consisting of amino acids 5–117, was selected and cloned into the prokaryotic expression vector pET-32a (+) to obtain the recombinant plasmid, pET-32a-BufHuV-VP1-1. These were then transformed into BL21 Escherichia coli to obtain BufHuV-VP1-1 recombinant proteins, which were then purified for used as coating antigens for ELISAs. An indirect ELISA was subsequently established by optimizing a series of operational steps. This VP1-1-ELISA had good specificity, sensitivity and repeatability, and the coincidence rate between the detection results and western blotting analysis was 95.8 %. A total of 997 clinical bovine serum samples were assessed by the VP1-1-ELISA, and the positive rate was 7.42 %. Overall, the VP1-1-ELISA established in this study is currently the first reported method to detect BufHuV serologically, and it will provide a powerful tool for the detection and epidemiological surveillance of hunniviruses in water buffaloes.

A New Approach to Rural Classification Based on the Filter-Method System: An Empirical Study in Nanning, South China

Rural revitalization is a strategic plan to address sustainable rural development in China and is an important revitalization task for Chinese villages. Rural classification is a key strategy for clarifying the direction and positioning of rural development and providing scientific policy decision-making Based on the findings of previous research on rural classification, we propose a new method for rural classification—the filter-method classification system. The operational steps of the classification are as follows: determining the type of villages, implementing the qualitative filter-method, implementing the quantitative filter-method, testing and feedback, and formulating the development guidelines. A total of 1425 villages in Nanning, the capital city of Guangxi, were classified. The classification results show that villages in Nanning city can be divided into four primary categories and eight secondary categories. The accuracy of the primary categories in the classification results was tested to verify the scientific objectivity and applicability of the classification idea and mode. Finally, development suggestions are presented based on the results of the classification of villages. The study results provide a reference for further rural classification work to help rural revitalization and improve the rural classification methodology and the scientific objectivity of classification. It also provides the basis for sustainable monitoring of rural development.

A facile detection method of fluazinam based on fluorescence resonance energy transfer by fluorescent sensor

A ratiometric fluorescent detection method was developed to detect fluazinam in vegetables based on fluorescence resonance energy transfer (FRET) effect through N,S-doped carbon quantum dots (N,S-CQDs) and 5, 10, 15, 20-tetrakis (4-methacryloyloxy) phenyl porphyrin (TMaPP) assemble entity. After co-mixturing of N,S-CQDs and TMaPP, fluorescent intensity of N,S-CQDs significantly decreased while concomitantly increased of TMaPP. Specific structure with abundant functional groups of TMaPP provided abundant affinitive sites for fluazinam in recognition by intermolecular interactions via hydrogen bonding and π-π stacking. Addition of fluazinam leads to impairing energy transfer from N,S-CQDs to TMaPP. FRET ratio metric fluorescent sensor exhibited a relative wide linear range from 50 nM to 20 µM/mL with a limit of detection (LOD) of 2.13 nM/mL. Application for real samples analysis demonstrated the proposed method is consistent with that of HPLC in sensitivity, selectivity and excellent reproducibility in addition to taking less operation steps and environment-friend merits.

Promoting the Economic Sustainability of Small-Scale Farmers Through Versatile Machinery in the Republic of Korea

The increasing use of tractors and implements is replacing manual labor, but adds financial burdens on small-scale farmers due to rising costs. Many farmers have turned to leasing and renting machinery to mitigate these expenses, while repair and maintenance costs remain significant. Government interventions aim to alleviate these burdens, but income disparities between urban and rural areas persist, and the impact of machinery use on climate change and the environment poses further challenges. Strategies like omitting some operation steps and adopting versatile machinery are proposed to cut costs and promote economic sustainability for small-scale farmers. Therefore, this study assessed the economic benefits of using versatile machinery in farming, especially for small-scale rural farmers. Farming processes were divided into field preparation and crop season activities. Field preparation included rotary tillage, ridge formation, and mulching, whereas crop season activities included harvesting and transportation. Annual usage and production cost analyses per hectare, including labor, fuel, and interest, alongside purchasing cost surveys, were conducted. Versatile machinery reduced annual usage costs for field preparation and crop season activities by 63.54% and 71.71%, respectively. This effect was more pronounced for farms under 2 ha, especially those employing manual harvest and transportation. Small-scale farmers, such as those cultivating hot pepper farms, are strongly encouraged to adopt versatile machinery to mitigate expenses and labor costs. The significance of adopting studied methodology will be amplified with the rising cost of labor. Consequently, utilization of versatile machinery in field farming for small-scale farms is projected to increase incomes not through enhanced production, but by significantly reducing the annual usage costs associated with agricultural machinery. This approach not only alleviates financial burdens but also enhances the sustainability of farm management, ensuring long-term viability and environmental stewardship.

The development, implementation, and evaluation of a pre-rotation quiz to improve resident preparedness for an abdominal wall reconstruction surgical rotation.

Although hernia repair constitutes a significant portion of surgical training, education around more complex hernia concepts such as abdominal wall reconstruction (AWR) or paraesophageal hernia repair may be lacking. We developed and implemented a pre-rotation quiz for residents on an AWR and minimally invasive surgery service. We also investigated the staff and resident perception of resident knowledge and experience of the rotation before and after quiz implementation. The multiple-choice quiz questions were written by clinical and research fellows, validated by four staff, two fellows, and two senior residents and implemented in June 2023. Questions assessed knowledge of anatomy, operative steps, mesh materials, clinical trials, and postoperative management specific to ventral, inguinal, and paraesophageal hernia repairs. Residents were notified of the summative quiz three weeks prior and provided with reference materials specific to quiz questions. Anonymous Likert-type surveys were distributed to staff and residents between 3/2023 and 3/2024. Responses were assessed based on the overall score as well as individual domains and then compared based on whether they were completed before or after implementation of the quiz. 17 seniors and 29 juniors rotated on service and all completed the pre-rotation quiz between 7/1/2023-3/4/2024. The mean first attempt score was 72%(± 12.4%) for junior residents and 88.4%(± 9.6%) for senior residents. Staff reported overall resident knowledge improved after quiz implementation (maximum 90, mean(SD): 46.25(± 8.58) vs. 75.5(± 11.24),p = 0.05). Sixteen(45.7%) residents responded to the survey before quiz implementation and 23(50%) after. Residents only reported improved knowledge regarding current literature (maximum 5, mean(SD):3.2 ± 0.98 vs. 3.8 ± 0.78,p = 0.04). Implementing a pre-rotation quiz effectively improves staff perception of resident knowledge and preparation.

BN SO31 - Pedicle First; a Paved Laparoscopic Approach for Huge Splenomegaly

Abstract Background Since its introduction for the first time by Delaitre et al1 in 1991, laparoscopic splenectomy (LS) has become the minimal invasive approach of choice for the management of the hematological splenic disorders2. Many agreed benefits have been achieved with this approach regarding the hospital stay, blood loss, duration of recovery, aesthetic results and quality of life; however, massive spleens remain a real technical challenge in front of achieving those benefits. The complex and non-typical variable configurations of the vascular system for the pancreatic body and tail which come from the splenic artery represents another faced point of anatomical complications3. Method From March 2020 to February 2024, a prospective study has included 30 patients presented with benign hematological disorders and massive splenomegaly (more than 20 cm longitudinal axis) who underwent laparoscopic splenectomy in our institution. Detailed data regarding their demographics, splenic size, operative time, blood loss, conversion rate, postoperative serum amylase and hospital stay were collected. Standardized anterior approach operative steps were adopted by the same surgeon for all patients with early control of the arterial system of the splenic circulation before mobilization (short gastric vessels and splenic artery 2 to 4 cm away from hilum). Results Thirty patients presented with huge splenomegaly have underwent laparoscopic splenectomy with a conversion rate of 6.6% (2 patients due to extensive perisplenic adhesions). The mean longitudinal splenic dimension was 24 ± 1.5 cm (range from 20 to 27 cm), mean operative time was 110 ± 16 minutes, mean operative blood loss was 160 ± 20 ml, mean hospital stay was 4 ± 1.5 days, postoperative rate of hyperamylasemia in 20% (asymptomatic 6 patients with no operative evidence of pancreatic injury), respiratory complications in 16.6 % (5 patients), and reactive thrombocytosis in 6.6% (2 patients). Conclusion Early laparoscopic control of the arterial system away from the splenic hilum can enable us to lessen the conversion rate for massive splenomegaly patients and achieve successfully the benefits of laparoscopy for those patients on the expense of the elevated postoperative hyperamylasemia rate.

Research on Path Planning of Agricultural UAV Based on Improved Deep Reinforcement Learning

Traditional manual or semi-mechanized pesticide spraying methods often suffer from issues such as redundant coverage and cumbersome operational steps, which fail to meet current pest and disease control requirements. Therefore, there is an urgent need to develop an efficient pest control technology system. This paper builds upon the Deep Q-Network algorithm by integrating the Bi-directional Long Short-Term Memory structure to propose the BL-DQN algorithm. Based on this, a path planning framework for pest and disease control using agricultural drones is designed. This framework comprises four modules: remote sensing image acquisition via the Google Earth platform, task area segmentation using a deep learning U-Net model, rasterized environmental map creation, and coverage path planning. The goal is to enhance the efficiency and safety of pesticide application by drones in complex agricultural environments. Through simulation experiments, the BL-DQN algorithm achieved a 41.68% improvement in coverage compared with the traditional DQN algorithm. The repeat coverage rate for BL-DQN was 5.56%, which is lower than the 9.78% achieved by the DQN algorithm and the 31.29% of the Depth-First Search (DFS) algorithm. Additionally, the number of steps required by BL-DQN was only 80.1% of that of the DFS algorithm. In terms of target point guidance, the BL-DQN algorithm also outperformed both DQN and DFS, demonstrating superior performance.

Critical infrastructure resilience: a guide for building indicator systems based on a multi-criteria framework with a focus on implementable actions

Abstract. Criteria and indicators are frequently used for assessing the resilience of critical infrastructure (CI). Moreover, to generate precise information on conditions, the assessment designed for CI resilience could rely on indicator systems. However, few practical tools exist for guiding CI managers to build specific indicator systems for considering real cases. Therefore, the main objective of this study is to develop a step-by-step guide that contains guidance on operational steps and required resources for criteria and indicator setting, reference definition, and data collection. This guide enables CI managers to build systems of indicators tailored to different real cases. This guide could assist CI managers in their decision-making process, as it is structured based on a multi-criteria framework that takes into account the cost–benefit analysis and side effects of implementable actions. This guide could furthermore advance the application of indicator-based CI resilience assessment in practical management. In addition, this study provides an example to demonstrate how to use this guide. This example is based on specific circumstances for the Nantes Ring Road (NRR) network: when the ring road is flooded and closed, the road network manager suggests alternative roads to the public. An indicator system consisting of 4 criteria, 7 sub-criteria, and 11 indicators was built for these circumstances using the guide developed in this paper. This example relates to criteria and indicators in the technical, social, and environmental dimensions and involves 62 676 data points.

Optimalisasi Proses Bisnis Menggunakan Metode Business Process Analysis (BPA) pada PT. XYZ

PT XYZ is one of the strategic industries owned by BUMN that produces the main defense equipment for Indonesia's defense system, especially in the maritime sector. In practice, the process of utilizing and managing assets at PT XYZ is in the Asset & Infrastructure Optimization Department which has various operational steps for asset management starting from the asset mapping process to utilizing these assets. This research aims to analyze and optimize business processes in asset management in the Asset & Infrastructure Optimization Department. The research method used is observation and interviews with related parties as well as Business Process Modeling and Notation analysis. The purpose and objective is to provide recommendations in optimizing business processes and increasing efficiency in managing company assets. One of the problems identified was the slow signing and return of agreement letters which caused delays in issuing invoices and payments. Recommendations included creating standard operating procedures, implementing electronic-based contracts and invoices, and utilizing technology for document delivery and storage. Overall, this research aims to improve operational performance and maximize the contribution of PT XYZ's assets to revenue.

Generating the assembly instructions of helicopter subassemblies using the hierarchical pruning strategy and large language model

Assembly instructions are process documents in detail describing the operation steps, materials, tools, fixtures, and assembly sequences in assembly procedures. Due to assembly instructions including numerous contents, and the content being easy for workers to understand, process designers need to spend lots of time thinking and authoring assembly instructions to ensure that workers can complete the assembly task according to the assembly instructions. Focusing on the difficulties of the variety of assembly instructions and the process factors implicit in the standard languages of assembly instructions, a method of assembly instruction generation for helicopter subassemblies is proposed. First, a data representation model of multi-source heterogeneous knowledge and information based on knowledge graphs is designed and established. Then, a hierarchical pruning VF3 algorithm is presented to reuse assembly instructions according to hybrid similarity. Finally, a process factor revision model based on RoBERTa-BiLSTM-CRF is proposed to generate revised assembly instructions. Helicopter subassemblies, which contain 11,240 assembly procedures, are used to evaluate the performance of the method for generating assembly instructions. The proposed method greatly reduces the time cost of assembly instruction authoring and promotes the intelligent development of assembly process design.

Convenient electrochemiluminescence biosensor for acute myeloid leukemia biomarker based on hyperbranched rolling circle amplification and vertically-ordered mesoporous silica film modified electrode

Vertically-ordered mesoporous silica film (VMSF), with large amount of small pores and abundant negative charges, had been modified on the surface of indium tin oxide electrodes and applied to develop an electrochemiluminescence (ECL) biosensor for acute myeloid leukemia biomarker hsa-miR-10a-5p (chosen as a model target). The small ECL indicator (Ru(phen)32+) can be enriched in the pores through electrostatic adsorption and then diffuse to the electrode surface to produce strong ECL signals. The presence of target can trigger hyperbranched rolling circle amplification (HRCA) and produce a large amount of double-stranded DNA (dsDNA). Ru(phen)32+ can embed into the groove structure of dsDNA and forms negatively charged large-sized complexes, which cannot pass through the narrow pores of VMSF to reach the electrode. This led to a significant decrease of ECL signal of the system. The change of the ECL intensity of the system had a linear relationship with logarithm of target concentration within the range of 1 fM–1 nM. The limit of detection was 1.23 fM. The developed biosensor had been applied to determine the target substance in serum samples with satisfied results without complicated sample pretreatment. The introduction of VMSF endows the biosensor with superior anti-interference capability and simpler operational steps, promising applications in the diagnosis of acute myeloid leukemia and potential extension to the analysis of other target molecules through primer design.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Prepare Linear Distributions with Quantum Arithmetic Units.

Quantum arithmetic logic units (QALUs) perform essential arithmetic operations within a quantum framework, serving as the building blocks for more complex computations and algorithms in quantum computing. In this paper, we present an approach to prepare linear probability distributions with quantum full adders. There are three main steps. Firstly, Hadamard gates are applied to the two input terms, preparing them at quantum states corresponding to uniform distribution. Next, the two input terms are summed up by applying quantum full adder, and the output sum is treated as a signed integer under two's complement representation. By the end, additional phase -1 is introduced to the negative components. Additionally, we can discard either the positive or negative components with the assistance of the Repeat-Until-Success process. Our work demonstrates a viable approach to prepare linear probability distributions with quantum adders. The resulting state can serve as an intermediate step for subsequent quantum operations.

Powering Hydrogen Evolution Reaction by Precise Control Over A Cu‐Ni Bimetallic Electrocatalyst

ABSTRACTPrecious metals are effective catalysts for the hydrogen evolution reaction, but their high cost with complicated operation steps drives people to search for non–noble‐metal alternatives. Building rational design concept for efficient electrocatalyst relies on the capability to control the structure and composition. Herein, a Ni/Cu bimetallic mesoporous MOFs with 4,4′,4″‐(1,3,5‐triazine‐2,4,6‐triyl)tribenzoic acid as the robust ligand has been assembled via a one‐step solvothermal method. Due to the extensive conjugate plane and high nitrogen content, the catalyst possesses large pore size of 17 nm and fast electron transfer rate, which favors hydrogen bubble overflow and exposes more active sites to solid–liquid interfaces. The bimetallic interaction between highly conductive Cu ions and Ni ions allows it to improve charge migration and realize excellent conductivity. The functionalized electrode requires an overpotential of 132 mV to achieve 10 mA current density with a small Tafel slope (87.7 mV·dec−1) and continuous electrolysis for 24 h.

Mathematical and neuro-mathematical connections activated by a teacher and his student in the geometric problems-solving: A view of networking of theories

The research goal is twofold: to articulate neuro-mathematics with the extended theory of mathematical connections that uses onto-semiotic approach tools and to explore the connections established by a teacher and his student when solving a problem about the volume of two boxes, one of toothpaste and the other of tomato. This research was developed in two stages: the theories were articulated assuming concordances and complementarities, highlighting the notion of connection, and a context of reflection was considered carried out in three phases where the participants were selected, participant observation was carried out in the classroom during solving a problem and then analyzing the data with the new tool to explore mathematical and neuro-mathematical connections. The findings present the mathematical connections established by the teacher and the student of meaning, feature, procedural, different representations (alternate, equivalent, and from a horizontal mathematization view), and part-whole, as well as neuro-mathematical connections of: recognition of terms and symbols; visual perception, spatial skills and motor coordination; association of mathematical concepts and formulas; intermediate calculations and unit conversion; solve operations step by step and understand the process; verification and conclusion, activated in the brain areas linked to each mathematical practice sequentially.

Research on the Strategy of Film and Television Operation Management Mode

At this stage, with the rapid development of the film industry, more and more film and television works have emerged, mainly films, TV series, and online dramas. The film industry is an important part of the cultural industry of various countries. Analysing the operation mechanism of the film production management model will help the prosperity and development of the film industry. The research is mainly about the operation and management mode of the film and television industry. It uses the methods of searching for literature, searching on the Internet, and finally summarises the steps and strategies of film and television operation. The operation steps of film and television mainly include four links: shooting, production, distribution, and screening. Each link is quite important and needs to be carefully arranged and operated, with a strong team and psychological quality to deal with various emergencies. It must invest much money and energy in every step to complete perfect work and create profits in the final release. The operation of film and television is still advancing and will continue to develop new models and update strategies to meet the development of the times.

Chemo- and diastereoselective four-component reactions with Rh carbynoids

Multi-component reactions (MCRs) provide an efficient method for constructing multiple chemical bonds by combining three or more starting materials in a single operational step, enabling rapid and cost-effective synthesis of structurally diverse compounds. Although carbynoids (R-C:+) have shown potential for the development of selective MCRs due to their unique carbene and carbocation characteristics, their application in four-component reactions (4CRs) has been constrained by challenges in chemoselectivity. Herein, we provide a general solution to the challenges of chemoselective 4CR, using halo diazo reagents as carbynoid precursors, followed by reacting with pyrazoles, alcohols and imines sequentially. This approach allows the simultaneous construction of three different C(sp3)-N, C(sp3)-O, and C(sp3)-C(sp3) bonds on the same carbon. The success of this protocol mainly depends on precise control of chemical kinetics. Detailed experimental studies elucidate that the generation rate of aza-Rh(II)-carbene is faster than oxy-Rh(II)-carbene.

Medical Student Role in the Cardiothoracic Operating Room: A Needs Assessment to Optimize Engagement

BackgroundFocused preparation for the cardiothoracic operating room (CTOR) may optimize intraoperative engagement and medical student interest, but such resources are lacking. We sought to characterize student educational needs in the CTOR to guide resource development. MethodsA web-based survey targeting cardiothoracic surgeons, trainees, and operating room staff was distributed to identify areas for student improvement in the CTOR. Concepts investigated explored common student mistakes and expectations for knowledge and participation in the CTOR. Descriptive analyses were performed on multiple-choice polls and open-ended responses. ResultsPolls received a mean of 317 responses (range, 222-504) and 20 open-ended comments. The most frequently cited student mistake was failure to understand their role in the CTOR (164 [32.5%]), followed by inappropriate chatting (141 [28.0%]) and breaking sterility (132 [26.2%]). Poll respondents valued students’ understanding of how to be helpful in the CTOR (101 [45.5%]) in addition to knowing what can or cannot be touched (47 [21.2%]) and basics of cardiopulmonary bypass (43 [19.4%]). Respondents indicated that students should assume active roles (84 [36.7%]), ask questions (66 [29%]), and help with minor tasks (41 [17.9%]). Respondents reported that students benefited most when they understood patient-specific clinicopathologic factors and basic operative steps. ConclusionsWe identified several areas for student improvement in the CTOR. Development of educational resources addressing these issues may enhance interest and augment recruitment of students to cardiothoracic surgery.

Research Progress of Transcatheter Tricuspid Regurgitation Repair Device

The tricuspid valve has been nicknamed the "forgotten valve" and is often neglected by clinicians. However, tricuspid regurgitation is a common clinical heart valve disease. With the continuous development of transcatheter interventional medical device technology, the treatment of tricuspid regurgitation has gradually attracted attention, and more and more companies are developing interventional medical devices for treating this disease. This review will provide an overview of the current research progress on transcatheter therapy for tricuspid regurgitation repair devices at home and abroad, including the design principles, operational steps, clinical outcomes, and the advantages and disadvantages of these devices.