Operational Instrument Research Articles

8402 Two-Port Total Laparoscopic Hysterectomy and Excision of Simple Endometriosis in a Transgender Male Patient.

<h3>Study Objective</h3> To provide an overview of a two-port total laparoscopic hysterectomy with bilateral salpingo-oophorectomy in a transgender male patient and to demonstrate the feasibility of excision of simple endometriosis by this approach. <h3>Design</h3> Surgical video. The American College of Obstetricians and Gynecologists recommends vaginal approach to hysterectomy, whenever feasible; however, in the transgender male patient, the vaginal approach to hysterectomy may pose technical challenges due to limited vaginal access: vaginal atrophy (when on testosterone therapy), lack of uterine descensus due to nulliparity that is common, and often times infrequent or no vaginal intercourse. Moreover, the frequent desire for salpingo-oophorectomy in this population can make the vaginal approach a challenging one. When patients have history of dysmenorrhea and/or pelvic pain, laparoscopy offers an adequate intrabdominal survey to diagnose and treat endometriosis, which is precluded with vaginal access alone. <h3>Setting</h3> Academic hospital with a referral-based practice for the transgender male patient who desire gender affirming surgery. <h3>Patients or Participants</h3> 35-year-old nulligravid trans male with gender dysphoria and history of severe dysmenorrhea prior to beginning testosterone therapy, who desires gender affirming surgery by hysterectomy and bilateral salpingo-oophorectomy. <h3>Interventions</h3> A 5 mm umbilical trocar is used for a 30-degree camera to maximize visualization. A 5 mm suprapubic trocar for the single operative instrument is placed above the level of the uterus fundus. Success of a two-port hysterectomy is achieved by having excellent uterine manipulation to generate appropriate counter traction on the uterus. The hysterectomy is completed in the standard fashion, and the excision of simple endometriosis is completed with a single instrument by using blunt and sharp dissection. The vaginal cuff is closed vaginally. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> A two-port laparoscopic approach avoids placement of ancillary trocars on the appropriate patient. This technique can be also used in the appropriate cis-gendered patients. Excision of simple endometriosis can be feasible with the two-port approach.

Using 3D Microscope for Hepatic Artery Reconstruction in Living Donor Liver Transplant.

Introduction: This study compares the intraoperative process of hepatic artery anastomosis using conventional microscope and novel 3D digital microscope and discusses our technique and operative set-up. Method: A retrospective comparative cohort study with 46 hepatic artery reconstructions in living donor liver transplant patients. Either an operational microscope (control group) or a 3D digital microscope Mitaka Kestrel View II (study group) was used for hepatic artery anastomosis. We then discuss and share our institution’s experience of improving surgical training. Results: Both operation instruments provide effective and comparable results. There was no statistical difference regarding operational objective results between conventional microscope and exoscope. Both instruments have no hepatic artery size limit, and both resulted in complete vessel patency rate. Conclusions: There was no statistical differences regarding hepatic artery anastomosis between microscope and exoscope cohorts. Microsurgeons should perform hepatic artery anastomosis efficiently with the instruments they are most proficient with. Yet, exoscope provided better ergonomics in the operation room and lessened musculoskeletal strain, allowing surgeons to work in a more neutral and comfortable posture while allowing the first assistant to learn and assist more effectively. Using exoscope with micro-forceps and modified tie technique make artery reconstruction easier.

3D printing and medicine

In modern conditions, the possibilities of using 3D printing in medicine are expanding, and it occupies about 11% of the global additive manufacturing market. At the Kirov Military Medical Academy and the ERA Military Innovation Technopolis, 3D printing is used for training, preoperative planning, the creation of splints, the manufacture of non-invasive functional products, and the creation of COVID-19 prevention aids.&#x0D; In order to determine the prospects for development, foreign experience in the use of 3D printing in medicine has been studied over the past 5 years.&#x0D; It is established that a register of clinical data on 3D printing is being created for training, 3D models are being printed to simulate tissue resistance during surgery. With the help of preoperative planning, Siamese twins are separated, doctors are trained in surgical operations on 3D models of elastic resin feet, cardiological models are used to predict the risk of complications during transcatheter implantation of an artificial aortic valve, as well as rehearsals of operations with congenital heart anomalies. Individual implants are manufactured for the lumbar and cervical spine, replacement of the damaged area of the chest and rib, finger phalanges, hip and knee replacements. As auxiliary products, individual surgical instruments for operations with low trauma, orthopedic insoles, elastic stents for the urethra and mesh stents of the trachea are created. New materials made of polyamide (PA11), polyesteresterketone, titanium alloys, absorbable polymer and biocompatible resin are offered for 3D printing. There are new 3D printing software and updates of existing ones. Personalized braces and aligners are printed in dentistry. With the help of 3D printing, individual multi-layered polytablets, smart tablets that release medicinal substances on command from a smartphone, childrens chewing tablets are created. For research purposes, the following devices have been printed: simulating cardiac tissue with sensors to track the effects of drugs and toxins; predicting the individual response of the biopsy tumor material to treatment; diagnosing some infectious diseases using a smartphone and a silicon microfluidic chip.&#x0D; The use of 3D printing in medicine individualizes and improves the quality of medical care.

Surface Potential Gradients and NEXRAD Radar Reflectivities Before the Onset of Lightning at the KSC‐ER

AbstractMeasurements provided by Next Generation Weather Radar and operational thunderstorm monitoring instruments at the Kennedy Space Center and the Air Force Eastern Range have been examined to determine the initial electrical development of 13 isolated, air mass thunderstorms. The same instruments were used to examine the surface potential gradient prior to and following 13 long, horizontal discharges that propagated into the area. The motivation and primary objective for this work was to evaluate the safety of the existing lightning‐related launch constraints associated with surface potential gradient and precipitation radar measurements. The onset of cloud electrification as seen by a large‐area surface electric field mill network was detected 3.7–14.6 min before the first lightning discharge, with lead‐times that depended on proximity to the storm. In 11 of 13 cases, the first detectable field change was a positive excursion in potential gradient close to the storm, likely indicating initial development of lower positive charge. Lead‐times for the radar‐derived cloud tops (0 dBZ) reaching −20°C were longer than those for early electrification in all but two cases. Surface potential gradients above +500 V/m or below −100 V/m “warning thresholds” were exceeded before the first lightning flash in all cases. Radar reflectivities &gt;35 dBZ above the −10°C level provided 3–14 min of lead time for lightning. Potential gradients just prior to and near long horizontal discharges exceeded 3 kV/m at most sites and were typically positive. Measurements at a single field mill site would not have provided adequate warning.

A GIS-based map of the Hg-impacted area in the Paglia River basin (Monte Amiata Mining District – Italy): An operational instrument for environmental management

In this study, we describe the elaboration of a GIS-based map of the Hg-impacted area of the upper part of the Paglia River basin. The map developed from a systematic collection of all existing geological and geochemical data, together with land cover and geomorphology data, integrated into a GIS-based geo-database. The Hg-impacted area was identified along the upper part of the Paglia River basin and was defined as a band within which there is at least one demonstrated occurrence of river/stream sediments and soils with concentrations of Hg ≥1 mg/kg. The Hg-impacted area covers about 20 km2 and the width roughly coincides with the Paglia River floodplain developed in the last 130 years. The identification of a Hg-impacted area will be a useful tool for the local communities in the Paglia River basin and for environmental national agencies when planning works involving the remobilization of river/stream sediments and soils to prevent the dispersal of contaminants. Considering that the extent of the Hg-contaminated area does not allow any remediation, the map can be used for site-specific risk assessment to ensure that anthropogenic activities occur at a minimum risk, considering the opportunity of revising local legislations regarding the permissible Hg-concentration in river/stream sediments in the area.

Extreme temperature events monitored by Raman lidar: Consistency and complementarity with spaceborne observations and modelling

AbstractTwo extreme temperature events (ETEs), both triggered by atmospheric blocking situations, were monitored by a pure rotational Raman lidar 20 km south of Paris. The first ETE lasted 6 days in late February 2018 with the onset of a cold wave surging from Siberia, and the second was a short heatwave that occurred at the end of July 2020. After calibration using simultaneous radiosoundings, lidar vertical profiles of temperature are derived with an uncertainty of less than 1 °C within both the planetary boundary layer and the lower/middle free troposphere (~3/6 km above ground level [a.g.l.] for day/night), with a final vertical resolution of 50 m and a temporal resolution of 30 min. Such capabilities fulfil the observational requirements of the World Meteorological Organisation and contribute to fill a gap left behind by current operational instruments, which struggle to follow the diurnal cycle of the planetary boundary layer due to insufficient spatial and temporal resolutions in the low troposphere. These case studies allow to assess how such weather events are represented by numerical weather prediction modelling and whether they can be correctly observed by the Infrared Atmospheric Sounding Interferometer (IASI) spaceborne mission. Our results demonstrate that during these events both ECMWF reanalyses and forecasts are in overall very good accordance with lidar observations (correlation &gt;0.9 in average). Still, they show warm biases (~1°C–2°C) compared with the lidar and improvable temperature field representation in the boundary layer. The radiances measured by IASI, assimilated in the operational model, do not capture temperature profiles adequately below ~2–3 km a.g.l., mainly due to the altitude location of its weighting functions. The bias computed against the lidar reaches 2°C during the heatwave and 4°C during the cold wave case in the first 2 km of the atmosphere, beyond expected errors found in the literature.

Retractorless Surgery for Petroclival Meningiomas via the Subtemporal Approach: A Try to Reduce Brain Retraction Injury.

Purpose To present our experience with retractorless surgery for resection of petroclival meningiomas (PCMs) via the subtemporal approach with routine operative instruments. Methods Clinical data of patients with PCMs who received surgical treatments via subtemporal approach were retrospectively analyzed. Patient demographics, duration of operation, extent of resection, postoperative brain injury rate, postoperative complication, and surgical outcome were reviewed. Results Twenty-nine consecutive patients with retractorless surgery via subtemporal approach performed between November 2018 and November 2021. The gross total resection rate was 82.8% (N = 24). The incidence of postoperative temporal lobe injury was 3.4% (N = 1). All the procedures were completed without fixed retraction or other specialized instruments. Conclusions Retractorless surgery via subtemporal approach is a reliable treatment option for PCMs, which can be completed with routine operative instruments.

Management information system in Nigerian secondary schools: challenges and way forward

Information is regarded as a fundamental resource to an organization and as such its management is apparently one of the most strategic operational instruments for organizational efficacy. Management information system plays an indispensable role in the smooth running of secondary schools. This paper examined the management information system in Nigerian secondary schools. The concept of a management information system was examined from different perspectives. Also, the features, components and development of management information systems in Nigeria were examined. The national policy on ICT integration in the Nigerian school system, the roles of MIS, challenges and strategies for effective integration of information systems in the Nigerian school system were elucidated consecutively. The study concluded that the school system requires an efficient management information system to take the secondary school a step further and boosts students’ academic success. It was recommended among others that secondary school administrators must maximally integrate educational management information system towards making an appropriate decision, seminars, conferences and workshops on educational management information system should be periodically organized for relevant stakeholders in secondary education and intensive efforts should be made by stakeholders (e.g. government, NGO, philanthropists) in secondary education towards genuine integration of ICT policies in the school.

Evaluation of Atmospheric Correction Algorithms over Lakes for High-Resolution Multispectral Imagery: Implications of Adjacency Effect

Atmospheric correction of satellite optical imagery over inland waters is a key remaining challenge in aquatic remote sensing. This is due to numerous confounding factors such as the complexity of water optical properties, the surface glint, the heterogeneous nature of atmospheric aerosols, and the proximity of bright land surfaces. This combination of factors makes it difficult to retrieve accurate information about the system observed. Moreover, the impact of radiance coming from adjacent land (adjacency effects) in complex geometries further adds to this challenge, especially for small lakes. In this study, ten atmospheric correction algorithms were evaluated for high-resolution multispectral imagery of Landsat-8 Operational Land Imager and Sentinel-2 MultiSpectral Instrument using in situ optical measurements from ~300 lakes across Canada. The results of the validation show that the performance of the algorithms varies by spectral band and evaluation metrics. The dark spectrum fitting algorithm had the best performance in terms of similarity angle (spectral shape), while the neural network-based models showed the lowest errors and bias per band. However, none of the tested atmospheric correction algorithms meet a 30% retrieval accuracy target across all the visible bands, likely due to uncorrected adjacency effects. To quantify this process, three-dimensional radiative transfer simulations were performed and compared to satellite observations. These simulations show that up to 60% of the top of atmosphere reflectance in the near-infrared bands over the lake was from the adjacent lands covered with green vegetation. The significance of these adjacency effects on atmospheric correction has been analyzed qualitatively, and potential efforts to improve the atmospheric correction algorithms are discussed.

The direct anterior approach without traction table: How does it compare with the posterior approach? – A prospective non-randomised trial

PurposeThe direct anterior approach (DAA) for total hip replacement (THR) is relatively new. It has been proved superior to other techniques concerning early functional outcomes, stability, and earlier recovery. But DAA-THR has a steeper surgical learning curve and, in its original description, needs special operating room equipment. This study aims to present clinical, functional, and radiological outcomes of DAA compared to the posterior approach (PA), performed using a routine operating table and instrumentation sets. MethodsEighty patients undergoing THR were non-randomly allocated prospectively into Group 1 DAA and Group 2 PA. Visual analog scale (VAS) for pain was recorded preoperatively and at 6, 12, 24, 48, and 72 h after the surgery and at 1st and 2nd year postoperatively. Both groups' functional outcomes were evaluated pre-and postoperatively at 1st and 2nd-year follow-up with Harris hip score (HHS) and SF-12. Perioperative parameters like blood loss, length of hospital stay, duration of surgery, postoperative complications, and radiological prosthesis positioning were also compared between the two groups. ResultsAll patients were comparable according to their baseline demographic characteristics. DAA was found to have significantly better early HHS at one year (p = 0.001) and VAS for hip pain (p < 0.05) at 12, 24, 48, and 72 hrs postoperative period only. Clinical outcomes were comparable at the final follow-up of 2 years. Perioperative variables were also similar except the incision length, length of stay in the hospital, and average time to weight bear without walking aids which were statistically better in DAA than PA group. There was no difference in radiological prosthesis positioning. Postoperative complication rates were also comparable in the two groups. ConclusionThough technically demanding, DAA provides better early functional outcomes with comparable radiological outcomes and complication rates than the PA.Level of evidence: Non-randomized comparative trial, Level II.

Comparison of the use of Landsat 8, Sentinel-2, and Gaofen-2 images for mapping soil pH in Dehui, northeastern China

Mapping the distribution and quantity of soil properties is important for black soil protection, management, and restoration in northeastern China. The objective of this study was to evaluate the effect of the spatial resolution on soil pH mapping using satellite images of the black soil region in northeastern China. A high spatial resolution Gaofen (GF)-2 high-definition image and multispectral images acquired by the Landsat 8 operational land imager and Sentinel-2 multi-spectral instrument were used to compare their performance in soil pH prediction. The spectral variables, including the original bands of the three satellite images and a variety of spectral indices derived from the original bands, were employed. Then, a machine learning model (quantile regression forest) was used to determine the relationships between the spectral variables and the measured soil pH, and prediction models were established to estimate the soil pH and to characterize the spatial pattern of the soil pH. The results revealed that the soil pH prediction model based on the GF-2 image had a slightly higher prediction accuracy than the models constructed using the Landsat 8 and Sentinel-2 images. The prediction models for Landsat 8, Sentinel-2, and GF-2 had root mean square errors of 0.34, 0.39, and 0.31, respectively. The use of remote sensing images with a high spatial resolution may not substantially increase the prediction accuracy of soil pH mapping compared with the results derived from medium-resolution images.

Zero Energy Building

Abstract: Decarbonizing the building sector is extremely important to mitigating climate change as the sector contributes 40% of the overall energy consumption and 36% of the total greenhouse gas emissions in the world. Net-zero energy buildings are one of the promising decarbonization attempts due to their potential of decreasing the use of energy and increasing the total share of renewable energy. To achieve a net-zero energy building, it is necessary to decrease the energy demand by applying efficiency enhancement measures and using renewable energy sources. Net zero energy buildings can be classified into four models (Net-Zero Site Energy buildings, Net Zero Emissions buildings, Net-Zero Source Energy buildings, and Net-Zero Cost Energy buildings). A variety of technical, financial, and environmental factors should be considered during the decision-making process of net-zero energy building development, justifying the use of multi-criteria decision analysis methods for the design of net-zero energy buildings. This paper also discussed the contributions of renewable energy generation (hydropower, wind energy, solar, heat pumps, and bioenergy) to the development of net-zero energy buildings and reviewed its role in tackling the decarbonization challenge. Costbenefit analysis and life cycle assessment of net-zero energy building designs and their challenges were reviewed to shape the priorities of future development. It is important to develop a universal decision instrument for optimum design and operation of net-zero energy buildings Keywords: Zero Energy Building, Energy Efficiency, Greenhouse gases, Renewable Energy, Grid

SUNSTORM 1/X-ray Flux Monitor for CubeSats (XFM-CS): Instrument characterization and first results

SUNSTORM 1 CubeSat was launched to Sun-synchronous low Earth orbit on August 17 2021. The primary purpose of the mission is an in-orbit demonstration of X-ray Flux Monitor (XFM) instrument. XFM is an innovative solar X-ray spectrometer for measuring and characterizing solar flares, which are known to be linked to a variety of space weather phenomena. XFM represents a next generation of solar X-ray flux monitors. It is based on silicon drift detector technology, which provides several notable performance improvements over its predecessors, which are based on Si PIN detectors. Transversal electric field and lower output capacitance allow operation at much faster pulse processing shaping times, allowing the system to achieve about 10 times higher throughput without saturation while also making it less sensitive to the increase of leakage current due to high temperature and/or radiation damage. Thus, XFM instruments can cover a very wide dynamic range of solar X-ray emission from the most quiescent conditions to the strongest X-class solar flares, while maintaining good spectral resolution (<200 eV at 6 keV). The instruments are thus well suited for both X-ray flux monitoring and spectroscopic studies of the solar corona.In this paper we describe the ground characterization and evaluation of the scientific performance of the first operational XFM instrument, a CubeSat version XFM-CS on-board SUNSTORM 1, which is a satellite built in the framework of the FLY element of ESA’s General Support Technology Programme, dedicated to the early space testing of promising new technologies. We also provide an analysis of the first results obtained during the in-orbit commissioning and early operations of SUNSTORM 1. We show the comparison of the observed scientific performance of XFM-CS with the expected performance based on theoretical modeling and ground calibration results. Finally, we describe the cross calibration of the X-ray flux data from XFM-CS with the new GOES-R series GOES X-ray sensors.

Mechanical characterization of yarns made from carbon nanotubes for the instrumentation of particle beams at CERN

Existing copper-coated carbon fibers used in wire scanners to measure the transverse beam profile in the accelerators at CERN are approaching material limits. A new instrument design has showed that the main limitation now comes from the centerpiece of the instrument: the wire. Large amplitude vibrations increase the risk of failure during scans. New required specifications concerning the beam measurements for the Future Circular Collider (FCC) project cannot be met. Fortunately, the commercial development of long microscopic yarns made of spun carbon nanotubes has paved the way for possible alternatives. The objective of this study is to determine if those Carbon NanoTube Yarns (CNTY) could replace the current carbon fibers (CF) for beam instrumentation, and if so, to determine the best configuration in terms of diameters and mounting system. To do so, we have made extensive testing and microscopy on CNT yarns with diameters of 10, 20 and 30 μm, with two different mounting systems, the Paper Frame conditioning (PF) or partial Copper-Coated conditioning (CC). A Weibull approach was used to extrapolate our results to the real length of the wires used in operational instruments. This study shows that considering the Weibull criteria, the best configuration to increase the accuracy of the beam profile measurement is to use a not copper-coated 20 μm diameter CNTY.

Validity Evidence for Procedure-Specific Competency Assessment Tools in Cardiovascular and Thoracic Surgery: A Scoping Review

Surgical education has shifted from a time-based approach to the achievement and demonstration of procedural competency. High quality, objective assessment instruments are required to support this new approach. This study comprehensively reviewed the literature to identify and evaluate available procedure-specific assessment instruments in cardiothoracic and vascular surgery. A systematic search of 8 databases identified studies containing procedure-specific operative assessment instruments in cardiothoracic and vascular surgery. Generic global rating scales were excluded, unless modified to be procedure-specific. Two reviewers independently evaluated the validity evidence, methodological rigour and educational utility of each instrument using objective scoring criteria. Validity evidence was evaluated with a scoring tool aligned with the contemporary framework of validity. Methodological rigour was evaluated using the Medical Education Research Study Quality Instrument. Educational utility was evaluated according to the Accreditation Council for Graduate Medical Education (ACGME) framework. There were 2130 unique studies describing procedure-specific assessment in surgery. Of these, 9 studies evaluating 8 procedure-specific assessment instruments met inclusion criteria for cardiothoracic and vascular surgery. Four instruments were identified in thoracic surgery, 2 in cardiac surgery, and 2 in vascular surgery. Only 1 instrument was designed to evaluate surgeon performance, with the remainder designed to evaluate residents. No single instrument scored the maximum score of 15 for validity evidence. The highest score was 11, with 62.5% (n = 5) of instruments scoring greater than 10. All tools attained high scores in content validity, with minimal evidence generally presented regarding the consequences of assessment using a particular instrument. All but 1 instrument scored greater than 11 out of a maximum 16.5 points for methodological rigour. Very few studies reported on the ACGME domains of educational utility. In an era where surgical education is shifting towards the demonstration of procedural competency, objective procedure-specific assessment is critical. This review identified that few procedure-specific assessment instruments in cardiothoracic and vascular surgery exist, emphasizing the need for such instruments to ensure the success of competency-based education models.

The ethics and politics of data sets in the age of machine learning: deleting traces and encountering remains

Individuals and communities increasingly depend on, and fill their lives with, machine cultures, in the form of both interfaces and infrastructures. This global push for machine cultures has given rise to an increasing demand for data and engendered a proliferation of public, private and public-private dataset repositories. While datasets form a foundational element of machine cultures, they rarely come into focus as objects of critical study. But in recent years a critical discursive formation on datasets has begun to emerge, which disturbs the idea of datasets as operational instruments of digital knowledge production and seek to instead ‘bring people back in’. The present article identifies these preliminary explorations as ‘critical dataset studies’ and draws on critical archival studies to articulate the ethico-political surfaced by these studies. Specifically it argues that critical dataset studies shows the need for an expanded ethical and conceptual approach to datasets that not only relies on linear notions of deletion and accountability but also on iterative frameworks of remains and response-ability.

A facility for radiation hardness studies based on a medical cyclotron

The development of instrumentation for operation in high-radiation environments represents a challenge in various research fields, particularly in particle physics experiments and space missions, and drives an ever-increasing demand for irradiation facilities dedicated to radiation hardness studies. Depending on the application, different needs arise in terms of particle type, energy and dose rate. In this article, we present a versatile installation based on a medical cyclotron located at the Bern University Hospital (Inselspital), which is used as a controlled 18-MeV proton source. This accelerator is used for daily production of medical radioisotopes, as well as for multidisciplinary research, thanks to a 6.5-meter long beam transfer line that terminates in an independent bunker, dedicated only to scientific activities. The facility offers a wide range of proton fluxes, due to an adjustable beam current from approximately 10 pA to the micro-ampere range, together with a series of steering and focusing magnets along the beamline that allow for the beam spot to be focused down to a few mm^2. The beamline can be instrumented with a variety of beam monitoring detectors, collimators, and beam current measurement devices to precisely control the irradiation conditions. The facility also hosts a well equipped laboratory dedicated to the characterisation of samples after irradiation. An experimental validation of the irradiation setup, with proton fluxes ranging from 5×10^9 cm^-2s^-1 to 4×10^11 cm^-2s^-1, is reported.

Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy: admittance standards of competence are needed.

BackgroundThe multi-site practice (MSP) policy has been practiced in China over 10 years. This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer (LSCRC) and gastric cancer (LSGC) under the Chinese MSP policy.MethodsWe collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital (n = 573) and his MSP institutions (n = 508) between January 2017 and December 2020. Baseline demographics, intraoperative outcomes, post-operative recovery, and pathological results were compared between the original hospital and MSP institutions, as well as between MSP institutions with and without specific competence (surgical skill, operative instrument, perioperative multi-discipline team).ResultsIn our study, 690 patients underwent LSCRC and 391 patients underwent LSGC. The prevalence of post-operative complications was comparable for LSCRC (11.5% vs 11.1%, P = 0.89) or LSGC (15.2% vs 12.6%, P = 0.46) between the original hospital and MSP institutions. However, patients in MSP institutions without qualified surgical assistant(s) and adequate instruments experienced longer operative time and greater intraoperative blood loss. The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC (11.5% vs 21.2%, P < 0.01) and LSGC (9.8% vs 20.5%, P < 0.01).ConclusionFor an experienced gastrointestinal surgeon, performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible, but relies on the precondition that the MSP institutions are equipped with qualified surgical skills, adequate operative instruments, and complete perioperative management.

OrbiSIMS metrology Part I: Optimisation of the target potential and collision cell pressure

In 2017, we introduced the OrbiSIMS instrument that features a dual analyser configuration with a time‐of‐flight (ToF) mass spectrometer (MS) and an Orbitrap MS, which confer advantages of speed and high‐performance mass spectrometry, respectively. The ability to combine the MS performance usually found in a state‐of‐the‐art proteomics and metabolomics MS with 3D imaging at the microscale and from nanolayers of &lt;10 nm of material has proved popular in a broad field of application from organic electronics to drug discovery. There are now several instruments in operation around the world, and metrology is needed to help ensure repeatability and reproducibility of the intensity scale. We conduct a systematic study of two key parameters, the target potential, VT, and the collision cell pressure, P, in the transfer optics on the transmitted secondary ion intensities. We measure VT–P maps of the ions across the mass range for Ag as a representative of inorganic materials and two different organic materials, Irganox 1010 and NPB (N,N′‐Di[1‐naphthyl]‐N,N′‐diphenyl‐4,4′‐biphenyldiamine). The manufacturer's defaults for these values ensure very good transmission for a broad range of analyte classes. However, the maps reveal a sometimes complex behaviour and indicate the possibility for additional separation of ions based on their shape, labile nature and kinetics of formation. Guidance is provided on how to optimise these parameters for sensitivity for different material classes and also the need for optimisation to improve spectral repeatability and reproducibility.

A versatile method for dorsal-approach plantar plate repair using standard operative instruments

BackgroundThe plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field.MethodsIn this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms.ResultsUsing this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14–38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0–6) and decreased to 0.6 (range, 0–3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8–10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75–100).ConclusionsOur study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments.Trial registrationClinicalTrials.gov, NCT04949685. July 2, 2021 - Retrospectively registered, Level of clinical evidence4