Operative Technique Research Articles

Modified Technique to Protect the Superior Sagittal Sinus in Cranial Vault Reconstruction for Scaphocephaly

AbstractScaphocephaly remains the most prevalent form of isolated single-suture synostosis. In most Pediatric Neurosurgery Centers, the treatment consists of extensive calvarial reshaping operations which are performed in relatively late ages. We described a modified open technique of cranial vault reconstruction for scaphocephaly and we report the anesthetic approach and how it influences our results and enables the performance of this surgery at earlier ages. A total of 47 patients with an average age of 11 ± 2.72 months underwent to the same surgical technique. Blood transfusion during the surgical intervention was needed in 25 patients (53%), and 22 patients (46.8%) did not need blood transfusion. None of the 14 patients who used tranexamic acid (TXA) needed blood transfusions. We reported a statistically significant association between the use of TXA and blood transfusion (p < 0.0001), with a decreased need for blood transfusion with the use of TXA. Besides sagittal suturectomy, we create new parasagittal sutures by replacing the prematurely fused one, and 1.5 cm of the anterior segment of bone of those 2 rectangular structures are cut before fixation, to enable the immediate shortening of the anteroposterior (AP) diameter of the skull. Finally, we put a mesh plate (SonicWeld Rx, KLS Martin Group, Tuttlingen, Baden-Wuerttemberg, Germany) over the superior sagittal sinus (SSS), which is fixed anteriorly and posteriorly with pins (SonicPins Rx, KLS Martin Group). This procedure enables an immediate reduction of the AP diameter of the skull, with no further therapies needed, and promotes a wide decompression and remodeling of the skull. With an experienced surgical team and an anesthesiologic protocol, we were able to perform this surgery at early ages, requiring no blood transfusions.

THE FRACTAL STRUCTURE OF ANALYTICAL SOLUTIONS TO FRACTIONAL RICCATI EQUATION

Analytical solutions to the fractional Riccati equation are considered in this paper. Solutions to fractional differential equations are expressed in the form of fractional power series in the Caputo algebra. It is demonstrated that solutions to higher-order Riccati fractional equations inherit some solutions from lower-order Riccati equations under special initial conditions. Such nested and fractal-like structure of solutions is investigated by means of analytical fractional differentiation operator techniques and computational experiments.

Laparoscopic repair of duodenal atresia: systematic review and meta-analysis after consistent implementation of the technique in the past decade.

Laparoscopic repair of duodenal atresia (LRDA) remains a technically challenging procedure and its benefits ambiguous. To assess the safety and efficacy of LRDA, we performed a systematic review of techniques and material for LRDA and a meta-analysis comparing outcomes with open repair (OR). Comprehensive search of EMBASSE, PubMed and Cochrane was performed from 2000 to 2023. Studies comparing LRDA with OR were identified and outcomes extracted included operative time, time to enteral feeds, length of hospitalisation, anastomotic leaks and stricture and total complications. χ2 was used to assess associations between complications and conversions rates of different LRDA approaches (laparoscopic technique, suturing technique). Comprehensive meta-analysis was used for Meta-analysis. Twelve studies were identified and 1731 patients were enrolled in the study (398 [LRDA] and 1325 [OR]). Total rate of complications and conversion for LRDA was 15.58% and 18.84%, respectively. Complication rates were not significantly affected by operative technique and suturing technique. Conversion rates were not significantly affected operative technique; using a combination of interrupted and running suturing was significantly higher than using running or interrupted (χ2 = 7.45, p < 0.05). Anastomotic leaks, strictures and total complications were equivocal between LRDA and OR (OR 1.672, 95% CI 0.796-3.514; OR 2.010, 95% CI 0.758-5.333; OR 1.172, 95% CI 0.195-7.03). Operative time was significantly greater for LRDA (SDM 1.035, 95% CI 0.574-1.495, p < 0.001). Time to initial and full enteral feeds and length of hospitalisation were shorter in the LRDA group (SDM -0.493, 95% CI -2.166 to 1.752, p = 0.466; SDM -0.207, 95% CI -1.807 to 0.822, p = 0.019; SDM -0.111, 95% CI -1.101 to 0.880, p = 0.466, respectively). LRDA showed equivalent complication rates compared to OR with an additional benefit of quicker establishment of feeds. There was no significant difference in complication and conversion rates between laparoscopic techniques. Despite a longer operative time, LRDA provides a safe minimal access approach for neonates after this consistent implementation of the technique in the past decade.

Study on the Improvement of Droplet Penetration Effect by Nozzle Tilt Angle under the Influence of Orthogonal Side Wind.

This study investigates the impact of varying side wind velocities and nozzle inclination angles on droplet penetration during plant protection spraying operations, focusing on citrus trees. Experiments were conducted across four wind speed levels (0, 1, 2, 3 m/s) perpendicular to the nozzle direction and seven nozzle inclination levels (0°, 8°, 15°, 23°, 30°, 38°, 45°) to evaluate droplet distribution under different spraying parameters. A baseline condition with 0 m/s wind speed and a 0° nozzle angle served as the control. Utilizing Computational Fluid Dynamics (CFD) and regression analysis techniques in conjunction with field trials, the droplet penetration was analyzed. Results indicate that at constant wind speeds, adjusting the nozzle inclination angle against the direction of the side wind can significantly enhance droplet deposition in the canopy, with a 23° inclination providing the optimal increase in deposition volume, averaging a change of +16.705 μL/cm2. Multivariate nonlinear regression analysis revealed that both wind speed and nozzle inclination angle significantly affect the droplet penetration ratio, demonstrating a correlation between these factors, with wind speed exerting a greater impact than nozzle angle. Increasing the nozzle inclination angle at higher wind speeds improves the penetration ratio, with the optimal parameters being a 23° angle and 3 m/s wind speed, showing a 12.6% improvement over the control. The model fitted for the impact of nozzle angle and wind speed on droplet penetration was validated through field experiments, identifying optimal angles for enhancing penetration at wind speeds of 1, 2, and 3 m/s as 8°, 17°, and 25°, respectively. This research provides insights for improving droplet penetration techniques in plant protection operations.

Novel Indium nanocomposites for Photonic applications

In the present communication, MgO:In2O3- 1:1 (MIO), SrO/MgO/In2O3 (1:1:1) (SMIO), SrO/Al2O3/In2O3 (1:1:1) (SAIO) and CeO2/ZnO/In2O3 (1:1:1) (CZIO) NCs are synthesized by Punicagranatum juice extract as a reducing agent followed by calcination at 600 °C for 3 h. The Bragg reflections confirm that Magnesium indate, SrO, Al2O3, ZnO crystallizes in orthorhombic, trigonal, rhombohedral and hexagonal crystalline phases whereas CeO2, In2O3 and MgO crystallizes in cubic phase. Surface morphology consists large number of irregularly sized and shaped nanoparticles along with few pores and hallows. The direct energy band gap was determined using Wood and Tauc’s plot. The direct energy band gap was found to be 3.12, 3.15, 3.18 and 3.05 eV. The optical nonlinearity of the specimens was investigated using the open aperture Z-scan technique. With the exception of SAIO, the synthesized samples exhibited reverse saturable absorption attributed to a two-photon absorption (2PA) process. The nonlinear absorption coefficient follows the order CZIO > MIO > SMIO. However, the optical limiting threshold follows the order SMIO > MIO > CZIO NCs. These findings distinctly highlight the superior potential of CZIO binary NCs for optical limiting applications. This characteristic is advantageous for shielding sensors and the human eye, providing protection against the detrimental effects of intense green laser radiation. Unexpectedly, the SAIO NCs displayed Q-switching behavior. This behavior holds potential applications in optical discriminators, spatial light filters, optical isolation, and other photonic mode-locking devices.

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved.

Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidityand is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. Level IV.

Management of pediatric posterior cruciate ligament avulsion fractures: a systematic review.

Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children. A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries. Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14months after injury and was 100/100. Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status. Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.

Operative Repair of Aortopulmonary Window: A 25-Year Experience.

Background: Aortopulmonary window (APW) is a rare anomaly with variable morphology and associated cardiac anomalies. We evaluated impact of patient and operative factors on mid-term outcomes following APW repair. Methods: Twenty-nine patients underwent surgical APW repair at our institution from 1996 to 2022. Eight (28%) had simple APW, accompanied by only atrial septal defect or patent ductus arteriosus; 21 (72%) had complex APW with additional cardiovascular lesions, including nine with interrupted aortic arch. Median operative age was 19 days (range 2 days-1.5 years) via single-patch (n = 12, 41%), double-patch (n = 15, 52%), or ligation and division (n = 2, 7%). Results: The only mortality occurred in-hospital 1.4 years postoperatively following remote myocardial infarction. Factors associated with longer postoperative length of stay were complex APW (P = .003), genetic syndrome (P = .003), noncardiovascular comorbidities (P = .002), lower birth weight (P = .03), and lower operative weight (P = .03). Six patients (21%) with complex APW underwent unplanned cardiothoracic reintervention(s), including two with arch reintervention following arch advancement for interruption. Reintervention-free survival was similar for simple versus complex APW, operative age categories, and repair techniques. At median follow-up 5.5 years postoperatively, no patients had residual APW or persistent pulmonary hypertension, 1 (3%) had greater than mild ventricular dysfunction, and 25 (89% survivors) had NYHA class I functional status. Conclusions: Operative APW repair has excellent mid-term survival, durability, and functional status, regardless of operative age, cardiovascular comorbidities, or repair technique. Cardiac and noncardiac comorbidities may be associated with prolonged length of stay.

ONE-YEAR FOLLOW-UP OF PATIENTS TREATED FOR RHIZARTHROSIS WITH THE RegJoint™ IMPLANT

Rhizarthrosis is the second most common degenerative disease of the hand, associated with pain, function disability, and impaired quality of life. The literature describes various operative techniques for the treatment of rhizarthrosis, but the outcomes of the effectiveness of RegJoint™ implant are still scarce. Purpose: The aim of this study is to determine the effectiveness of using the RegJoint™ implant in the operative treatment of rhizarthrosis and the subsequent recovery. Material and methods: In the period 2019-2023, a total of 48 patients diagnosed with rhizarthrosis (46 women and 2 men) of average age 61.4 (±3.2) years went for treatment through the clinical bases of UМHAT "Kaneff" - Ruse and UMHAT "SOFIAMED"- Sofia. All of them were operated with the bioabsorbable implant - RegJoint™, after which the thumb was immobilized using a fixation splint for 6 weeks. Their average hospital stay was 3.2 (±1.3) days, after which they underwent rehabilitation procedures for 6 months. Results: Functional capacity was assessed using the DASH test, and thumb movements were tested using the Kapanji score three times - preoperatively and at the end of the 6th and 12th postoperative months. The results at the end of 6 months and 1 year period show a significant improvement in terms of pain, swelling and functional status of the operated hand. Conclusion: The combined surgical intervention for the treatment of rhizarthrosis with a RegJoint™ implant, combined with adequate and timely physiotherapy, ensures a high-quality, fast and painless functional restoration of the thumb and the overall function of the hand.

Certified Fellowship in Abdominal Wall Surgery-A Collaboration Between the UEMS and the European Hernia Society.

Background: Abdominal wall surgery (AWS) is characterised by the increasing caseload and the complexity of the surgical procedures. The introduction of a tailored approach to AWS utilising laparoendoscopic, robotic and/or open techniques requires the surgeon to master several surgical techniques. All of which have an associated learning curve, and the necessary knowledge/experience to know which operation is the right one for the individual patient. However, the reality in general surgery training shows that training in just a limited number of procedures is not enough. By the end of general surgery training, many chief residents do not feel they are yet ready to carry out surgery independently. Therefore, hernia surgery experts and societies have called for the introduction of a Fellowship in Abdominal Wall Surgery. Methods: The UEMS (Union Européenne des Médecins Spécialistes, European Union of Medical Specialists) in collaboration with the European Hernia Society (EHS) introduced a fellowship by examination in 2019. As a prerequisite, candidates must complete further training of at least 2years with a special focus on abdominal wall surgery after having completed their training in general surgery. To be eligible for the examination, candidates must provide evidence of having performed 300 hernia procedures. In addition, candidates must have accrued sufficient "knowledge points" by attending abdominal wall surgery congresses, courses and clinical visitations, and engaged in scientific activities. On meeting the requirements, a candidate may be admitted to the written and oral examination. Results: To date, three examinations have been held on the occasion of the Annual Congress of the European Hernia Society in Copenhagen (2021), Manchester (2022) and Barcelona (2023). Having met the requirements, 48 surgeons passed the written and oral examination and were awarded the Fellow European Board of Surgery-Abdominal Wall Surgery certificate. During this time period, a further 25 surgeons applied to sit the examination but did not fulfil all the criteria to be eligible for the examination. Fifty experienced abdominal wall surgeons applied to become an Honorary Fellow European Board of Surgery-Abdominal Wall Surgery. Fourty eight were successful in their application. Conclusion: The Fellowship of the European Board of Surgery - Abdominal Wall Surgery by examination has been successfully introduced at European level by the joint work of the UEMS and the EHS. The examination is also open to surgeons who work outside the European area, if they can fulfil the eligibility criteria.

Spatial Silhouette: A Study on the Creation Strategy of Strong Bamboo Architecture with “Negative Space” as the Main Feature—A Case Study of Phu Quoc Island Visitor Centre, Vietnam

The Gestalt theory of mental completeness in architecture gave rise to the ideas of “positive space” and “negative space”. This research digs into the sturdy structural building process of bamboo architecture, which is essentially distinguished by “negative space”. It examines how bamboo is articulated in architectural space, while attempting to establish a balance between form and structure, with the goal of discovering the current value and spiritual position that bamboo in architecture represents. Using the Phu Quoc Island Visitor Center in Vietnam as an example, we introduce the strong structure concept and examine its design process in terms of spatial operation technique and strong structural expression logic. The fundamental strategy for creating bamboo architecture under this concept is to take the lead in negative space design and use the material capabilities of bamboo to build structural space prototypes. This further encourages the use of green building materials and offers architects working with bamboo a reference.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Open intraperitoneal onlay mesh repair with anterior component separation as a bail-out procedure in the management of complex hernias.

Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates. This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10cm in their transverse diameter and had an open IPOM repair with bilateral ACS. In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months. Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.

AI-POWERED FINANCIAL OPERATION STRATEGY FOR CLOUD COMPUTING COST OPTIMIZATION FOR FUTURE

Cloud computing has revolutionized the way groupings feature by way of manner of presenting scalable and flexible infrastructure services. However, dealing with cloud cost efficiently remains a project, as cloud environments emerge as more complex. This paper proposes an AI-powered financial operation approach for optimizing cloud computing cost. The method leverages AI algorithms to research utilization patterns, forecast future calls, and advise price-saving measures. By imposing this approach, agencies can acquire massive financial savings at the same time as ensuring the nice everyday normal performance and scalability in their cloud infrastructure. Cloud computing has obtained massive prominence in commercial enterprise because of its capacities. However, the effective management of cloud cost remains a complex agency. However, incorporating automation and Machine Learning (ML) gives a possibility to manipulate and mitigate cloud charges successfully, rendering cloud computing an additional economically viable solution. This study will investigate into the transformative effect of automation and Machine learning cloud cost optimization, providing insights into how companies can harness those technologies to curtail fees on the equal time as addressing ability implementation-demanding situations. As organizations increasingly trust upon cloud computing services for their operations, optimizing the related prices performances into a crucial factor of financial management. This paper proposes an AI-powered financial operation technique for cloud computing fee optimization. The technique leverages tool-reading algorithms to investigate historic utilization patterns, forecast future desires, and perceive capability fee-saving possibilities. It integrates with cloud service providers' APIs to continuously reveal useful resource usage and adjust provisioning ranges dynamically. Additionally, the technique includes anomaly detection strategies to discover inefficiencies or sudden spikes in utilization, permitting proactive fee management. Through the implementation of this AI-powered technique, businesses can gain huge discounts in cloud computing costs even while preserving the finest overall performance and scalability.

The risk of facial nerve palsy after benign parotidectomy. A quality project

Background Facial nerve palsy is a potential complication of parotidectomy for benign salivary gland tumours, necessitating a comprehensive understanding of its incidence and associated risk factors for improved patient counselling and preoperative planning. Aim/objectives This single-centre retrospective study aimed to assess the rate of facial nerve palsy following benign parotidectomy at a University Teaching Hospital. Material and methods Over a 3-year period, 160 patients undergoing parotid surgery for benign tumours were included. Data, encompassing sex, age, operation technique, tumour pathology, facial nerve function, and follow-up duration, were collected from medical records. Exclusion criteria comprised patients with prior parotid gland surgery or preoperative facial nerve palsy. Results The study revealed a 3.75% incidence of facial nerve palsy with no total paralysis post-parotidectomy for benign disease. Pleomorphic adenoma (50.6%) and Warthin’s tumour (44.4%) were the predominant tumour types. No significant differences were noted between groups with and without postoperative facial palsy based on obtained covariates. Conclusion and significance Our findings endorse partial superficial parotidectomy and extracapsular dissection as low-risk treatments for benign parotid tumours. However, prospective studies are warranted to elucidate recovery rates and long-term consequences of facial nerve palsy, contributing to refined surgical approaches and patient care in parotid surgery.

Early results of eTEP access surgery with preperitoneal repair of primary midline ventral hernias and diastasis recti. A 33 patient case series of "PeTEP".

This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. The analysis included 33 patients operated with thepreperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90min ± 25min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.

A Hierarchical approach for isolating sensor faults from un-stealthy attacks in large-scale systems

This paper proposes a novel hierarchical-adaptive threshold abnormal behavior discrimination scheme (HATAD) for Lipschitz nonlinear large-scale systems with disturbances and uncertain dynamics. Two layers of groups of interlinked observers, namely the supervisor and local layers, are designed. The local layer using open loop observers, switching technique, and local controllers is first developed to protect the physical system from the attack effects, where the proposed switching technique can connect the plant to the local controller under the attack conditions. At the supervisor layer, the main controllers and three types of observers are constructed to detect and discriminate the abnormal behaviors and determine the faulty unit. This architecture leads to less restrictive mathematical conditions and analyses, which ensure the stability and the L2−L∞ performance of the estimation error dynamics. To demonstrate the effectiveness of the proposed approach, a simulation study has been conducted on a large-scale system of two units of benchmark continuous stirred tank reactor (CSTR).

A minimally invasive hybrid procedure to correct pectus arcuatum

BackgroundPectus arcuatum, also known as horns of steer anomaly or Currarino–Silverman Syndrome, is a distinct chest wall anomaly characterized by severe manubriosternal angulation, a shortened sternum, and mild pectus excavatum. The anomaly is typically repaired using open techniques, employing orthopedic fixation devices. Here, we report the results of a minimally invasive hybrid procedure to repair pectus arcuatum. MethodsThe procedure combines a standard Nuss procedure to correct the depressed sternum with a short upper chest (in boys) or inter-mammary (in girls) incision for bilateral subperichondrial resection of the upper costal cartilages, osteotomy, and correction of the manubrial angulation. The medical records of all patients who underwent the procedure over the last 10 years were reviewed. ResultsFive patients, 3 boys and 2 girls, aged 14 to 17 years, underwent the procedure. Three patients had their pectus bars removed 3–4 years after repair. Follow-up after correction ranged from 6 months to 7 years. Good correction resulted in all patients achieving recovery without complications and recurrence. To date, all patients have been satisfied with their results. ConclusionsThe minimally invasive hybrid procedure adequately corrects pectus arcuatum with minimal scarring and high satisfaction.

Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy.

Although cervical laminoplasty is a frequently utilized surgical intervention for cervical spondylotic myelopathy, it is primarily performed using conventional open surgical techniques. We attempted the minimally invasive cervical laminoplasty using biportal endoscopic approach. Contralateral lamina access is facilitated by creating space through spinous process drilling, followed by lamina hinge formation. Subsequently, the incised lamina is elevated from ipsilateral aspect, and secure metal plate fixation is performed. We successfully performed the cervical open door laminoplasty using biportal endoscopic approach. Biportal endoscopic cervical open-door laminoplasty may be a minimally invasive technique that can prevent complications related with open surgery.

Computational and stability analysis of Ebola virus epidemic model with piecewise hybrid fractional operator.

In this manuscript, we developed a nonlinear fractional order Ebola virus with a novel piecewise hybrid technique to observe the dynamical transmission having eight compartments. The existence and uniqueness of a solution of piecewise derivative is treated for a system with Arzel'a-Ascoli and Schauder conditions. We investigate the effects of classical and modified fractional calculus operators, specifically the classical Caputo piecewise operator, on the behavior of the model. A model shows that a completely continuous operator is uniformly continuous, and bounded according to the equilibrium points. The reproductive number R0 is derived for the biological feasibility of the model with sensitivity analysis with different parameters impact on the model. Sensitivity analysis is an essential tool for comprehending how various model parameters affect the spread of illness. Through a methodical manipulation of important parameters and an assessment of their impact on Ro, we are able to learn more about the resiliency and susceptibility of the model. Local stability is established with next Matignon method and global stability is conducted with the Lyapunov function for a feasible solution of the proposed model. In the end, a numerical solution is derived with Newton's polynomial technique for a piecewise Caputo operator through simulations of the compartments at various fractional orders by using real data. Our findings highlight the importance of fractional operators in enhancing the accuracy of the model in capturing the intricate dynamics of the disease. This research contributes to a deeper understanding of Ebola virus dynamics and provides valuable insights for improving disease modeling and public health strategies.