Operative Variables Research Articles

Evaluation of a new complement-dependent lymphocytotoxicity cross match method using an automated cell counter, the NucleoCounter® NC-3000™.

Complement-dependent lymphocytotoxicity cross match (CDC-XM) is the ultimate test of donor/recipient compatibility prior to organ transplantation. This test is based on cell viability, evaluated under fluorescence microscopy by an operator after proper staining. The determination of the positivity threshold may vary depending on the operator. We developed a new method in which the final step of determining cell viability is automated using the NC-3000™ (Chemometec®), an image cytometer able to precisely determine the percentage of dead/live cells in a suspension. After T and B donor cells isolation by negative selection, complement-dependent lysis was performed in macrovolumes in a PCR plate. Then, cell viability was measured by the NC-3000™. The sensitivity and routine CDC-XM results of this new method were compared to those of CDC-XM reference method using Terasaki plates. The sensitivity of CDC-XM expressed in the ASHI scoring system of this method was similar to the reference method results for a dilution range of the positive controls. Similarly, the results of the new method were comparable in a clinical situation to those obtained with the reference method after a study of 10 cross-matches, of which 5 cross-matches with DSA were positive and five cross-matches without DSA were negative. Moreover, ASHI scores were similar to those obtained using the reference method, and the mortality percentage was reproducible (CV < 15%). The assessment of cell viability by the NC-3000™ is easy to perform and highly reproducible but requires CDC-XM to be performed by the macrovolume method. The determination of a precise percentage of viability/mortality by the automation excludes operator variability and allows a better understanding of results close to the decision threshold.

Unsupervised data normalization for continuous dynamic monitoring by an innovative hybrid feature weighting-selection algorithm and natural nearest neighbor searching

Continuous dynamic monitoring brings an important opportunity to evaluate the health and integrity of civil structures in a long-term manner. However, high dimensionality and sparsity of data caused by long-term monitoring and negative influences of environmental and/or operational variability are major challenges in this process. To address these important issues, this article proposes an innovative unsupervised data normalization method based on a novel hybrid feature weighting-selection algorithm and the idea of natural nearest neighbor (NN) searching emanated from the theory of mutual friendships in human societies. The proposed hybrid algorithm is a combination of global feature weighting with a new weighting measure and local feature selection. For this algorithm, this article leverages the natural NN searching that seeks to find adequate NNs automatically. The main objective of the proposed method is to remove the environmental and/or operational effects and provide normalized weighted features for reliable continuous dynamic monitoring. Using such features, an anomaly detector based on the Mahalanobis-squared distance is developed to assess and detect structural damage. The key innovations of this paper contain proposing a fully nonparametric unsupervised learning technique in two parts of data normalization and anomaly detection and developing a novel hybrid algorithm for removing the environmental and/or operational variations. Long-term dynamic features (modal frequencies) of a three-span box-girder concrete bridge (Z24 Bridge) and a long-span concrete arch bridge (Infante Dom Henrique Bridge) are considered to verify the proposed technique with several comparisons. Results indicate that this technique is successful and reliable in mitigating the environmental and/or operational effects and notifying accurate structural states.

MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH

You have accessJournal of UrologyCME1 Apr 2023MP13-08 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES AFTER MINIMALLY INVASIVE SURGICAL THERAPIES (MIST) FOR BPH Mark Assmus, Nick Dean, Matthew Lee, Jenny Guo, and Amy Krambeck Mark AssmusMark Assmus More articles by this author , Nick DeanNick Dean More articles by this author , Matthew LeeMatthew Lee More articles by this author , Jenny GuoJenny Guo More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 2021 American Urologic Association benign prostate hyperplasia (BPH) guideline recommends several minimally invasive surgical therapies (MIST). We look to describe outcomes of individuals undergoing holmium laser enucleation of the prostate (HoLEP) after failing prior minimally invasive BPH procedures, specifically prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), robotic waterjet treatment (RWT) or prostatic artery embolization (PAE). METHODS: We retrospectively examined patients within our IRB approved clinical database that underwent HoLEP over a 19-month period (March 2021 – Oct 2022). Patient demographics, surgical BPH treatments, operative variables, and perioperative courses were examined. Patients with a prior neurological diagnosis or prior bladder cancer were excluded from the analysis. Descriptive statistics, two-tailed T-Tests, and ANOVA were performed with SPSS (p<0.05). Although PAE is not an office-based procedure, due to its minimally invasive nature we included it in the MIST category. RESULTS: We identified 600 HoLEP patients who met inclusion criteria, with 24.2% (n=145) of patients having undergone a prior BPH procedure. Of these procedures, 31.7% (n=46) were MISTs including PUL (n=22), WVTT (n=11), RWT (n=3), and PAE (n=10) and the remaining 68.3% (n=99) of procedures were TURP (n=63) and photo-selective vaporization of the prostate (PVP) (n=36). Time from original treatment to HoLEP did not differ between MIST procedures (p>0.05), but was significantly shortened comparing MISTs to TURP and PVP (2.9 versus 6.8 years, p<0.01). Patients with a prior BPH procedure were older (72.4 versus 69.7 years, p<0.01) than those without a history of BPH procedures; however, there were no other differences in pre-operative patient variables or post-operative functional outcomes including catheter free status, anti-cholinergic requirements, and continence rates, or 90-day complications (all p>0.05). Patients with a prior PUL had a significantly worse morcellation efficiency (7.3 vs 9.0 grams/min, p=0.03) and required more sets of morcellator blades per case (1.3 vs 1.0, p=0.03) compared to other prior BPH treatments. CONCLUSIONS: Patients undergoing HoLEP after prior failed BPH surgery experienced equivalent outcomes to patients without prior BPH surgery. Patient functional outcomes after HoLEP were maintained regardless of prior treatment modality. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Nick Dean More articles by this author Matthew Lee More articles by this author Jenny Guo More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

Effectiveness of Brachial Plexus Blocks in Obesity: Secondary Analysis of Randomized Controlled Trial.

Brachial plexus block for hand and upper extremity procedures in the obese presents a unique set of technical challenges. The authors examined how obesity affects procedural success, quality of anesthesia, and patient satisfaction. Secondary analysis of a randomized control trial comparing the retroclavicular versus supraclavicular brachial plexus block for distal upper extremity surgery was conducted. Patients were randomized to supraclavicular or retroclavicular brachial plexus block groups in the original trial. In this study, the authors dichotomized patients by obesity to compare differences in outcomes. Sixteen of 117 patients (13.7%) were obese. The groups were statistically well balanced in terms of baseline and operative variables. Obese patients had increased imaging time 2.7 minutes (95% confidence interval [CI], 1.44-3.92) versus 1.9 minutes (95% CI, 1.64-2.16), P value = .05; needling time 6.6 minutes (95% CI, 5.17-7.95) versus 5.8 minutes (95% CI, 5.04-5.74), P = .02; and procedure time 9.3 minutes (95% CI, 7.04-11.46) versus 7.3 minutes (95% CI, 6.79-7.79), P = .01. Block success and complications were not statistically significant. The visual analog scores during the block, at 2 hours, and 24 hours after were not statistically different. Patient satisfaction score among obese patients was 9.1 (95% CI, 8.6-9.6) versus 9.2 (95% CI, 9.1-9.4), P = .63. Findings from this trial suggest that despite an increased procedural difficulty, the use of both supraclavicular and retroclavicular brachial plexus blocks is associated with comparable quality of anesthesia, similar complication profile, equal opioid requirements, and similar patient satisfaction in the obese.

Coupling of XGBoost ensemble methods and discrete element modelling in predicting autogenous grinding mill throughput

Autogenous Grinding (AG) is one the most important mineral processing assets in the comminution circuit, and its production performance directly impacts on the circuit throughput. Understanding the key parameters impacting the AG mill throughput is critical to reducing the operational variability and to improve throughput predictions. This study aims to develop a coupled discrete element modelling and machine learning ensemble method for AG mill throughput predictions. Discrete Element Modelling (DEM) was coupled to an extreme gradient boosting (XGBoost) decision tree method to construct an accurate mill throughput prediction model. Hyperparameter optimizations and model pruning were conducted to improve the generalized model prediction capability. A suite of operational data as well as DEM modelling results from a 32FT AG mill were used to train and validate the developed model. Results indicated that the coupled method showed good agreement with the validation dataset. The impact from each mill operational parameter on the mill throughput was also evaluated and ranked, from which the improvement strategy on mill operation can then be devised.

The nuances of abdominal free flap harvest: Technical and patient factors affecting abdominal donor site morbidity in autologous breast reconstruction

Abdominal donor site morbidity after autologous breast reconstruction is common and often underreported. This work aims to compare prospectively collected technical details of the procedure and patient factors and their impact on the development of symptomatic and asymptomatic abdominal bulges (ASB and SB). A review of patients undergoing abdominal-based autologous breast reconstruction from May 2012 to October 2017 by two surgeons at a single institution was performed. Demographics, prior medical and surgical history, intraoperative data, and postoperative course were collected. Primary outcomes of interest were ASB or SB and wound healing complications. Overall, 196 free flaps from 117 patients were included. The average follow-up was 1.9±1.7 years. Thirteen (11.1%) patients developed ASB, and 13 (11.1%) patients developed SB. Patients with BMI ≥30, bilateral ms-TRAM reconstruction, and an onlay type of abdominal closure were 2×, 2.3×, and 8.1× more likely to develop a bulge, respectively (p=0.017, p=0.010, p=0.049). Every one-point increase in BMI above 30 increased the odds of developing a bulge by 10.8%. Prior abdominal surgery increased the risk of SB by 7-fold (p=0.017). The size of the harvested muscle, use of mesh, or nerve preservation did not affect the rate of bulge development. High BMI, bilateral ms-TRAM, onlay type of abdominal closure, and prior abdominal surgery increase the risk of ASB and SB development to varying degrees, while several other operative variables did not seem to make a difference. Breast reconstruction patients can use this information for preoperative counseling and intraoperative decision-making.

Benefits of laparoscopic liver resection in elderly patients.

The indications of laparoscopic liver resection (LLR) have expanded to high-risk patients, such as elderly people. However, to date, little evidence has been established of the safety and feasibility of LLR in elderly patients. The short-term outcomes of LLR in elderly patients as compared to non-elderly patients were investigated. Data of a total of 297 patients who underwent LLR were reviewed. Among these 297 patients, 181 patients were < 75years age (non-elderly) and 116 patients were ≥ 75years age (elderly), and the surgical outcomes were compared between the groups. In addition, we evaluated the risk factors for postoperative morbidity (Clavien-Dindo grade ≥ IIIa) utilizing the preoperative, operative, and postoperative variables RESULTS: The preoperative liver/renal function, frequency of anti-thrombotic drug use, number of comorbidities, and American Society of Anesthesiologists-physical status classification were more unfavorable in elderly patients than in non-elderly patients. No significant inter-group differences were observed in the operation time, blood loss, conversion rate, postoperative morbidity, or 30-day mortality. The 3-year overall survival rate was comparable between the two groups. Multivariate analysis identified anti-thrombotic drug use, operation time > 7h, and peak serum total bilirubin > 2mg/dl within postoperative day 3 as independent risk factors for Clavien-Dindo ≥ IIIa postoperative morbidity (P = 0.016, P < 0.001, and P = 0.001, respectively). LLR in elderly patients may provide comparable short-term outcomes to those in non-elderly patients.

On paracomposition and change of variables in paradifferential operators

On paracomposition and change of variables in paradifferential operators

Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year Review.

Routine pathology examination of breast tissue in reduction mammaplasty (RM) is performed with aims of detecting incidental malignancy or risk-increasing lesions. In adolescent patients, the reported incidence ranges between 0% to 0.01%, and costs of pathology claims range between $23 and $614 per analysis. We aim to investigate the rate of incidental findings and the cost-effectiveness of routine pathology examination in adolescent RM. A single-center retrospective review of the pathology results for 132 breast specimens from 66 consecutive RM patients was performed. Data collected for analysis included breast cancer risk factors, demographic information, and operative variables. Zero cases of incidental malignant or risk-increasing lesions were found among the 132 breast specimens from 66 patients aged between 10 and 24 years. Of the 132 specimens, 34 (26%) contained benign fibrocystic disease, which was significantly associated a body mass index greater than 30 kg/m 2 and tissue resection weight greater than 1000 g per breast ( P = 0.003, P = 0.007) respectively. Based on the available data, the use of routine specimen analysis costs more than US $150 million for one breast cancer diagnosis during RM in this age group. In our study, zero atypical, precancerous, or cancerous lesions were detected in a 7-year analysis. The results of this study support the current literature, which reports no occurrence of incidental findings in young women and may promote a greater understanding of evidence-based healthcare spending while concomitantly decreasing the strain placed on histopathology services.

On Born’s Reciprocal Relativity, Algebraic Extensions of the Yang and Quaplectic Algebra, and Noncommutative Curved Phase Spaces

After a brief introduction of Born’s reciprocal relativity theory is presented, we review the construction of the deformed quaplectic group that is given by the semi-direct product of U(1,3) with the deformed (noncommutative) Weyl–Heisenberg group corresponding to noncommutative fiber coordinates and momenta [Xa,Xb]≠0; [Pa,Pb]≠0. This construction leads to more general algebras given by a two-parameter family of deformations of the quaplectic algebra, and to further algebraic extensions involving antisymmetric tensor coordinates and momenta of higher ranks [Xa1a2⋯an,Xb1b2⋯bn]≠0; [Pa1a2⋯an,Pb1b2⋯bn]≠0. We continue by examining algebraic extensions of the Yang algebra in extended noncommutative phase spaces and compare them with the above extensions of the deformed quaplectic algebra. A solution is found for the exact analytical mapping of the noncommuting xμ,pμ operator variables (associated to an 8D curved phase space) to the canonical YA,ΠA operator variables of a flat 12D phase space. We explore the geometrical implications of this mapping which provides, in the classical limit, the embedding functions YA(x,p),ΠA(x,p) of an 8D curved phase space into a flat 12D phase space background. The latter embedding functions determine the functional forms of the base spacetime metric gμν(x,p), the fiber metric of the vertical space hab(x,p), and the nonlinear connection Naμ(x,p) associated with the 8D cotangent space of the 4D spacetime. Consequently, we find a direct link between noncommutative curved phase spaces in lower dimensions and commutative flat phase spaces in higher dimensions.

Reconstruction of sleeper displacements from measured accelerations for model-based condition monitoring of railway crossing panels

Railway switches and crossings (S&C, turnouts) connect different track sections and create a railway network by allowing trains to change tracks. This functionality comes at a cost as the load-inducing rail discontinuities in the switch and crossing panels cause much larger degradation rates for S&C compared to regular plain line tracks. The high degradation rates make remote condition monitoring an interesting prospect for infrastructure managers to optimise maintenance and ensure safe operations. To this end, this paper addresses the development of tailored signal processing tools for condition monitoring using embedded accelerometers in crossing panels. Multibody simulations of the dynamic train–track interaction are used to aid the interpretation of the measured signals in a first step towards building a model-based condition monitoring system. An analysis is performed using sleeper acceleration measurement data generated by 100 000 train passages in eight crossing panels. Based on the given data, a novel frequency-domain displacement reconstruction method is developed and the robustness of the method with respect to encountered operational variability of the measured data is demonstrated. The separation of the track response into quasi-static and dynamic domains based on deformation wavelength regions is proposed as a promising strategy to observe the ballast condition and the crossing geometry condition, respectively.

H∞‐optimal observer design for systems with multiple delays in states, inputs and outputs: A PIE approach

AbstractThis article investigates the ‐optimal estimation problem of a class of linear system with delays in states, disturbance input, and outputs. The estimator uses an extended Luenberger estimator format which estimates both the present and history states. The estimator is designed using an equivalent Partial Integral Equation (PIE) representation of the coupled nominal system. The advantage of the resulting PIE representation is compact and delay free—obviating the need for commonly used bounding technique such as integral inequalities which typically introduces conservatism into the resulting optimization problem. The ‐optimal estimator synthesis problem is then reformulated as a Linear Partial Inequality (LPI)—a form of convex optimization using operator variables and inequlities. Such LPI‐based optimization problems can be solved using semidefinite programming via the PIETOOLS toolbox in Matlab. Compared with previous work, the proposed method simplifies the analysis and computation process and resulting in observers which are non‐conservtism to 4 decimal places when compared with Pad‐based ODE observer design methodologies. Numerical examples and simulation results are given to illustrate the effectiveness and scalability of the proposed approach.

Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation.

Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a "dead space" that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain. To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. Case series; Level of evidence, 4. Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables. At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30). Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.

Validation of sound propagation from outdoor music venues—A comparison of measurement and models

The post pandemic United States has seen a surge in new outdoor entertainment venues springing up with various levels of planning in regard to sound impact on communities. The variability of sound systems, artists, audio engineers and operators, low frequency content ratios, and weather conditions beg the need to predict potential impact of venues on communities and understand what sound management is possible. Two venues will be shown with controlled sound system tests measured compared with propagation computer models. In addition, iterative design efforts with architectural noise control to reduce impact on the nearby community will be shown, in particular an attempt to reduce low frequencies and the limits of modeling standards in regard to diffraction.

Robustness Analysis of 3–2 Adder Compressor Designed in 7-nm FinFET Technology

Adder compressors (ACs) have been employed for several prominent computing datapaths as multipliers, machine learning, discrete transforms, and filters. This brief investigates the robustness of the 3–2 AC against the process, voltage, and temperature (PVT) variability targeting a design for a predictive ASAP7 7nm FinFET technology. The variability impacts on the delay, power, and product-delay-power (PDP) of the 3–2 AC for both super- and near-threshold voltages operating regimes are herein evaluated. Our results demonstrate that process is the main concern among the variability issues for both operating regimes, presenting an even more alarming level of variability in near-threshold operation.

Human papillomavirus self-sampling for cervical cancer screening

Screening along with treatment is the foremost tool for cervical cancer elimination in addition to vaccination strategies. At present, India lacks a comprehensive screening programme. There are huge issues in terms of feasibility, acceptability and implementation of the existing cervical screening programme in the country. Less than 2% (Urban-2.2% and Rural-1.7%) of women in India have been screened. The current strategy recommended by Ministry of Health and Family Welfare is Visual Inspection with Acetic Acid (VIA) every 5 years for women aged between 30 and 65 years. A significant improvement in terms of decreasing incidence and mortality of cervical cancer has been seen in two randomized controlled trials conducted in India. However, VIA lacks sensitivity, requires extensive training to be given to the medical staff for accurate diagnosis, has substantial operator variability and has less acceptability among women when compared to the newer methods of cervical cancer screening such as human papillomavirus (HPV) self-sampling. HPV self-sampling is a more sensitive, accurate and more acceptable method of cervical cancer screening for women in India and abroad. It can help the existing VIA-based strategy of cervical screening by increasing participation resulting in more population being screened in the various geographical regions and populations in India. However, VIA-based screening should also be continued because of its affordability and cost-effectiveness in India where there is a significant population belonging to low socio-economic background. There are numerous evidences such as systematic reviews, meta-analyses, randomised controlled trials of India and abroad that have been used as sources in this review article to come to the conclusion that HPV self-sampling is an acceptable, accurate and sensitive method that can be used as a primary screening tool in cervical cancer screening programmes globally and in India. It can also be used as an effective triage test for prioritising high-risk populations who require urgent and effective treatment for cervical pre-cancer and cancer. To conclude, HPV self-sampling should be integrated and implemented by the government and private sector in addition to VIA-based screening strategies for achieving the goal of cervical cancer elimination in India.

Postoperative Proton Pump Inhibitors are associated with a significantly higher rate of delayed gastric emptying after pancreatoduodenectomy

BackgroundProton pump inhibitors (PPIs) are effective in reducing marginal ulcers after pancreatoduodenectomy. However, their impact on perioperative complications has not been defined. MethodsWe retrospectively analyzed the effect of postoperative PPIs on 90-day perioperative outcomes in all patients who underwent pancreatoduodenectomy at our institution from April 2017 to December 2020. Results284 patients were included; 206 (72.5%) received perioperative PPIs, 78 (27.5%) did not. The two cohorts were similar in demographics and operative variables. Postoperatively, the PPI cohort had significantly higher rates of overall complications (74.3% vs. 53.8%) and delayed gastric emptying (28.6% vs. 11.5%), p < 0.05. However, no differences in infectious complications, postoperative pancreatic fistula, or anastomotic leaks were seen. On multivariate analysis, PPI was independently associated with a higher risk of overall complications (OR 2.46, CI 1.33–4.54) and delayed gastric emptying (OR 2.73, CI 1.26–5.91), p = 0.011. Four patients developed marginal ulcers within 90-days postoperatively; all were in the group who received PPIs. ConclusionPostoperative proton pump inhibitor use was associated with a significantly higher rate of overall complications and delayed gastric emptying after pancreatoduodenectomy.

Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery

BackgroundMultiple risk factors for recurrent lumbosacral disc herniation (rLDH) have been evaluated. However, it has been difficult to establish a consensus due to conflicting results. Therefore, the aim of our study was to evaluate the predictors of reoperation in Hispanic-Americans with rLDH following primary hemilaminectomy and discectomy surgery. MethodsA retrospective case-control study of 451 Hispanic-Americans with lumbosacral disc herniation (LDH) was conducted. The sample was divided into two groups: reoperated (cases) and non-reoperated (controls). Preoperative, operative, and postoperative variables of initial surgery were compared between the two groups. ResultsThe reoperation rate was 11.5%, with a mean interval between primary surgery and reoperation of 3.32 years ± 2.07. Analysis of preoperative variables identified a higher rate of reoperation in patients who were unemployed (cases: 48.1%, controls: 17.1%, p=0.001). A significant difference was also seen regarding the presence of gastrointestinal disease (cases: 11.5%, controls: 4.3%, p=0.038). However, there were no differences in the sociodemographic factors, preoperative physical exam, preoperative management, radiological parameters, or operative data. Those patients with persistent postoperative lower extremity pain, radiculopathy, low back pain, and buttock pain demonstrated a higher correlation with rLDH. Multivariable logistic regression analysis identified a significant difference only in work status (employed; OR and 95% CI [0.60 (0.55, 0.67)], p=0.002) and presence of postoperative low back pain (OR and 95% CI [2.17 (1.13, 4.29)], p=0.014). ConclusionsPatients who required reoperation due to rLDH were more frequently unemployed and/or suffered postoperative low back pain after primary hemilaminectomy and discectomy surgery.

Pain management after robot-assisted minimally invasive esophagectomy

BackgroundAdequate pain control after open esophagectomy is associated with reduced complications, earlier recovery and higher patient satisfaction. While further developing surgical procedures like robot-assisted minimally invasive esophagectomy (RAMIE) it is relevant to adapt postoperative pain management. The primary question of this observational survey was whether one of the two standard treatments, thoracic epidural analgesia (TEA) or intravenous patient-controlled analgesia (PCA), is superior for pain control after RAMIE as the optimal pain management for these patients still remains unclear. Use of additional analgesics, changes in forced expiratory volume in 1 s (FEV1), postoperative complications and duration of intensive care and hospital stay were also analyzed. MethodsThis prospective observational pilot study analyzed 50 patients undergoing RAMIE (postoperative PCA with piritramide or TEA using bupivacaine; each n = 25). Patient reported pain using the numeric rating scale score and differences in FEV1 using a micro spirometer were measured at postoperative day 1, 3 and 7. Additional data of secondary endpoints were collected from patient charts. ResultsKey demographics, comorbidity, clinical and operative variables were equivalently distributed. Patients receiving TEA had lower pain scores and a longer-lasting pain relief. Moreover, TEA was an independent predictive variable for reduced length of hospital stay (HR -3.560 (95% CI: −6.838 to −0.282), p = 0.034). ConclusionsAlthough RAMIE leads to reduced surgical trauma, a less invasive pain therapy with PCA appears to be inferior compared to TEA in case of sufficient postoperative analgesia and length of hospital stay. According to the results of this observational pilot study analgesia with TEA provided better and longer-lasting pain relief compared to PCA. Further randomized controlled trials should be conducted to evaluate the optimal postoperative analgesic treatment for RAMIE.

A model for green order quantity allocation in a collaborative supply chain

Several models have been proposed in the literature for allocating quantity orders, but few of them consider collaboration to enhance supply chain (SC) performance sustainably. Despite the increasing attention given to sustainability and the triple bottom line (TBL) criteria, the existing models for order allocation are limited to considering TBL scores only in the phase of selecting suppliers, thus evaluating mainly environmental attributes, without integrating economic and social ones. For these reasons, based on the main research gaps in the current literature, this paper aims to investigate the green order allocation problem in an SC with high operational variability, exploiting the advantages of a collaborative and sustainable SC. The model we propose considers the uncertainty of the demand, the limited capacity of the suppliers, the minimum levels of purchase and production, the environmental, economic, and social scores of suppliers, and the total emissions related to the production, ordering, maintenance, and transport of the allocated items. Our model is based on allocation curves that are continuously updated and shared between the customer and the supplier. On the customer side, it allows to dynamically optimise order allocation, and on the supplier side, it provides clear information on the possible future requests from the customer based on the overall and real economic, environmental, and social performance. To validate the model, the authors applied it to a numerical example, which resulted in minimising both costs and the TBL impacts. Moreover, considering the TBL scores only in the selection of suppliers led to non-optimal choices in the present case study; for example, assigning the largest share of the order to the supplier with the lowest TBL score did not result in the most sustainable allocation. The continuous exchange of information and the synchronism triggered by the buyer–supplier collaboration allows managers to know in advance of any critical issues that may arise in the future and intervene promptly to reorganise the allocation. Therefore, the proposed model can help both researchers and practitioners establish a systematic approach to green order allocation and might help firms increase their sustainability degrees throughout the supply chain.