Operative Site Research Articles

A safe, novel and ingenious method for autogenous bone graft storage in spine surgery with constrained resources - operative site as the bone bank.

The aim of our study is to establish whether the bone graft harvested and stored in the surgical wound by our novel technique is safe, reproducible and preserves the viability of the graft. In doing so, it promises successful bony fusion in spine and orthopaedic surgeries. A prospective clinical case series was conducted for autogenous bone graft storage in complex spine surgeries requiring staged procedures, in resource constrained settings. The bone graft harvested was morselized, wrapped in moist sterile gauze and stored in the paraspinal gutter within the operative site. Thereafter, the surgical wound was easily closed without tension. During the second stage surgery, the stored bone was retrieved and mixed with more autologous/allogenic bone (if necessary) and appropriately laid at fusion sites. Bacterial samples were sent before implantation. 16 complex spinal deformity patients who underwent surgery in a resource constrained hospital over a period of 5 years were included. Duration between both stages was within 2 weeks. All patients showed successful fusion, with mean follow-up of 2.6 years. There were no cases of deep or systemic infection in our series. Surgeons found harvesting, storing and retrieval of graft to be straightforward. The operative site provides an ideal, safe and reproducible location for bone graft storage for staged surgeries conducted in resource constrained situations. The osteogenic potential of the autogenous bone graft is retained. This technique can be extrapolated to other orthopaedic surgeries conducted under resource limited environments like in surgical camps or combat medical facilities.

Research on fall prevention and safety protection for electric power tower climbing operations based on the longhorn whisker algorithm

Abstract With the continuous development of the power industry, the safety of power tower climbing operations is increasingly valued. This study focuses on the anti-fall safety protection of electric power tower climbing operations and proposes a study on the anti-fall safety protection of electric power tower climbing operations based on the Longhorn whisker algorithm. Firstly, real-time image acquisition of the climbing operation site is carried out through the camera equipment carried by the drone, ensuring clear and comprehensive information on the working environment is obtained. Secondly, extract hazardous features in climbing operations, such as abnormal worker posture, tool detachment, etc. These features are important indicators of potential fall risks. Finally, a fall hazard detection model is constructed and optimized using the Longhorn Whisker algorithm to identify and warn of impending fall events, thereby providing timely safety protection for climbing operators. The experimental results show that this method has shown significant effectiveness in improving job safety, providing strong technical support for the safety protection of power tower climbing operations.

Sex differences in autonomic functions and cognitive performance during cold-air exposure and cold-water partial immersion.

This study investigated the differences between males and females in autonomic functions and cognitive performance during cold-air exposure and cold-water partial-immersion compared to a room temperature-air environment. Although several studies have investigated the effects of cold-air or cold-water exposures on autonomic function and cognitive performance, biological sex differences are often under-researched. Twenty-two males and nineteen females participated in the current study. Subjects completed a battery of cognitive tasks based upon those used within the Defense Automated Neurobehavioral Assessment (DANA), consisting of five subtasks that assess simple and procedural reaction time, spatial manipulation, attention, and immediate memory. In total, subjects took the battery within a 15-minute period across 30-minute intervals throughout the duration of environmental exposure. Across three separate days, subjects were exposed to three different environmental conditions: room temperature air (23°C), cold air (10°C), and cold water (15°C; in which subjects were immersed up to their necks). Room temperature and cold-air conditions consisted of five sessions (about 2.5h), and the cold-water condition consisted of three sessions (about 1.5h). During each experimental condition, physiological data were collected to assess autonomic function, including electrodermal activity (EDA) data and heart rate variability (HRV) derived from electrocardiogram signals. Females showed slower reaction time in spatial manipulation tasks, immediate memory, and attention during cold-air exposures compared to room temperature air, whereas the performance of males were similar or better during cold-air exposures compared to room temperature air. Cold-water immersion affected the immediate memory performance of males. Both males and females exhibited smaller EDA amplitudes during cold-air and cold-water conditions compared to room temperature air. For HRV, only male subjects exhibited significantly greater values in low-frequency and very-low-frequency components during cold air exposure compared to the normal condition. Sex introduces important differences in cognitive performance and autonomic functions during exposure to cold-air and cold-water. Therefore, sex should be considered when assessing the autonomic nervous system in cold environments and when establishing optimal thermal clothing for performance in operational environments. Our findings can assist with determination of operational clothing, temperature in operating environment, and personnel deployment to operational sites, particularly in settings involving both males and females.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:<0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: <0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.

Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications. A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected. The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group. The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.

Assessment of impacts of air pollution on people living in Ezza North close to quarry operation sites in Ebonyi State, Nigeria

Quarrying activities have become lucrative work for low income people in low income countries most found in Africa. This study aimed assess the impacts of air pollution on people living in Ezza North close to quarry operation sites in Ebonyi State, Nigeria. A descriptive cross sectional study was used and pollution level was determined with the use of calibrated Handheld GPS, Amex multiple gas meter, Sound meter and interview of participants with a questionnaire on the health status. The collected data were entered into the Statistical Package for Social Sciences (SPSS) software (version 21). The one sample T-test was used to test the hypotheses at 95% confidence interval and 0.05 level of significance. The results showed that 31–40 years had 19(5.37%) males and 20(5.65%) females as highest quarrying workers. The concentration of carbon monoxide was highest at 193ppm, Sulphur dioxide at 568ppm, nitrogen dioxide at 1.9ppm, Suspended particulate Matter (SPM) at 1982ppm and sound level at 82.9dB. The concentrations of these pollutants were found to be significantly higher (P<0.05) than normal levels apart from sound level without significant impact at P = 0.285. The 93.3% of the participants reported blasting of rocks produced highest air pollution, 87.5% that reported crushing, conveying, sieving produce a lot of dust. Also, 80% of participants reported high level of noise came from machinery blasting rocks, processing and haulage trucks. In all, 35% reported they had fair health condition when asked about the health status since they started quarrying work. In conclusion, the concentrations of carbon monoxide, carbon dioxide, sulphur dioxide, particulate matter and nitrogen oxides were all higher than normal. It was observed air pollutants had association with respiratory system. Therefore, the air pollution at quarrying site can be mitigated through dust suppression techniques and treating quarry pit with water before discharging.

Determinants of Unfolding Cooperativity and Binding Are Decoupled in a DNA Binding Domain.

The relative magnitudes of noncovalent stabilization energies or the coupling free energies in folded proteins are anisotropically distributed, uniquely influencing folding and functional behaviors. In this regard, the fructose repressor (FruR) DBD belonging to the LacR repressor family harbors a three-residue insertion─KQY─between the canonical second and third helices. This sequence insertion promotes a strong Tyr-Tyr stacking interaction that is not observed in related homologues. Combining experiments with simulations, we show that the Tyr-Tyr stacking contributes to a decoupled unfolding due to the localization of a large part of the stabilization energy in this specific structural region. This leads to melting temperatures from different probes spanning nearly 10 K, while concomitantly stabilizing a partially structured intermediate state. Disruption of the aromatic stacking interaction via an alanine mutation promotes a molten-globular state whose native ensemble is replete with non-native interactions while displaying enhanced thermodynamic fluctuations and minimal calorimetric cooperativity. Surprisingly, the molten-globular variant of FruR DBD binds to the operator site on DNA with an affinity similar to that of the wild-type but with altered secondary-structure characteristics in the bound state, underscoring the chaperone-like role of DNA through its large negative electrostatic potential. FruR DBD thus appears to be at the verge of disorder as expected of an entropically destabilizing three-residue insertion but is rescued by the aromatic stacking interaction that distinctly dictates the finer details of stability, cooperativity, and binding.

Insulation Detection Algorithm for Gloves Based on Improved YOLOv8n

With the rapid development of China's industry, the safety problems in the process of electrical operation are highly concerned by the electrical industry. In order to reduce the incidence of electrical safety accidents, it is very necessary to wear insulating gloves for electric power construction, which is also of great significance to ensure the safety of electric power production. However, the small target of insulating gloves and the complexity of the electrician operation site, which undoubtedly increases the difficulty of identifying the algorithm model of insulating gloves. For this problem, insulation glove target detection algorithm based on YOLOv8n improvement model. Through many experiments, YOLOv8n was selected as the basic framework of the insulating glove detection algorithm. In order to make the model more accurately locate and identify the targets of interest, the efficient coordinate attention mechanism Coordinate Attention was inserted into backbone to improve the accuracy of the model. The introduction of PConv in necbricks reduces redundant computation and memory access for a more efficient extraction of spatial features. After the improved YOLOv8n algorithm, the mAP is increased from the initial 96.4% to 98.6%, which provides a good reference value for the subsequent research of the target detection algorithm of insulating gloves.

Kiteboarding Injuries: Epidemiology, Common Treatment Strategies, and Time to Return to Kiteboarding Following Injury.

To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4). Recreational kiteboarding. Retrospective cohort. Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study. Age, sex, experience, and the use of protective gear. Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data. The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction. The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable.

Appropriate timing for the removal of urinary catheters in gastrointestinal surgery with epidural anesthesia: a randomized controlled trial.

The purpose of this randomized controlled trial was to evaluate whether early urinary catheter removal is feasible during epidural anesthesia during gastrointestinal surgery in male patients at high risk for urinary retention. Male patients who underwent radical surgery for gastric or colon cancer were enrolled in this randomized controlled trial. Patients were randomized 1:1 into 2 groups: the early group, in which the urinary catheter was removed before removal of the epidural catheter on the second or third postoperative day, and the late group, in which the urinary catheter was removed after removal of the epidural catheter. The randomization adjustment factors were age (≥ 65 or < 65 years) and operative site (gastric or colon). The primary endpoint was urinary retention. The secondary endpoints were the incidence of urinary tract infection and length of postoperative hospital stay. Seventy-three patients were enrolled between March 2020 and February 2024 and assigned to the Early (n = 37) and Late (n = 36) groups. Four patients withdrew their consent after randomization. The intention-to-treat analysis showed that urinary retention occurred in 4 patients (11.1%) in the early group and 1 patient (3.0%) in the late group (P = 0.20). Urinary tract infection occurred in 1 patient (3.0%) in the late group. The median postoperative hospital stay was 9 days in both groups. Early urinary catheter removal in male patients undergoing gastrointestinal surgery with epidural anesthesia could increase urinary retention within the expected acceptable range. UMIN000040468, Date of registration: May 21, 2020.

Utilisation of the site assessment energy indices for aquaculture in exposed waters: biology, technology, operations and maintenance

When moving from a very sheltered aquaculture site to a very exposed oceanic aquaculture site, the energy increases proportionally in a continuum. Lojek et al. (in review) considered the primary influential parameters (water current, wave height, wave period, wavelength and water depth) which influence the species, structure, technology, methods, and operational aspects of any aquaculture endeavour and investigated six possible indices which cover these variables. Added to advanced computer modelling, assisted by detailed and constant environmental monitoring, it may be possible to refine site selection, structure selection and design, species selection, equipment and logistic requirements and health and safety requirements. This manuscript has selected two indicative indices: Specific Exposure Energy (SEE) index and Exposure Velocity (EV) index from the potential equations provided by Lojek et al. (in review) and compared them with known operational aquaculture sites highlighting present structural capability and limitations. The two indices are also utilized to reflect on their suitability for assessing sample sites with respect to biological, technological, operational or maintenance aspects of aquaculture activities. The indices have shown themselves to be useful tools in the general assessment of the energy that will influence the species and structure selection at potential aquaculture sites. This information can help prospective fish farmers characterize their sites concisely and accurately to consultants, regulators, equipment vendors, and insurance brokers.

Simulation study on thermal performance of solar coupled air source heat pump system with phase change heat storage in cold regions

The development of efficient and clean heating technologies is profoundly significant for the reduction of carbon emissions in cold regions. This paper puts forth a novel solar-coupled air source heat pump system integrated with phase change heat storage technology, which is well-suited for regions with such climatic conditions. A numerical model of the components and coupled systems is established using the lumped parameter method, and an iterative method is employed for the computational solution in MATLAB software. A variety of system performance aspects are then simulated and analysed following the configuration of component structural parameters and initial operating conditions. The results of the simulations indicate that an increase in the phase change temperature interval of the phase change materials leads to a higher average heat release power. In particular, a 2 °C increase in the phase change temperature interval results in an increase in the heat release power of over 10 %. Furthermore, when the system is applied in typical cold regions, including Kunming, Hangzhou, Lhasa, and Harbin, the average coefficient of performance is 10.23, 8.87, 8.49, and 7.70, respectively. The proportion of solar energy input contributes to an increase in system efficiency across all regions. A case study of Hangzhou reveals that the incorporation of solar energy into the system results in an increase in efficiency of 70.91 %. This research provides valuable operational methods and site selection recommendations for engineering practices, laying a theoretical foundation for its widespread application in cold regions.

Comparative Study on the Performances of a Hinged Flap-Type Wave Energy Converter Considering Both Fixed and Floating Bases

The dynamical modeling and power optimization of floating wind–wave platforms, especially in regard to configurations based on constrained floating multi-body systems, lack in-depth systematic investigation. In this study, a floating wind-flap platform consisting of a flap-type wave energy converter and a floating offshore wind turbine is solved in the frequency domain considering the mechanical and hydrodynamic couplings of floating multi-body geometries and a model that suits the constraints of the hinge connection, which can accurately calculate the frequency domain dynamic response of the flap-type WEC. The results are compared with bottom-fixed flap-type wave energy converters in the absence of coupling with a floating wind platform. Moreover, combined with traditional optimization methods of power take-off systems for wave energy conversion, an optimization method is developed to suit the requirements of floating wind-flap platform configurations. The results are drawn for a specific operation site in the South China Sea, whereas a sensitivity analysis of the parameters is performed. It is found that the floating wind-flap platform has better wave energy absorption performance in the low-frequency range than the bottom-fixed flap-type wave energy converter; the average power generation in the low-frequency range can increase by up to 150 kW, mainly due to constructive hydrodynamic interactions, though it significantly fluctuates from the sea waves’ frequency range to the high-frequency range. Based on spectral analysis, operational results are drawn for irregular sea states, and the expected power for both types of flap-type WECs is around 30 kW, which points to a similar wave energy absorption performance when comparing the bottom-fixed flap with the flap within the hybrid configuration.

Surgical Pearls for Safe and Precise Decision-Making during Modified Selective Neurectomy Surgery.

In this short communication: (1) A transcutaneous electrical nerve stimulaton stimulator is a cost-effective solution for the predictable stimulation of mimicry and for precise decision-making. (2) Positioning a simple shatterproof mirror in front of an operated facial half enables the primary surgeon to simultaneously see and stimulate at the operative site and to scrutinize the mimicry for decision-making. (3) A misconception in the literature regarding colors used for tagging "branches for transection" and "branches for preservation" is clarified, and a third tag-color is suggested for times of ambiguity. (4) The principle of distal execution of the surgery and technical considerations are underlined for maximal transection and maximal preservation. The modified selective neurectomy surgery is the current golden standard of post facial paralysis synkinesis treatment, and developing a learning curve in this type of surgery is like walking a tightrope, where the surgeon must keep pushing the limits with precise decision-making and a small margin of error. It is important to be reminded that the first aim is primum non nocere, and the second aim is to improve the condition of patients as much as possible. The above-mentioned principles and solutions increase precision and safety, assisting surgeons to achieve better outcomes.

BACTERIOLOGICAL PROFILE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF SURGICAL SITE INFECTIONS IN A TEACHING HOSPITAL

Objective: Surgical site infections (SSI) are defined as infections occurring within 30 or 90 d after surgical operation or within 1 y, if an implant is left in place after procedure and affecting either incision or deep tissues at the operation site. SSI is one of the quality indicators of the healthcare system. Due to advent of newer antibiotics and emergence of multidrug-resistant bacteria, SSI requires reappraisal of the microbiological flora and in vitro antibiotic sensitivity pattern. The aim of the present study is to determine the incidence etiology of SSI, and determine their Antibiogram. Methods: Cross-sectional study conducted for a period of three months from January 2024 to March 2024. A total of fifty swabs/pus specimens from various types of surgical sites suspected to be infected on clinical grounds were collected from the post-operative wards of surgical departments and processed in Microbiology laboratory. Isolation and identification of bacterial agents were done as per standard protocols. Antimicrobial susceptibility testing was performed by Kirby-Bauer’s disc diffusion method. Results: Out of 50 samples, 32 were culture-positive. 87.50% showed monomicrobial growth and 12.50% showed polymicrobial growth. Analysis of bacterial profile shows Staphylococcus aureus (27.77%) was the predominant isolate, followed by Pseudomonas aeruginosa (19.44%) and Escherichia coli (19.44%). Antibiogram of gram-positive isolates showed sensitivity to Teicoplanin, Vancomycin, and linezolid, whereas gram-negative isolates were sensitive to Meropenem, Piperacillin-tazobactam and levofloxacin. Conclusion: Status of SSI is the main quality indicators of hospital infection control and prevention measures. Continuous surveillance on etiology and antibiogram of SSI is necessary to monitor antimicrobial resistance and guide in empirical treatment.

The Public Health Leader Who Brought Antisepsis to William Halsted.

William Halsted wrote to aging surgeon, Stephen Smith, in 1919, that he remembered the lessons Smith had taught him, "when I walked with you through the wards of Bellevue Hospital." Smith was an early advocate of Joseph Lister's antiseptic method, and because of his public health work, he was also an early advocate of environmental hygiene and microbial control based on the unproved germ theory. While Lister's work at the time emphasized germ-killing around the operative site with carbolic acid (antisepsis), Smith adopted and encouraged surgical practices at Bellevue that would be hallmarks of the germ-preventing (asepsis) surgical approach that fully developed after German bacteriologic discoveries in the mid-1880s, and with which Halsted is historically identified. Some physicians and historians have emphasized temporal and conceptual differences between Lister's antisepsis and German asepsis, but Smith and Halsted's experiences argue that surgical asepsis was the evolutionary outcome of germ theory-based surgical changes that began well before scientific proof arrived.

A simple machine learning model for the prediction of acute kidney injury following noncardiac surgery in geriatric patients: a prospective cohort study

BackgroundSurgery in geriatric patients often poses risk of major postoperative complications. Acute kidney injury (AKI) is a common complication following noncardiac surgery and is associated with increased mortality. Early identification of geriatric patients at high risk of AKI could facilitate preventive measures and improve patient prognosis. This study used machine learning methods to identify important features and predict AKI following noncardiac surgery in geriatric patients.MethodsThe data for this study were obtained from a prospective cohort. Patients aged ≥ 65 years who received noncardiac surgery from June 2019 to December 2021 were enrolled. Data were split into training set (from June 2019 to March 2021) and internal validation set (from April 2021 to December 2021) by time. The least absolute shrinkage and selection operator (LASSO) regularization algorithm and the random forest recursive feature elimination algorithm (RF-RFE) were used to screen important predictors. Models were trained through extreme gradient boosting (XGBoost), random forest, and LASSO. The SHapley Additive exPlanations (SHAP) package was used to interpret the machine learning model.ResultsThe training set included 6753 geriatric patients. Of these, 250 (3.70%) patients developed AKI. The XGBoost model with RF-RFE selected features outperformed other models with an area under the precision-recall curve (AUPRC) of 0.505 (95% confidence interval [CI]: 0.369–0.626) and an area under the receiver operating characteristic curve (AUROC) of 0.806 (95%CI: 0.733–0.875). The model incorporated ten predictors, including operation site and hypertension. The internal validation set included 3808 geriatric patients, and 96 (2.52%) patients developed AKI. The model maintained good predictive performance with an AUPRC of 0.431 (95%CI: 0.331–0.524) and an AUROC of 0.845 (95%CI: 0.796–0.888) in the internal validation.ConclusionsThis study developed a simple machine learning model and a web calculator for predicting AKI following noncardiac surgery in geriatric patients. This model may be a valuable tool for guiding preventive measures and improving patient prognosis.Trial registrationThe protocol of this study was approved by the Committee of Ethics from West China Hospital of Sichuan University (2019–473) with a waiver of informed consent and registered at www.chictr.org.cn (ChiCTR1900025160, 15/08/2019).

Endoscopic En Bloc Resection of Giant Cell Tumor of Tendon Sheath of Anterior Ankle

Giant cell tumor of the tendon sheath (GCTTS) originates from the synovial cells of the tendon sheath. It is one of the most common benign soft-tissue tumors of the foot and ankle affecting the joints, bursae, and tendon sheaths and can behave in a locally aggressive manner. Complete surgical resection with long-term follow-up is the preferred treatment. Because GCTTS is a benign condition, the equilibrium between the quality of the surgical margins and functional preservation should be considered. If more aggressive resection is applied, the outcome may negatively affect quality of life, whereas incomplete resection may lead to recurrence. The purpose of this technical note is to describe the details of endoscopic en bloc resection of GCTTS of the anterior ankle. This endoscopic approach can provide a magnified view of the operative site, allowing accurate surgical assessment to ensure complete resection of the lesion without damage to the adjacent normal structures.

Self-detection of thermal ambient parameters for air-conditioned space by learning operation data and self-prediction of indoor temperature and power consumption

For efficient energy use of air conditioning unit (AC), there is a need to find an optimal control method for operation. To deduce an optimal control algorithm, indoor temperature and power consumption need to be predicted according to given operating conditions. Among the key factors, the thermal ambient parameters such as thermal resistances of the operation sites are most difficult to identify. This study proposed a method for an AC to deduce these parameters for itself by learning operation data obtained from the embedded sensors and autonomously predict indoor temperature and power consumption by solving the transient energy conservation equation incorporating refrigeration cycle simulation. A novel aspect of this study is that the AC can autonomously perceive thermal ambient parameters of its surroundings and utilize these parameters to predict indoor temperature variations and power consumption. These data could be fed back to the control software of the AC in real time. To validate the proposed method, experiments were conducted in model house test facility using a real air-conditioner, and the results were compared with the simulation results. It was confirmed that the time to reach the air temperature setpoint was within 3 min and the power consumption could be predicted within 9 %.

Utilizing Single-Branched Stent in Combination With Fenestration or Chimney for Endovascular Repair of Aortic Arch Lesions With Aberrant Subclavian Artery.

The study was to figure out the feasibility, efficacy, and safety of a single-branched stent graft, namely Castor, in combination with fenestration or chimney in the context of aortic arch lesions presenting with aberrant subclavian artery (ASA) and/or Kommerell's diverticulum (KD). All consecutive patients with aortic arch lesions and ASA and/or KD receiving Castor from June 2018 to June 2023 were investigated. Incorporating 18 patients, the study encompassed 11 cases with KD, 3 cases with dysphagia; 2 cases of right-sided aortic arch with left-sided aberrant left subclavian artery (ALSA), and 16 cases of left-sided aortic arch with right-sided aberrant right subclavian artery (ARSA). The mean operation time was 132±23 minutes. The mean measured proximal aortic diameter was 30.9±1.6 mm, and proximal diameter of Castor stent was 34 (32, 34.5) mm, with oversize of 9.1±1.6%; the mean measured branch diameter was 8.8±0.97 mm, and branch diameter of Castor stent was 10 (8, 10) mm, with oversize of 0.86±0.57 mm. Technical success rate was 100%, and no in-hospital mortality, no stroke, and no endoleak were identified. One (5.6%) case with spinal cord ischemia and one (5.6%) case with poor healing of operative site were identified. During the follow-up period, no aortic-related death or secondary intervention was recorded. The maximal aortic diameter was significantly reduced at the sixth postoperative month (padj=0.031); KD diameter was significantly reduced at the third (padj=0.001) and sixth (padj<0.001) postoperative month. Totally endovascular repair of aortic arch lesions with ASA and KD via Castor stent in combination with fenestration or chimney is feasible, effective, and safe, which can achieve an encouraging medium-term outcome and provide excellent remodeling at the lesions. Single branched stent in combination with fenestration or chimney achieved a sufficient proximal landing zone and provided an encouraging medium-term outcome in this retrospective review of 18 patients receiving endovascular treatment of pathological aortic arch with aberrant subclavian artery and/or Kommerell's diverticulum. The authors suggest this time-saving and efficient technique to establish systematic experience for the treatment in this kind of patients.