Operative Site Research Articles

Desarda’s repair versus Mesh hernioplasty for a strangulated inguinal hernia a randomized double-blind comparative study

Groin hernias are the commonest abdominal wall hernias; these hernias are known to develop various complications. Strangulation is a serious and life-threatening complication. Various surgical procedures like primary tissue repair, mesh repair, keep open with secondary repair, etc. are in practice for strangulated groin hernias. Post-operative infection and recurrence are the main concerns with these procedures. The aim of conducting this study was to compare the outcomes of the mesh hernioplasty with Desarda’s purely tissue hernioplasty in the treatment of strangulated inguinal hernia. A total of one hundred and twenty-four patients were included in the study. These patients were grouped into group A (mesh hernioplasty group) and group B (Desarda’s tissue repair group) and randomization was done. Results of these two techniques were compared with respect to post-operative seroma, surgical site infection, recurrence, and chronic pain. Seroma formation was more in group A, which accounts for 35.48%(22) of patients than in group B patients accounts for 19.35%(12). Operative site infection was more in group A, which accounts for 35.48%(22) patients than in group B 9.67%(6) patients. Recurrence was more in Group A patients which accounts for 22.58%(14) than in Group B patients which accounts for 3.22%(2). More patients account for 19.35%(12) in group A experienced chronic pain than the patients 1.61%(1) in Group B. The current study showed that Desarda’s technique is a safe, effective, and single-sitting technique with a significantly reduced risk of seroma, surgical site infection, chronic pain, and recurrence than mesh hernioplasty for strangulated inguinal hernia

Anatomic feasibility study of osteocutaneous free flap from the proximal ulna

ObjectiveThe present anatomic study aimed to assess the feasibility of an osteocutaneous free flap harvested from the proximal ulna for reconstruction after complex hand trauma. MethodNineteen upper limb specimens free of scarring in the elbow region were injected in the brachial artery. After S-shaped incision centered on the medial epicondyle, a systematic approach to the epitrochlear-olecranal groove exposed the superior ulnar collateral artery and ulnar nerve. Bone and skin perforators were screened for during dissection and their emergence with respect to the medial epicondyle was assessed. Pedicle length was also assessed. The skin paddle was harvested in the distal part of the S incision and the operative site was closed by local skin plasticity. ResultsBone and skin perforators from the superior ulnar collateral artery were found in all 19 specimens. Mean pedicle length from the artery was greater than 9cm in all cases. The skin perforator emerged at a mean 19mm distally from the medial epicondyle, and the bone perforator at a mean 40mm. DiscussionAn osteocutaneous free flap can be harvested from the proximal ulna and medial side of the elbow. As bone and skin perforators were found in all 19 cases, this flap can be used routinely. Harvesting, however, systematically involves ulnar nerve release and anterior transposition. This osteocutaneous free flap harvested from the proximal ulna offers an alternative for osteocutaneous defects in the hand, with harvesting from the same limb. ConclusionIn this anatomic series, an osteocutaneous free flap could in all cases be harvested from the posterior ulnar recurrent artery via a medial elbow approach. Safety and efficacy remain to be demonstrated in in vivo reconstruction. Level of evidenceIII.

Postpartum Acquired Hemophilia (PAH) – A Rare Entity

Objective: Acquired Hemophilia A (AHA) is a rare autoimmune disease that can result in life threatening bleeding. Formation of auto-antibodies (inhibitors) against coagulation factor VIII develops the hemorrhagic syndrome that may appear at any age; however, prevalence of AHA is chiefly observed in post-partum and elderly persons. Idiopathic acquired hemophilia is commonest type of acquired hemophilia whereas it is also associated with autoimmune disease, malignant neoplasm, medication and vaccinations. Post-partum acquired hemophilia (PAH) may develop due to development of antibodies against fetal FVIII. In this case report, 36-year-old Asian woman presented with complain of bruises from 2 months. There was history of cesarean section four months ago. Family history, past medical and drug history were not significant. As there was no active bleeding, patient was started an oral prednisolone along with azathioprine and was counseled regarding disease and precautions. Patient presented after 2 weeks with severe PV bleed, anemia secondary to self-induced medicine abortion. For this she receives pack cells and cryoprecipitate. Steroids and azathioprine were continued and patient was discharged in stable condition. Her ultrasound pelvis however showed small fibroids. Patient went back to her village where she again develops severe PV bleed and for that she underwent hysterectomy. Patient presented in our hospital with severe operative site bleeding, pain and anemia. She was managed with Packed Red Blood (PRBCs), Fresh Frozen Plasma (FFP), Recombinant Activated Clotting Factor VII (rFVIIa), prednisolone IV and azathioprine PO. Her Activated Partial Thromboplastin, Hemoglobin were continuously monitored. After a week bleeding was stopped but Activated Partial Thromboplastin Time (APTT) was still prolonged so we tapered rFVIIa dose and advice two sessions of plasmapheresis. APTT, hemoglobin levels, inhibitor titer, High-Sensitivity C – reactive protein (hs-CRP) levels were improved. Patient was discharged in a stable condition and was advised to continue medication at home with supportive care and wound dressing.

Analysis of swallowing function after anterior/posterior surgery for cervical degenerative disorders and factors related to the occurrence of postoperative dysphagia

BACKGROUND CONTEXTDysphagia is one of the postoperative complications of cervical degenerative disorders. However, few studies have evaluated the pre- and postoperative swallowing function in detail. PURPOSETo analyze pre- and postoperative swallowing dynamics kinetically and investigate factors associated with postoperative dysphagia in patients with cervical degenerative disorders. STUDY DESIGNRetrospective review of prospectively collected data. PATIENT SAMPLEA total of 41 consecutive patients who underwent an anterior approach (anterior cervical discectomy/corpectomy and fusion (ACDF, ACCF), hybrid surgery (ACDF+ACCF) and total disc replacement) and 44 consecutive patients who underwent a posterior approach (laminoplasty and laminoplasty/laminectomy with fusion). OUTCOME MEASURESWe compared the pre- and postoperative functional oral intake scale (FOIS), dysphagia severity scale (DSS), esophageal dysphagia, anterior/superior hyoid movement, upper esophageal sphincter (UES) opening, pharyngeal transit time, bolus residue scale (BRS), and the number of swallows. METHODSVideofluoroscopy was performed on the day before surgery and within two weeks after surgery. Data related to age, gender, disease, surgical procedure, surgical site, operative time, and blood loss were collected from the medical records. Pre- and postoperative data were compared for each item in the anterior and posterior approaches. The odds ratio of dysphagia after an anterior approach was also calculated. RESULTSIn the anterior approach, DSS, FOIS, the anterior and superior hyoid movements, maximum UES opening, BRS, and number of swallows worsened postoperatively (p<.05, respectively). In the posterior approach, DSS, FOIS, the anterior hyoid movement, and BRS worsened postoperatively (p<.05, respectively). The factors associated with dysphagia were a proximal surgical site above C3 (OR: 14.40, CI: 2.84−73.02), blood loss >100 mL (OR: 9.60, CI: 2.06−44.74), an operative time >200 minutes (OR: 8.18, CI: 1.51−44.49), and an extensive surgical field of more than three intervertebral levels (OR: 6.72, CI: 1.50−30.07). The decline in swallowing function after the posterior approach was related to aging (p=.045). CONCLUSIONSEach approach may decrease swallowing function, especially because of the limitation on the anterior hyoid movement. Dysphagia after anterior approaches was associated with the operative site, operative time, and blood loss.

OGC P12 Maintaining high volume oesophagagogastric resections during the COVID-19 pandemic: a single centres experience utilising the independent sector

Abstract Background With many resources redirected to care for the those affected by the COVID-19 pandemic, the NHS faced unprecedented pressure to maintain oesophagogastric (OG) cancer resectional services. Our institution along with many tertiary units across the country were faced with limited access to essential critical care beds. The implementation of emergency contracts between the NHS and the independent sector (IS) allowed our unit to maintain a high volume resectional service by utilising the resources of a local private hospital with HDU/ ITU provision. We began operating within the IS shortly after the first UK lockdown in March 2020, and continued through till February 2022. During this period, we continued operating at our tertiary unit (TU) albeit at a reduced capacity. This study aimed to evaluate the surgical outcomes of patients undergoing major OG resectional surgery between the two sites. Methods This retrospective study included all patients who underwent major OG resectional surgery (including GIST) from March 2020-February 2022. Operation type and site were identified using OPCS-4 clinical codes and combined with National OG Cancer Audit (NOGCA) data to compare basic patient demographics, length of stay, complication rates, COVID infection rates and 90-day mortality. Descriptive and statistical analysis between the two operating sites was performed. Results A total of 204 major OG resections were undertaken, 44% (89) at our TU;57 oesophagectomies and 32 gastrectomies, with 56% (115) at a local IS hospital;86 oesophagectomies and 29 gastrectomies. Additionally, 13 (6.4%) open and close procedures were performed across both sites. Median patient age was similar, 69 (45–86) years at our TU v. 68 (38–85) years at the IS site. A higher proportion of ASA 3 patients (46%) were operated on at our TU. No difference in median length of stay was observed; TU= 8 (1–93) days v. IS =9 (3–69) days, this included all patients who were repatriated to the TU. Higher complication rates seemed to occur in patients operated at the IS site v. the TU though these did not reach statistical significance; 18 (15.7%) patients suffered an anastomotic leak v. 9 (10.1%) respectively (p= 0.246). 21 (18.3%) v. 13 (14.6%) patients suffered a major respiratory (p=0.487) and 4 (3.5%) v. 1 (1.1%) a major cardiac (p=0.281) complication. There were no cases of COVID infection within 30 days of primary procedure at the IS site, with 2 cases within the TU cohort. Our 90-day mortality rates were similar (IS= 4.54% v. TU=5.32%), p=0.661. Conclusions Our study demonstrates that resection of patients with OG cancer is feasible in an independent sector hospital if supported by critical care. It allowed a high-volume tertiary unit to continue offering potentially curative surgery to patients whose treatment options would have otherwise been limited to oncological therapy only. Long term survival data compared to non-resecting trusts is required to determine whether this approach was superior. When considering future pandemic planning, we have demonstrated the value of this model in maintaining major OG resectional services.

Lumboperitoneal shunt surgery via continuous two-stage procedure: Technique notes and outcomes.

Lumboperitoneal shunt (LPS) is an effective procedure for managing communicating hydrocephalus. LPS is performed as a one-stage procedure with the patient placed in the lateral position or as a two-stage procedure in which the patient's position is changed. Both methods can be bothersome to neurosurgeons. We designed a continuous two-stage LPS procedure in which the operative sites did not need to be sterilized again, and the surgical drapes did not have to be changed after changing the patient's position. In this study, we analyzed this procedure in terms of the technical features and outcomes. All patients from our institute who underwent LPS using the continuous two-stage procedure from October 2019 to August 2021 were reviewed retrospectively. The patient's demographic information, clinical features, operative data, and outcomes were analyzed. A total of 46 consecutive patients who underwent LPS using the continuous two-stage procedure were enrolled. The mean operative duration was 70.6 ± 12.7 min. The 180-day revision rate for these patients was 2.2% (1/46). Moreover, 76.1% of the patients (35/46) experienced clinical improvement after LPS during the 180-day follow-up, and 70.0% of the patients (32/46) experienced an improvement in neuroimaging. We described a continuous two-stage LPS procedure. This method simplified the two-stage LPS procedure and maintained a low malfunction rate and shunt infection rate in our series.

Quantifying Spatio-temporal risk of Harmful Algal Blooms and their impacts on bivalve shellfish mariculture using a data-driven modelling approach

Harmful algal blooms (HABs) intoxicate and asphyxiate marine life, causing devastating environmental and socio-economic impacts, costing at least $8bn/yr globally. Accumulation of phycotoxins from HAB phytoplankton in filter-feeding shellfish can poison human consumers, prompting harvesting closures at shellfish production sites. To quantify long-term intoxication risk from Dinophysis HAB species, we used historical HAB monitoring data (2009–2020) to develop a new modelling approach to predict Dinophysis toxin concentrations in a range of bivalve shellfish species at shellfish sites in Western Scotland, South-West England and Northern France. A spatiotemporal statistical modelling framework was developed within the Generalized Additive Model (GAM) framework to quantify long-term HAB risks for different bivalve shellfish species across each region, capturing seasonal variations, and spatiotemporal interactions. In all regions spatial functions were most important for predicting seasonal HAB risk, offering the potential to inform optimal siting of new shellfish operations and safe harvesting periods for businesses. A 10-fold cross-validation experiment was carried out for each region, to test the models’ ability to predict toxin risk at harvesting locations for which data were withheld from the model. Performance was assessed by comparing ranked predicted and observed mean toxin levels at each site within each region: the correlation of ranks was 0.78 for Northern France, 0.64 for Western Scotland, and 0.34 for South-West England, indicating our approach has promise for predicting unknown HAB risk, depending on the region and suitability of training data.

Reversible switching and stability of the epigenetic memory system in bacteria.

In previous work, we have developed a DNA methylation-based epigenetic memory system that operates in Escherichia coli to detect environmental signals, trigger a phenotypic switch of the cells and store the information in DNA methylation. The system is based on the CcrM DNA methyltransferase and a synthetic zinc finger (ZnF4), which binds DNA in a CcrM methylation-dependent manner and functions as a repressor for a ccrM gene expressed together with an egfp reporter gene. Here, we developed a reversible reset for this memory system by adding an increased concentration of ZnSO4 to the bacterial cultivation medium and demonstrate that one bacterial culture could be reversibly switched ON and OFF in several cycles. We show that a previously developed differential equationmodel of the memory system can also describe the new data. Then, we studied the long-term stability of the ON-state of the system over approximately 100 cell divisions showing a gradual loss of ON-state signal starting after 4 days of cultivation that is caused by individual cells switching from an ON- into the OFF-state. Over time, the methylation of the ZnF4-binding sites is not fully maintained leading to an increased OFF switching probability of cells, because stronger binding of ZnF4 to partially demethylated operator sites leads to further reductions in the cellular concentrations of CcrM. These data will support future design to further stabilize the ON-state and enforce the binary switching behaviour of the system. Together with the development of a reversible OFF switch, our new findings strongly increase the capabilities of bacterial epigenetic biosensors.

A case report of Wernicke Korsakoff syndrome in a patient with cholangiocellular carcinoma: An underestimated cause of encephalopathy in cancer patients

Wernicke's encephalopathy, a disorder caused by thiamin deficiency, is characterized by a classical triad of encephalopathy, ataxia, and ophthalmoplegia. Although alcoholism is the most common predisposing factor, it can also be associated with nonalcoholic states (hyperemesis gravidarum, intestinal obstruction, bariatric surgery, and others). This work presents a case of nonalcoholic Wernicke-Korsakoff syndrome diagnosed in a cholangiocellular carcinoma patient and literature review. A 65-year-old male patient with a history of cholangiocellular carcinoma (Klatskin tumor) was treated with radiotherapy at the operation site after Roux-en-Y hepaticojejunostomy. During follow-up, the patient developed gastric outlet obstruction and was diagnosed with peritoneal carcinomatosis after a palliative gastrojejunostomy. As the patient could not tolerate oral nutrition during hospitalization, total parenteral nutrition was administered. After 10 days of admission, the patient showed decreased response to verbal stimuli as well as bilateral horizontal nystagmus, lethargy, and disorientation. Furthermore, the patient displayed confabulation. Clinical and imaging findings were consistent with Wernicke's encephalopathy. Therefore, treatment with intravenous thiamin replacement was initiated. The patient's encephalopathy regressed on the second day after treatment, and he recovered the place-person-time orientation. In the following month, the abnormal imaging findings were almost entirely resolved. In order to prevent irreversible brain damage induced by chronic thiamin deficiency, thiamin replacement therapy with parenteral nutrition solutions should be included as a treatment for hospitalized cancer patients unable to receive enteral nutrition for a long time.

Research on Automatic Replacement Tool of Linear Insulator for Live Working in distribution network

Aiming at the problems of high risk, high labor intensity, and complex operation processes in the existing manual replacement of insulators, an automatic replacement tool for linear insulators was developed. The device can be used for the quick replacement of linear insulators under live working conditions. Firstly, a mechanical structure with high positioning accuracy and strong stability was designed according to the shape of the linear insulator and the simulation of the artificial live working process. Secondly, the static simulation of the clamping mechanism of the device was carried out. The results show that the strength of the clamping mechanism is high, and the maximum elastic deformation is 4.952 mm, which meets the requirement of the structure design. Finally, the relevant simulation test of the automatic replacement tool was carried out at the operation site. The experimental results show that the designed mechanical structure is light and convenient, which can quickly complete the automatic disassembly, installation, and fastening of linear insulators. The designed mechanical structure also effectively improves the efficiency of maintenance operations and has high promotion and application value.

Distal Clavicle Autograft in Fractures of the Proximal Humerus: Surgical Technique

Introduction: The surgical treatment of the proximal humerus fractures is challenging because of various presentations, especially in osteoporotic bones. The use of fixed-angle locked plates combined with grafts increases the fixation stability and healing rate. This study aims to describe a novel option of autogenous bone graft from the distal clavicle in the treatment of the proximal humerus fracture. Materials and Methods: This is a descriptive study of a novel technique including patients undergoing surgical treatment of the proximal humerus fracture with locked plates and autograft from the distal clavicle. Results: A total of 3 female patients underwent treatment in the last year, and there are no complications reported. All fractures remained stable without varus collapse of the humeral head. Conclusion: We are the first to describe the use of the distal clavicle as an option of autograft for the treatment of the proximal humerus fractures. This technique has low morbidity and complexity, easy reproduction and low cost and can be harvested in the same donor region as the operative site.

Development in Emergency Device of Live Deficiency Elimination for SF6 Electrical Equipment

With the increase in the operating life of SF6 gas insulation equipment, the issues of excessive SF6 micro-water content, its excessive decomposition products, and its decreased purity have serious repercussions for safe and stable equipment operation. The conventional treatment is affected by the power outage and cannot completely eliminate the deficiencies. A set of the SF6 online dialysis device that can be operated without power failure needs designing and processing to realize online purification of micro-water with ultra-standard SF6 gas and impurity gases in it; when the high-voltage equipment leaks and cannot be powered off, this device can automatically control the air supply to ensure the safe equipment operation and earn time for subsequent repairs. The lightweight design and self-loading and unloading configuration of this device can satisfy the needs of special operating environments and sites.

Tuning of Gene Expression in Clostridium phytofermentans Using Synthetic Promoters and CRISPRi.

Control of gene expression is fundamental to cell engineering. Here we demonstrate a set of approaches to tune gene expression in Clostridia using the model Clostridium phytofermentans. Initially, we develop a simple benchtop electroporation method that we use to identify a set of replicating plasmids and resistance markers that can be cotransformed into C. phytofermentans. We define a series of promoters spanning a >100-fold expression range by testing a promoter library driving the expression of a luminescent reporter. By insertion of tet operator sites upstream of the reporter, its expression can be quantitatively altered using the Tet repressor and anhydrotetracycline (aTc). We integrate these methods into an aTc-regulated dCas12a system with which we show in vivo CRISPRi-mediated repression of reporter and fermentation genes in C. phytofermentans. Together, these approaches advance genetic transformation and experimental control of gene expression in Clostridia.

MANAGEMENT OF PERMANENT LANDING AND TAKE-OFF AREAS NETWORK FOR HELICOPTER EMERGENCY MEDICAL SERVICES AND NATIONAL CRISIS MANAGEMENT

The aim of the article is to identify and describe the praxeological problem that for primary flights of Helicopter Emergency Medical Services and for fulfilling tasks within the national crisis management in emergency situations, we need to have a professionally managed and technologically secured network of permanent landing and take-off areas for helicopters, in the field and at the permanent centers of HEMS (or permanent airports). Technologies on these terrain landing areas are intended to improve the level of information security of helicopter flight crews, especially meteorological information for flights to "ad hoc" primary flight sites, or to use permanent terrain areas to bring a rescue team closer to the emergency operation site. The mentioned network is important for rescue helicopters, police, and air force helicopters for intervention in the field, in case of natural disasters, industrial accidents, or in solving the supervision of migratory waves, pandemic management in the region, etc. At the same time, these landing areas will guarantee the requirements for safe air traffic and the quality of the air services provided. The administration of the network of permanent landing areas for helicopters in the field can be co-financed in several sources, within the budget of the components of the integrated rescue system and crisis management of the state up to the share of funds from compulsory vehicle insurance in the relevant year, etc. Keywords: management, helicopters, medical services, crisis management.

Molecular mechanism of GylR-mediated regulation of glycerol metabolism in Streptomyces clavuligerus NRRL 3585.

Glycerol is a readily available and low-cost simple polyol compound, which can be used as a carbon source for microorganisms to produce various value-added products. Understanding the underlying regulatory mechanism in glycerol metabolism is critical for making better use of glycerol for diverse applications. In a few reported Streptomyces strains, the glycerol utilization gene cluster (glp operon) was shown to be regulated by the IclR family transcriptional regulator GylR. However, the molecular regulatory mechanism mediated by GylR has not been fully elucidated. In this study, we first analyzed the available Actinobacteria genomes in the NCBI Genome database, and found that the glp operon-like gene clusters are conserved in Streptomyces and several other genera of Actinobacteria. By taking Streptomyces clavuligerus NRRL 3585 as a model system, we identified that GylR represses the expressions of glp operon and gylR by directly binding to their promoter regions. Both glycerol-3-phosphate and dihydroxyacetone phosphate can induce the dissociation of GylR from its binding sequences. Furthermore, we identified a minimal essential operator site (a palindromic 18-bp sequence) of GylR-like regulators in Streptomyces. Our study for the first time reported the binding sequences and effector molecules of GylR-like proteins in Streptomyces. The molecular regulatory mechanism mediated by GylR presumably exists widely in Streptomyces. Our findings would facilitate the design of glycerol utilization pathways for producing valuable products. Moreover, our study provided new basic elements for the development of glycerol-inducible regulatory tools for synthetic biology research in the future.

Efficacy of single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis

ObjectiveWe aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis.MethodsFrom October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time.ResultsIn the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all < 0.05). No tuberculosis recurrence was found at the last follow-up, ESR and CRP returned to normal, and there were no statistically significant differences in bone graft fusion time, VAS score, ASIA scale, correction rate of kyphosis, and angle loss between two groups (P all > 0.05).ConclusionSingle-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications.

Fascia Repair with Vicryl Suture in Urologic Surgeries

Background: Closing the fascia after surgery should be quick, easy, and strong but comfortable for the patient. Polydioxanone thread is not available in Iran. Thus, we used Vicryl sutures for almost all patients. Methods: This study was conducted at Imam Reza and Imam Khomeini Medical Centers in Ardabil from January 2018 to January 2020. The fascia was continuously sutured with size 0 or 1 of Vicryl in a double layer for all patients in the Urology Department. Results: Here, 642 patients were evaluated in two years. The fascia suturing was at the site of the inguinal, midline Gibson, and flank areas. The data showed that incisional hernia and infection were more prevalent in obese and diabetic patients. We had no incisional complications in radical cystectomy or even kidney transplantation, which are complicated and time-consuming surgeries. Overall, the surgical site complication rate (including incisional hernia and surgical site infection) was 0.9%, which could be negligible. Conclusions: The fascia repair could be treated with Vicryl suture in a continuous form in all urologic surgeries, with a very low rate of wound infection and hernia at the operation site, sinus formation, and long-term surgical site discomfort. However, we suggest more research to confirm the Vicryl suture safety in urologic fascia repairs.

Real-World Outcomes of Emicizumab in Hemophilia A with or without FVIII Inhibitors from the Canadian Hemophilia Bleeding Disorder Registry

Background: Hemophilia A is a bleeding disorder characterized by deficiency or absence of blood coagulation factor (F)VIII, which leads to lifelong bleeding tendency. The Canadian Bleeding Disorders Registry (CBDR) is a clinical database designed to assist clinicians in Canadian hemophilia treatment centers with the management of people with bleeding disorders and gain a better understanding of their incidence and prevalence, their treatment patterns, outcomes, and safety. Emicizumab is a bispecific monoclonal antibody that bridges activated FIX and FX to substitute for missing activated FVIII in people with hemophilia A (PwHA), thereby restoring hemostasis. Emicizumab was approved by Health Canada for the treatment of PwHA with FVIII inhibitors in 2018, and for PwHA without FVIII inhibitors in 2019. In this non-interventional, secondary data use cohort study, we use data routinely collected by the CBDR to evaluate the effectiveness, safety, and treatment patterns of emicizumab in Canada. The study includes patients treated according to routine clinical practice; therefore, it reflects patterns of care and outcomes in the real world, outside of the experimental setting. Methods: We retrieved de-identified data from the CBDR database of all registered PwHA who had received emicizumab at least once prior to December 31, 2021. Baseline demographic characteristics, including sex, body mass index, FVIII inhibitor status, emicizumab regimen, and immune tolerance induction (ITI) while receiving emicizumab were stratified by disease severity (defined by the level of endogenous FVIII activity) and age. Real-world efficacy outcomes were measured by the proportion of patients with zero traumatic, spontaneous, or joint bleeds as well as annualized bleeding rates (ABR) for any treated bleed. ABRs were calculated as (total number of bleeds/duration of follow-up [days])*365.25. Efficacy outcomes also included patients’ Hemophilia Joint Health Score (HJHS), Patient Reported Outcomes Burdens and Experiences (PROBE), and EQ-5D index and visual analog scale (VAS) scores. We performed a complete data analysis, without imputation. Intra-patient comparisons of bleeding were performed for all patients This study was approved by the research ethics board of McMaster University and other participating centers, and abides by the guiding principles of the Declaration of Helsinki. Results: In total, 146 PwHA received emicizumab at least once up to December 2021 in the CBDR database. The median (Q1, Q3) age at initiation of emicizumab was 13.9 (6.7, 28.7) years; 58.9% (n=86) of PwHA were ≤18 years (Table 1). Overall, 132 PwHA had severe disease, 10 had moderate disease, and 4 had mild disease. In total, 40.4% (n=59) of PwHA had current FVIII inhibitors, 15.1% (n=22) had a history of FVIII inhibitors, and 44.5% (n=65) had no history of inhibitors; 4.1% (n=6, all with severe HA) received ITI while on emicizumab. Three adverse events were reported during 2021, including two allergic reactions and one case of large hematoma at the operative site following removal of a port-a-cath. No thromboembolisms or thrombotic microangiopathies were reported. Over a median follow-up of 389.0 days, 76.7% (n=112) of PwHA had no recorded bleeds (Table 2). For the 34 patients with recorded bleeds on emicizumab, median (Q1, Q3) ABR was 1.0 (0.5, 2.0); 13 of the 34 had joint bleeds, 18 had traumatic bleeds, and 19 had spontaneous bleeds. An intra-patient comparison in all PwHA (n=146) showed a decrease in mean (95% confidence interval [CI]) ABR from 2.38 (1.77-3.22) pre-emicizumab (2018, prior to first dose) to 0.36 (0.24-0.53) post-emicizumab (rate ratio [RR] 0.15, p<0.0001). In PwHA with bleeds before or after initiation of emicizumab (n=97), mean (95% CI) ABR decreased from 5.31 (3.79-7.45) pre-emicizumab to 0.87 (0.58-1.32) post-emicizumab (RR 0.16, p<0.0001). Conclusions: This analysis describes the baseline characteristics, bleed outcomes, and safety of Canadian PwHA treated with emicizumab before December 31, 2021. The majority had severe disease and current or historical FVIII inhibitors. The data show 76.7% had no recorded bleeds and there was a substantial decrease in bleeds post-emicizumab. The CBDR allows for a longitudinal follow-up of the Canadian hemophilia A population, which can inform healthcare practitioners and regulatory authorities of the real-world safety and effectiveness outcomes of treatments. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effects of NGF and Photobiomodulation Therapy on Crush Nerve Injury and Fracture Healing: A Stereological and Histopathological Study in an Animal Model.

A stereological and histopathological study in an animal model. This study explores the effects of the nerve growth factor and photobiomodulation therapy on the damaged nerve tissue and fracture healing. A total of 24 rabbits were divided into 4 groups: control group (n = 5), nerve growth factor (NGF) group (n = 7), photobiomodulation (PBMT) group (n = 6), and nerve growth factor and photobiomodulation therapy (NGF+PBMT) group (n = 6). The vertical fracture was performed between the mental foramen and the first premolar, and the mental nerve was crushed for 30 seconds with a standard serrated clamp with a force of approximately 50N in all groups. The control group received an isotonic solution (.02mL, .09% NaCl) to the operation site locally. The NGF group received 1μg human NGF-β/.9% .2mL NaCl solution for 7 days locally. The PBMT group received PBMT treatment (GaAlAs laser, 810nm, .3W, 18J/cm2) every 48 hours for 14 sessions following the surgery. The NGF+PBMT group received both NGF and PBMT treatment as described above. After 28 days, the bone tissues and mental nerves from all groups were harvested and histologically and stereologically analyzed. According to the stereological results, the volume of the new vessel and the volume of the new bone were significantly higher in the PBMT group than in other groups (P < .001). According to the histopathological examinations, higher myelinated axons were observed in experimental groups than in the control group. As a result, PBMT has beneficial effects on bone regeneration. Based on the light microscopic evaluation, more regenerated axon populations were observed in the NGF group than in the PBMT and PBMT + NGF groups in terms of myelinated axon content.

Fouling and Slagging Investigation on Ash Derived from Sasol Coal Using ICP and XRF Analytical Techniques

During coal combustion in boilers, light fly ash particles are carried away along with the hot flue gases and the heavier bottom ash particles fall to the bottom of the boiler. The fly ash particles stick on the convective heat transfer surfaces and the furnace wall, causing fouling and slagging deposition problems during the boiler operation. The fouling and slagging effect reduces the boiler’s operational efficiency. This study was motivated by the decline in the operational efficiency of the installed boilers at Sasol synfuel operations in Secunda, Mpumalanga province in the Republic of South Africa. It was assumed that the drop in the boiler efficiency was caused by the coal ash deposition during the boiler operations. The rate of ash deposition and accumulation in the convective heat transfer tubes and furnace water walls during the boiler operation depends on the chemical composition of the coal ash produced during combustion. Coal fly and bottom ash samples were collected from the operational site for laboratory analysis to determine their chemical composition using induced coupled plasma optical emission spectroscopy, induced coupled plasma mass spectroscopy (ICP-OES, ICP-MS) and X-ray fluorescence (XRF) analytical methods. The major, minor and trace elements by mass (%) in the ash samples were obtained from the ICP-OES and ICP-MS, whereas the elemental composition in an oxidised atmosphere was obtained from the XRF analysis. The amount of unburnt coal particles within the ash samples was determined from the loss on ignition (LOI) test. The fouling and slagging prediction during Sasol boiler operation was evaluated using previously developed fouling and slagging indices as a guide using the analysed ash chemical composition results obtained in this study. It was concluded from the analysed results using the guided evaluated indices from the analysed coal ash chemistry that during the operations of Sasol boiler(s) there is a low to medium fouling prediction occurrence on the convective heat transfer tubes and a low slagging in the boiler furnace walls.