Original Operation Research Articles

Missed aortic valve endocarditis resulting in complete atrioventricular block and redo aortic valve replacement

BACKGROUND: Infective endocarditis is a rare disease associated with high morbidity and mortality. As a result, early diagnosis, prompt antibiotic treatment with or without surgical intervention is crucial in the management of such a condition. CASE REPORT: We report a case of missed infective endocarditis of the aortic valve. The patient underwent mechanical aortic valve replacement, with the native valve sent for histopathological analysis. On re-admission with syncope and shortness of breath he was noted to have complete heart block and severe aortic regurgitation and paravalvular leak. DISCUSSION: On review of the histopathology, endocarditis was identified which had not been acted upon at the original operation. The patient underwent redo aortic valve replacement with insertion of a permanent pacemaker and treatment with appropriate antibiotics. CONCLUSION: We highlight the importance of following up histopathological results as well as the need for multidisciplinary treatment of endocarditis with a combination of surgical and antibiotic therapy.

Normal Postoperative Computed Tomography Findings after a Variety of Pancreatic Surgeries.

Pancreatic surgery remains the only curative treatment for pancreatic neoplasms, and plays an important role in the management of medically intractable diseases. Since the original Whipple operation in the 20th century, surgical techniques have advanced, resulting in decreased postoperative complications and better clinical outcomes. Normal postoperative imaging findings vary greatly depending on the surgical technique used. Radiologists are required to be familiar with the normal postoperative imaging findings, in order to distinguish from postoperative complications or tumor recurrence. In this study, we briefly review a variety of surgical techniques for the pancreas, and present the normal postoperative computed tomography findings.

Evaluation of life extension by migrating the legacy TTS to be under HLA architecture

Numerous military existing simulation systems are faced with the phenomenon of aging, resulting in high maintenance costs and system instability issues. It would be expensive and risk in their retirement life extension and interoperability. The aim of this study was to analyse the aging tactical training simulation (TTS) system, to seek a way to transfer it under the HLA architecture to achieve, not only prolong life, but also gives interoperability. TTS assessment process including the restoration of the original structure and operation of the process, introduce the concept of HLA in the analysis of defects and ways to improve their TTS architecture such as replacing TTS_MANAGER module. We must complete upgrades as the main body of the TTS with HLA trunk: internal system of communication and APP modules. This study provides military traditional simulation systems solutions, and paved the way for the creation of synthetic battlefield environment, can benefit military training, planning, procurement and resource allocation scheme.

Jejunogastric intussuception presenting as an epigastric mass: A rare case report

Jejunogastric intussusception is a potentially lethal complication of gastric surgery intussusceptions that can occur in any patient who has had a gastrojejunostomy. The diagnostic triad consists of high intestinal obstruction, left hypochondriac mass and hematemesis. On abdominal examination there may be left upper quadrant tenderness and guarding, and occasionally a mass may be felt. Often the mass is concealed by the rib cage and the guarding. Because the lesion is intraluminal, there is no peritoneal irritation and ileus is a late sign. This complication may occur at a variable period after original gastric operation. The treatment of acute variety of jejunogastric intussusception is prompt surgery. Delay in surgery beyond 48 hours is associated with an approximately 50% mortality.

Operation Mode Study in Cloud Manufacturing Ecosystem

With cloud manufacturing and its shared big-data, the life-cycle management of the massive distributed manufacturing resources can be considered as an ecosystem, in which every entity makes their own decisions depend on the enriched information, which will affect the life cycle of the resources and the overall industry states. In this paper, an original operation mode with three extensions are proposed to describe the life cycle vicissitude of each resource. An agent-based model was designed to simulate the ecosystem modes from the very beginning, and the results show that the ecosystem has: 1) shorter job queue length and lower resource idle rate with incubation mode; 2) a little shorter job queue length and fewer amount of registered resource with outsourcing mode; 3) the fewest amount of registered resource but a little higher resource idle rate with metabolism mode.

Based on Flex to Design the Automatic Scoring System of Flash Operation Questions

The use of Flex technology carried out the parsing of the SWF file for the Flash operation problem, to analyze and extract the internal data feature about the SWF file, to reverse the inference to revert the original operation on the Flash. The result will be compared with the requested operation to determine whether to meet the requirement or not. Then the score about the Flash opescoring problem will be given automatically.

A partially delay‐dependent and disordered controller design for discrete‐time delayed systems

SummaryThis paper considers the stabilization problem for a class of discrete‐time delayed systems by exploiting a partially delay‐dependent controller whose gains suffer a disordering phenomenon simultaneously. Two stochastic variables are used to describe the partially delay‐dependent and disordering properties, which are not independent, and referred to the original operation modes here. By introducing an augmented Markov chain, the corresponding closed‐loop system is transformed into a Markovian jump system with four new operation modes (NOMs). Based on the proposed model, a kind of controller depending on NOMs is firstly proposed with linear matrix inequalities forms. Moreover, without designing a controller containing NOMs directly, another kind of stabilizing controller referring to one depending on original operation modes is developed, which is composed of a series of NOM‐dependent controllers and satisfies a minimum variance approximation. Finally, two numerical examples are used to demonstrate the utility and superiority of the proposed methods. Copyright © 2016 John Wiley & Sons, Ltd.

CancerSurvivorship: Defining the Incidence of Incisional Hernia After Resection for Intra-Abdominal Malignancy.

Cancer survivorship focuses largely on improving quality of life. We aimed to determine the rate of ventral incisional hernia (VIH) formation after cancer resection, with implications for survivorship. Patients without prior VIH who underwent abdominal malignancy resections at a tertiary center were followed up to 2years. Patients with a viewable preoperative computed tomography (CT) scan and CT within 2years postoperatively were included. Primary outcome was postoperative VIH on CT, reviewed by a panel of surgeons uninvolved with the original operation. Factors associated with VIH were determined using Cox proportional hazards regression. 1847 CTs were reviewed among 491 patients (59% men), with inter-rater reliability 0.85 for the panel. Mean age was 60±12years; mean follow-up time 13±8months. VIH occurred in 41% and differed across diagnoses: urologic/gynecologic (30%), colorectal (53%), and all others (56%) (p<0.001). Factors associated with VIH (adjusting for stage, age, adjuvant therapy, smoking, and steroid use) included: incision location [flank (ref), midline, hazard ratio (HR) 6.89 (95%CI 2.43-19.57); periumbilical, HR 6.24 (95%CI 1.84-21.22); subcostal, HR 4.55 (95%CI 1.51-13.70)], cancer type [urologic/gynecologic (ref), other {gastrointestinal, pancreatic, hepatobiliary, retroperitoneal, and others} HR 1.86 (95%CI 1.26-2.73)], laparoscopic-assisted operation [laparoscopic (ref), HR 2.68 (95%CI 1.44-4.98)], surgical site infection [HR 1.60 (95%CI 1.08-2.37)], and body mass index [HR 1.06 (95%CI 1.03-1.08)]. The rate of VIH after abdominal cancer operations is high. VIH may impact cancer survivorship with pain and need for additional operations. Further studies assessing the impact on QOL and prevention efforts are needed.

Three-dimensional printing technology for treatment of intracranial aneurysm

The development of three-dimensional (3D) printing technology provides a new method for surgical treatment, but currently there are few reports on its application in the treatment of aneurysm. The aim of the present study was to explore the materials and methods of fabricating 3D printed individual aneurysm model and its value in the treatment of intracranial aneurysm. Twenty-four patients with intracranial aneurysm diagnosed by CTA who had undergone operation in our hospital were analyzed retrospectively. CTA Data collected at the time of surgery was used for reconstruction. Soft Mimics 17.0 was used to reconstruct the thin layer CTA scan data into 3D image and the final data was sent to the 3D printer for fabricating the model. We compared the proposed 3D printed model-based preoperative plan and the actual approach used in the surgery based on CTA data to evaluate the value of the 3D printed model in preoperative planning, and picked out the materials which were more suitable for the clinic. Twenty-four aneurysm models with high degree of reality were fabricated successfully with 3D-printing technology. The patients’ blood vessels, skulls and aneurysms were printed into the reality model at a ratio of 1:1. It is reported that the soft material-based, 3D printed vascular and aneurysm model more closely resembled the characteristics of the real blood vessels, thus provides a better simulation compared to the plaster-based model. Compared with the original operation plan, 3D printed model could be used for pre-operative aneurysm clip selection, and provide more intuitive information in selection of operational approach. 3D printed model can be used as an operational physical model to design operative schemes, choose the best operative paths and select suitable aneurysm clips by its high simulation degree and individualized characteristics. The model is helpful for surgical planning, especially for the preoperative plan of treating refractory multiple aneurysms and giant aneurysms.

Tracheostomy decannulation at the Royal Hospital for Sick Children in Glasgow: Predictors of success and failure

BackgroundTracheostomy techniques, indications and care are extensively covered in the literature. However, little is written about the process of removing the tracheostomy tube. At the Royal Hospital for Sick Children in Glasgow we use a stepwise ward-based protocol for safe tracheostomy decannulation. Our aim therefore was to review all the paediatric tracheostomy decannulations that we attempted over the last 3 years to evaluate our protocol, to determine our success rate and to see whether any modifications to the protocol are required. MethodWe reviewed all patients who had undergone ward decannulation between January 2012 and May 2015. We extracted data from clinical records including patient characteristics, indications for tracheostomy, timing of decannulation and success or failure of the process. ResultsThe 45 children in the study underwent 57 attempts at decannulation during the study period. 25 were male (56%) and 20 were female (44%), and they were aged between 1 day and 16 years 6 months at the time of the original tracheostomy operation. 33 attempts were successful (58%). 10 children had more than one attempt at decannulation. Children were found to fail at every stage of the protocol, with the commonest point of failure being day 2 when the tracheostomy tube was capped. DiscussionWe have demonstrated that our current protocol for ward decannulation is effective and safe, and that all five days of the protocol are required.

A Survey of Public Auditing for Shared Data Storage with User Revocation in Cloud Computing

Cloud computing technology has matured, so cloud computing produces a wide range of cloud service. Cloud storage services are one of cloud services where cloud service provider can provide storage space to customers. Because cloud storage services bring a lot of convenience, many enterprises and users store the data to the cloud storage. However, the user will outsource data to the cloud storage service, but the user is difficult to manage remote data in the cloud. Therefore, how users verify data integrity is a major challenge. In recent years, public audit is used to verify data integrity by which the user allows other to verify the user's data. Because the feature of cloud service allows users to communicate with each other on the cloud platform, the cloud storage service allows the data owner to share their data to other users. Therefore, public auditing extends to the share data, so the original operation becomes not the same including signature, public audits, dynamic data and user revocation which generates on the situation of shared data. In the paper, we define the requirements of public auditing with shared data and explain four representative approaches which include analysis function, security, and performance requirements. Finally, we provide some topics for future research.

Optimizing bus services with variable directional and temporal demand using genetic algorithm

As a major mode choice of commuters for daily travel, bus transit plays an important role in many urban and metropolitan areas. This work proposes a mathematical model to optimize bus service by minimizing total cost and considering a temporally and directionally variable demand. An integrated bus service, consisting of all-stop and stop-skipping services is proposed and optimized subject to directional frequency conservation, capacity and operable fleet size constraints. Since the research problem is a combinatorial optimization problem, a genetic algorithm is developed to search for the optimal result in a large solution space. The model was successfully implemented on a bus transit route in the City of Chengdu, China, and the optimal solution was proved to be better than the original operation in terms of total cost. The sensitivity of model parameters to some key attributes/variables is analyzed and discussed to explore further the potential of accruing additional benefits or avoiding some of the drawbacks of stop-skipping services.

Is weekend surgery a risk factor for post-tonsillectomy haemorrhage?

Tonsillectomy is a common, low-risk procedure. Post-tonsillectomy haemorrhage remains the most serious complication. Recent nationwide studies in the UK have identified an increased morbidity and mortality for both high-risk and low-risk elective general surgery performed at the weekend. Data for tonsillectomies performed at a district general hospital over a three-year period were retrospectively reviewed. The same group of surgeons performed elective tonsillectomies on both weekends and weekdays. All patients who developed a post-tonsillectomy haemorrhage were identified and the day of original operation was noted. Between 2010 and 2013, 2208 (94.00 per cent) elective tonsillectomies were performed on a weekday and 141 (6.00 per cent) were performed on the weekend. Post-tonsillectomy haemorrhages occurred in 104 patients (4.71 per cent) who underwent their procedure on a weekday and in 10 patients (7.09 per cent) who had their surgery at the weekend (p = 0.20). There is no difference in the rate of post-tonsillectomy haemorrhage for procedures performed on a weekday or weekend.

Clinical research and surgical treatment of Hashimoto's disease complicated with papillary thyroid carcinoma

Objective:To analyze the clinical characteristics of Hashimoto's disease complicated with papillary thyroid carcinoma and research surgical treatment and Hashimoto's disease's effect to papillary thyroid carcinoma. Method:Three hundred and twelve cases of papillary thyroid carcinoma were retrospectively reviewed. Among 70 cases of papillary thyroid carcinoma associated Hashimoto's disease (the observation group), 242 cases of single papillary thyroid carcinoma (the control group). Result:The observation group compared with the control group, there was a significant difference in gender, tumor size, thyroid antibody level and the lymph node metastasis, with statistical significance (P<0.05). Conclusion:Hashimoto's disease is a kind of protective factors of thyroid papillary carcinoma, Hashimoto's disease with coexistent papillary thyroid carcinoma is smaller in tumor diameter and have lower lymph node metastasis. Surgery takes the original operation primary radical and central lymph node dissection, try to avoid the preventive side neck lymph node dissection.

Gastric bypass reversal: a 7-year experience

BackgroundAfter gastric bypass, some patients develop conditions that ultimately require reversal of the bypass. There are currently few publications on the topic to guide clinicians. ObjectivesTo describe the indications, techniques, and outcomes for gastric bypass reversal. SettingTwo academic medical centers. MethodsWe conducted a retrospective chart review of all patients who underwent gastric bypass reversal at our institutions between 2008 and 2015. Information regarding the original operation, the indications for reversal, procedures performed, and the postoperative outcomes were collected and analyzed. ResultsNineteen patients underwent gastric bypass reversal. All but 4 reversal operations were performed laparoscopically. The indications for reversal were malnutrition or excessive weight loss (6 patients); chronic nausea, vomiting, and abdominal pain (5); neuroglycopenia (4); massive small bowel loss due to internal hernia (3); and need for surveillance gastric endoscopy (1). In the perioperative period, 4 patients had a complication that required intervention. Five patients required additional delayed procedures. One patient was lost to follow-up. The remaining patients’ mean follow-up was 22±18 months. Symptoms that prompted reversal of the gastric bypass resolved in the majority of patients. However, 1 patient’s hypoglycemia did not resolve and 2 continued to have diarrhea. Six patients were weaned off of total parenteral nutrition. ConclusionsLaparoscopic gastric bypass reversal is feasible and well tolerated. The procedure can be employed to treat a variety of conditions that may occur after gastric bypass and the majority of patients benefit, with resolution of symptoms. In a carefully selected patient population, gastric bypass reversal should be considered if conservative approaches to adverse conditions fail.

The original Operation Twist: the War Finance Corporation's war bond purchases, 1918–1920

In 1918 the United States Treasury delegated to the War Finance Corporation, a newly created off-budget federal agency, the task of buying Liberty bonds and later Victory notes in an effort to stabilize prices. Bayesian vector autoregression analysis of the security purchases indicates that the WFC purchases provided statistically significant price support, and marginally lowered bond yields while the program operated. Once WFC purchases ended, war bond yields increased substantially. Between bond issues, the Treasury financed its operations, including security purchases from the WFC, by issuing short-term debt, which affected the money market interest rate. The WFC's bond purchases are found to have a positive and significant impact on the call loan rate. Thus the WFC's bond purchases twisted the yield curve.

Osteosinteza „în dublu X“ tip Burnei în fracturile supracondiliene de humerus la copil

Pediatric Orthopaedics Group for Research and Study – 2012 has initiated this retrospective analysis because in Romania, but also in other countries, the therapy procedures, although in great number, do not provide practicing physicians with a clear orientation according to certain therapeutic criteria in the treatment of supracondylar fractures of the humerus. As a consequence, the number of complications and their severity have drawn attention over existing lack of knowledge in the medical or surgical act. To correct complications, valgus and varus elbow, Prof. Al. Pesamosca announced an original operation entitled „Personal method in correction of varus post-traumatic elbow“ in Bacau County Meeting of 24 June 1978. This operation was later popularized by Gh. Burnei &amp; al. with surgical interventions in patients with varus or valgus post-traumatic elbow and then presented at several congresses in the country and abroad. The last work that addressed this subject was presented at the 29th Annual Congress of the European Pediatric Orthopedic Society (EPOS) from 7 to 10 April 2010, Zagreb, Croatia, and is entitled „Distal humeral Z-osteotomy for posttraumatic cubitus varus or valgus“ having authored by Gh. Burnei, Ileana Georgescu, Stefan Gavriliu, Costel Vlad and Daniela Dan. As members of this group, based on studies we made, we want to popularize a new type of osteosynthesis, which ensures a snug fit, avoids complications, and allows rapid recovery after surgery. The best approach to this kind of fractures is orthopedic and must be carried out urgently, in the first 6 hours by reduction and immobilization in a cast, or by closed or open reduction with fixation using multiple methods (Judet, Boehler, Kapandji, San Antonio, San Diego, double-X Burnei). Open treatment is necessary in supracondylar irreducible, reducible and unstable fractures, in supracondylar fractures occurring within multiple accidental trauma, in fractures with vascular complications, in unreasonably delayed, fractures, in orthopaedically managed fractures which have displaced under cast, or in surgically treated fractures where fixation is damaged. We use Burnei technique for about 10 years. Here in Romania, great work has been done in this field by Al. Pesamosca, D. Vereanu, Ionel Ionescu, N. Negus, Pompiliu Parota, T. Zamfir, Gh. Burnei, I. Hutanu, etc. Abroad, important papers on the treatment of supracondylar fractures of the humerus have been published by L. Böhler, A. Kapandji, K. Wilkins, D. Skaggs, E. Edomnds, E. Swanson, etc. Between October 2001 and October 2011 in „Alexandru Pesamosca“ Surgery Clinic, 56 cases have been resolved with the help of Burnei’s „double-x“ osteosynthesis. These patients were operated using Kocher type unique approach, the intervention beeing primarily aimed at providing osteosynthesis that is not followed by immobilization in a cast and also enabling mobilization 24 hours after surgery. Wires placed in „double-X“ should not sit olecranon fossa. Immobilization must be anatomical and olecranon fossa must be free. After surgical intervention, check elbow flexion and extension which should be normal, without providing crackles or limitations. This intervention was done in patients: having secondary displacement in plaster after 10 days of immobilization; with other types of damaged osteosynthesis; with polytrauma with supracondylar fracture; who neglected or unjustifiedly delayed fractures that were not orthopaedically reduced in emergency and had swelling and blistering. Using Burnei’s „double-X“ osteosynthesis in supracondylar humerus fractures, does not require cast immobilization. In oblique trajectory fractures, the stability of the fracture by reduction, with or without wiring, is ensured more difficultly and often followed by joint stiffness and/or ulnar nerve paresis. Burnei’s „double-X“ osteosynthesis provides stability to such fractures and avoids complications. Mobilization of the elbow may begin immediately after surgery. The process provides comfort to the patient and doctor and if multiple injuries require repeated exams, preferred positions or care of extensive lesions of the skin.

Rediseño del modelo de defensa penitenciaria para adultos privados de libertad en el nuevo sistema procesal penal

El presente estudio de caso tiene como objeto central rediseñar aspectos del “Programa de Defensa Penal Pública Penitenciaria” a partir de un análisis de su diseño original y funcionamiento actual, utilizando la metodología de marco lógico. La pregunta de investigación busca revisar si este programa contribuye a fortalecer el acceso a la justicia de las personas condenadas privadas de libertad. El estudio se desarrolló a través de la realización y posterior análisis de entrevistas a los actores claves del programa provenientes de la Defensoría Penal Pública y de Gendarmería de Chile. La visión de ambas instituciones resulta fundamental en la detección de los problemas y aciertos en la implementación del programa a fin de poder proponer algunos cambios y mejoras. Asimismo, se realizó un taller con condenados y se analizaron entrevistas de percepción de usuarios en las tres regiones en funcionamiento, con el propósito de poder contar con la percepción de los beneficiarios de este programa.

Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don't tell, they won't know

OBJECTIVES:This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control.METHOD:This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911.RESULTS:Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery.CONCLUSIONS:If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.

Angiomatoid fibrous histiocytoma

Angiomatoid fibrous histiocytoma[AFH] is a rare soft tissue tumour most commonly occurring in children, adolescents, and young adults. It is considered to be a tumour of intermediate malignancy because of its less aggressive course in contrast to conventional malignant fibrous histiocytoma[MFH]. It accounts for approximately 0.3% of soft-tissue neoplasms. The majority of cases occur in the extremities, are slow growing and are typically painless. We report a case of AFH on the scalp of a 40-year old man, locally recurring within two years of the original operation. AFH is a rare condition with the potential of local recurrence and metastasis. It should be considered in the differential diagnosis of a soft tissue mass in a child or adolescent.