Operative Outcomes Research Articles

Enhanced ovarian cancer survival prediction using temporal analysis and graph neural networks

Ovarian cancer is a formidable health challenge that demands accurate and timely survival predictions to guide clinical interventions. Existing methods, while commendable, suffer from limitations in harnessing the temporal evolution of patient data and capturing intricate interdependencies among different data elements. In this paper, we present a novel methodology which combines Temporal Analysis and Graph Neural Networks (GNNs) to significantly enhance ovarian cancer survival rate predictions. The shortcomings of current processes originate from their disability to correctly seize the complex interactions amongst diverse scientific information units in addition to the dynamic modifications that arise in a affected person`s nation over time. By combining temporal information evaluation and GNNs, our cautioned approach overcomes those drawbacks and, whilst as compared to preceding methods, yields a noteworthy 8.3% benefit in precision, 4.9% more accuracy, 5.5% more advantageous recall, and a considerable 2.9% reduction in prediction latency. Our method’s Temporal Analysis factor uses longitudinal affected person information to perceive good-sized styles and tendencies that offer precious insights into the direction of ovarian cancer. Through the combination of GNNs, we offer a robust framework able to shoot complicated interactions among exclusive capabilities of scientific data, permitting the version to realize diffused dependencies that would affect survival results. Our paintings have tremendous implications for scientific practice. Prompt and correct estimation of the survival price of ovarian most cancers allows scientific experts to customize remedy regimens, manipulate assets efficiently, and provide individualized care to patients. Additionally, the interpretability of our version`s predictions promotes a collaborative method for affected person care via way of means of strengthening agreement among scientific employees and the AI-driven selection help system. The proposed approach not only outperforms existing methods but also has the possible to develop ovarian cancer treatment by providing clinicians through a reliable tool for informed decision-making. Through a fusion of Temporal Analysis and Graph Neural Networks, we conduit the gap among data-driven insights and clinical practice, proposing a capable opportunity for refining patient outcomes in ovarian cancer management operations.

Routine single-incision laparoscopic common bile duct exploration with concomitant cholecystectomy for elderly patients: a 6-year retrospective comparative study.

While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012-June 2016 and July 2018-July 2020). Forty patients with an age of 65years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p < .001), longer total hospital stay (p < .001), higher procedural conversion rate (p < .05), higher complication rate (p < .001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien-Dindo grade I. Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated.

A novel underactuated smart surface for parts feeding and sorting

In material handling, numerous solutions have been proposed to enhance the flexibility and adaptability of transport systems. Among these solutions, smart surfaces stand out as one of the most interesting responses, utilizing an array of actuators for common feeding tasks. The current paper focuses on a novel system within this category, notable for its distinguishing factor of being underactuated. With this characteristic, the concept leads to a simplified cost-effective design and a not actively driven functioning, leveraging gravity or object own velocity to manipulate the material flow maintaining top class performances, as the sorting rate reaches 4000 pcs/h. Specifically, the article begins with an introduction of the concept design and its digital model, followed by a description of the experimental setup built to test the surface’s functionality and evaluate the predictions of the virtual counterpart. On top of that, a method to determine the essential parameters for the surface simulation is proposed and applied. As a result, the prototype successfully completed the three main intralogistic tasks experimented, i.e., sorting, slowing, and stopping of packages. Lastly, the digital model outcomes of the same operations were computed and compared with the measured results, demonstrating an accuracy of prediction with displacements and time errors below 7%.

Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and prior abdominal surgery and outcomes.

Peritoneal dialysis (PD) is associated with comparable outcomes to hemodialysis and is much less expensive to provide in most parts of the world. A well functioning PD catheter is required, but complications are frequent, and while there are guidelines for the placement and care of a PD access, they are based on low-quality evidence. Data reporting the outcomes of percutaneous, as compared to surgical pathways for placement of catheters and the role of operator type in determining outcomes are examined. The impact of prior abdominal procedures on patient selection and the prognostic importance of the presence of adhesions at the time of catheter insertion are reviewed. There are conflicting data about the relative merits of percutaneous as compared to surgical placement of catheters that may relate to differences in patient selection, operator experience, or operator volume. Prior abdominal procedures are not associated with worse PD catheter outcomes and likely should not influence patient selection, except in exceptional circumstances. Finally, the presence of adhesions is associated with a higher risk of complications. However, even in the presence of adhesions, the termination of PD therapy and need for re-intervention occurs in <20% of patients.

Outcomes and Management of Dislocated Hip Hemiarthroplasty.

Purpose and aims Hip hemiarthroplasty (HHA) is a common procedure undertaken to manage intracapsular neck of femur fractures. Dislocation of HHA is one of the most dreadful complications. There is a paucity of clinical evidence to guide decision-making for managing these patients. The aim of this study was to describe the operative management and outcomes of patients with dislocated hemiarthroplasties of the hip and outline a treatment strategy for their management. Methods We conducted a retrospective analysis of all the patients presenting to University Hospitals of Derby and Burton, UK with hip fractures between 2016-2022. We included all the patients who underwent a hemiarthroplasty for their fracture. We excluded patients who had malignancy and if clinical data was missing. Each operative intervention and subsequent dislocationswere recorded. We recorded the following outcome measures: dislocation, surgical interventions, mortality, revision surgery, cognition status, residential status, and mobility. We also compare these outcomes with the patients who had HHA and did not sustain any dislocation. Results Of the 1134 patients treated with HHA during this period, 33 patients sustained dislocation. Of the 33 patients, 29 were female and 4 were male with mean ages of87.4±7.4 and89.25±9.54,​ respectively. Following the first dislocation, 25 patients were treated with closed reduction, six patients had excision arthroplasty (EA), and two patients were treated non-operatively. About 21 patients went on to have second and third dislocations, none of these had EA and others had conversion to total hip replacement (THR). Nearly 80% of dislocations occurred within two months of the initial procedure. The mean mental test score was 7.91±2.01 (p=0.001) and was significantly higher in patients who underwent conversion to THR. The average ASA grade was significantly higher in patients who had closed reduction (2.93±0.25, p=0.001)and EA (3.28±0.46, p=0.002)compared to the patients who had no dislocation. Patients who underwent EA had significantly higher acute length of hospital stay23.5±13.5(p=0.02) and mortality (p=0.001)compared to other groups. We found no significant difference in dislocation rates where the initial procedure was carried out by registrars or consultants (p=0.567). Conclusion We concluded that the dislocation risk is higher in females and within the first two months of the index procedure. More than 80% of patients had a second dislocation following a successful closed reduction. In our cohort, 45% of patients had EA (Girdlestone procedure) and 36% had a conversion to THR. EA was associated with increased mortality rates, acute length of hospital stays, and significant change to premorbid mobility status. Amultidisciplinary team (MDT) approachis necessary following the second dislocation to prevent further morbidity associated with recurrent dislocations.

The Role of WHO Surgical Checklists in Reducing Postoperative Adverse Outcomes: A Systematic Review.

Surgical safety remains a critical aspect of modern healthcare, particularly as the number of surgical procedures continues to rise, placing greater demands on resources and increasing the potential for errors. In response to this challenge, various mitigation strategies have been implemented to improve operative outcomes. One such strategy, introduced by the WHO in 2008, is the Surgical Safety Checklist. Despite its widespread adoption globally, its acceptance remains limited in developing countries. This systematic review aimed to evaluate the impact of the WHO Surgical Safety Checklist, specifically the sign-in, time-out, and sign-out components, on reducing post-operative adverse effects in surgical patients. A single-step search strategy was employed across multiple databases, including Medline, CINAHL, Embase, Cochrane Database, ProQuest, Index Copernicus, Google Scholar, and Scopus. Additionally, reference lists of identified reports and articles were manually searched to identify further relevant studies. Only studies published in English before September 2022 that focused exclusively on the WHO Surgical Safety Checklist were included. Studies on other checklists or those with confounding factors, such as international surgical outcomes studies, were excluded from this analysis. After screening 17,821 publications based on their titles and abstracts, 93 studies met the initial inclusion criteria and underwent full retrieval and assessment for methodological quality. Ultimately, 13 studies were deemed of sufficient quality to be included in the review. Among these, 10 studies reported outcomes related to complication rates, with nine of them demonstrating a decrease in complication rates following checklist implementation. Similarly, 13 studies reported outcomes related to mortality rates, with 12 reporting a decrease in mortality rates associated with checklist use. In conclusion, the application of the WHO Surgical Safety Checklist has been shown to improve surgical outcomes by reducing post-operative adverse effects, including mortality and complication rates. However, further research is warranted to assess the checklist's impact on the quality of life of surgical patients, which would contribute to enhancing its overall acceptability. Continued investigation into these areas will help further strengthen the evidence supporting the widespread adoption and effective implementation of the WHO Surgical Safety Checklist across diverse healthcare settings globally.

Community Engagement in BUMDes PUJA BERSINAR Management Practices

Background: This study explores the critical role of village-owned enterprises (BUMDes) in improving community welfare through effective management. Specific Background: It focuses on the management of BUMDes Puja Bersinar and the challenges it encounters. Knowledge Gap: There is limited understanding of the practical implementation of oversight frameworks in BUMDes, particularly regarding community involvement and transparency. Aims: The study aims to analyze the management practices and barriers of BUMDes Puja Bersinar. Results: Findings reveal that while oversight mechanisms exist, challenges such as insufficient internal audits and limited community engagement hinder effective management. Novelty: This research provides new insights into the operational dynamics of BUMDes, emphasizing the need for better participatory practices. Implications: Enhancing financial report transparency and establishing community feedback forums could significantly improve BUMDes management and promote sustainable community welfare outcomes. Highlights : Effective management of BUMDes is crucial for community welfare improvement. Challenges include inadequate internal audits and limited community participation. Enhancing transparency and feedback mechanisms can lead to better operational outcomes. Keywords: BUMDes, community welfare, management practices, transparency, oversight

Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction.

Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of post-operative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss. A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009-2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fischer exact and t-tests for discrete and continuous variables, respectively. Intraoperative complications were analyzed for 1465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90% vs 0.44%, p=.03) and alternate venous outflow (14.29% vs 0.41%, p=.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80% vs 0.51%, p=.001), venous revision (5.45% vs 0.57%, p=.007), intraoperative thrombosis (12.12% vs 0.49%, p<.001), and difficult flap dissection (2.91% vs 0.59%, p=.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80% vs 1.69%, p=.004). Late total flap loss only occurred in 6/1465 flaps, the sole association being difficult recipient vessel dissection (2.78% vs 0.29%, p=.03). Post-operative arterial and venous compromise occurred in 1.10% (13/1187) and 2.53% (30/1187) of cases with no intraoperative complications, respectively, compared to 3.2% (9/278, p=0.02) and 6.12% (17/278, p=0.002) in cases with an intraoperative complication. Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis, and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.

Green supply chain management in the Southern Brazilian rice industry: A survey and structural analysis

The purpose of this study is to evaluate the influence of Green Supply Chain Management (GSCM) dimensions on the performance of an agrifood supply chain, with a specific focus on the rice industry in southern Brazil. The region's rice industry produces a substantial amount of biomass, fostering circular economy practices that align with both economic and environmental objectives. Using Structural Equation Modeling with Partial Least Squares (SEM-PLS), this research analyzes data from a survey of 92 companies. The measurement model incorporates 21 input and 11 output indicators, organized into six constructs. The input constructs—green strategy, green innovation, and green operations—are instrumental in shaping industry competitiveness, the fourth construct. The output constructs measure results and reputation. The findings indicate that green innovation and green operations significantly enhance competitiveness, whereas green strategy exerts minimal influence. The scope is limited to the rice industry in southern Brazil. Practical implications include offering a strategic framework for agrifood industry practitioners to improve competitiveness by optimizing green practices within their supply chains. Theoretical implications suggest that while green strategy alone may not be sufficient to drive competitiveness, the integration of green innovation and operations can enhance it. The originality of this research lies in the development of a comprehensive measurement model for assessing competitiveness in agrifood businesses, which evaluates both operational outcomes and reputational impact.

Validity of laparoscopic surgery for lower gastrointestinal perforations.

This study aimed to clarify the validity of laparoscopic surgery for lower gastrointestinal perforation by comparing the clinical outcomes of laparoscopic and open emergency surgery. We reviewed the data of patients who underwent surgery for lower gastrointestinal perforation. Patients were categorized into two groups: the laparoscopic group who underwent laparoscopic surgery, and the open group who underwent laparotomy. Clinical and operative outcomes between the two groups were evaluated. A total of 219 patients were included in the study. There were 66 and 153 patients with small bowel and colorectal perforations, respectively. The median operative time in the laparoscopic group was shorter than that in the open group (126 min vs. 146 min, p = .049). The mean amount of intraoperative blood loss was significantly lower in the laparoscopic group (50.4 mL vs. 400.1 mL, p < .001). The incidence of postoperative complication was higher in the open group (20.0% vs. 66.5%, p < .001), especially wound infection (0% vs. 26.3%, p = .002). Median hospital stays were 14 days and 24 days in the laparoscopic and open groups, respectively (p < .001). In the laparoscopic group, hospital mortality was 0%. The laparoscopic approach for small bowel and colorectal perforation in an emergency setting is a safe procedure in carefully selected patients and may contribute to decreased intraoperative blood loss, shortened hospital stay, and decreased incidence of postoperative complications, especially wound infection.

Outcomes of Left Atrioventricular Valve Operation following Atrioventricular Septal Defect Repair

Left atrioventricular valve (LAVV) operation following repair of atrioventricular septal defects (AVSD) can be challenging. We sought to describe characteristics and outcomes of patients requiring LAVV operation. Retrospective review of AVSDs requiring LAVV operation between 2000-2020. Patients who experienced adverse events (AEs; defined as the need for a LAVV reoperation (repair or replacement) or death) were compared to patients without AEs. Freedom from adverse events was displayed using the Kaplan-Meier method. Reoperation and death were characterized in terms of cumulative incidence function, estimated using competing risk models. Of 843 patients with AVSD repaired, 59 (7.3%) required a LAVV operation and 7 (9%) valve replacement. A simple repair (cleft closure and/or annuloplasty) occurred in 26 (48.1%) and complex repair using multiple techniques in 28 (51.8%) cases. Eleven patients (20%) required further LAVV reoperation; 3 replacement of mechanical valve, 6 new valve replacement (2 Melody, 4 Mechanical) and 2 re-repair. The cumulative incidence of freedom from AE was 84.1% (75.0%, 94.2%), 78.3% (68.2%, 90.0%), 73.4% (62.2%, 86.7%), 69.7% (57.5%, 84.7%) at 1, 5, 10 and 15 years respectively. Cox univariable regression showed smaller weight (p=0.027) and early need for LAVV operation (p=0.02) were associated with AEs while cleft closure (p = 0.003) was protective against AEs. The estimated cumulative incidence of reoperation was higher in complex repairs (17.3% (7.8%, 38.7%) vs 0.5% (NA, NA) at 1 year. Greys p = 0.02). In a comparison of eras (2000-2009, 2010- 2020) there was no difference in AE (Greys p = 0.96). Adverse outcomes following LAVV reoperation remain common. Smaller infants, those requiring earlier reoperation and complex type repairs are at highest risk. Future studies should focus on which high risk LAVVs are more suited to early LAVV replacement.

Dentin Grafts: Navigating the Paradigm Shift in Regenerative Dentistry.

The biomaterial of dentin has emerged as a promising candidate for the tissue engineering of dental hard tissues. In bone tissue engineering, it may serve as either a scaffold or a reservoir of growth factors. The physical and chemical similarities between the dentin structure and bone have sparked scientific interest in using its features for the development of a new bone transplant material. Dentin, unlike hard and fragile enamel, is viscoelastic, making it a very effective bone replacement. The regeneration of pulp tissue has proven challenging due to its encasement in dentin, which lacks collateral blood flow except from the apical end of the root. Yet, the emergence of contemporary tissue engineering and the identification of dental stem cells have enabled experimentation with the regeneration of both pulp and dentin. This review will explain the different types of dentin grafts, their biocompatibility, safety, and effectiveness, along with difficulties. Additionally, the paper covers several strategies for creating autogenous dentin grafts and gives evidence-based insights into their clinical effectiveness. Overall, dentin grafts appear as a potential alternative to standard graft materials, stimulating tissue regeneration and enhancing patient outcomes in regenerative dentistry operations.

The impact of green supply chain management on corporate performance under the full process model: A MASEM analysis based on heterogeneous moderation

This study explores the impact of green supply chain management on corporate performance, focusing on environmental, economic, operational, and social outcomes. Using Meta-Analytic Structural Equation Modeling, we analyzed data from 98 quantitative studies conducted since 2001. Our findings demonstrate that green supply chain management practices significantly enhance corporate performance. We also identify key moderating factors, such as industry diversity, company size, geographical location, economic development, cultural level, and logistics performance, that influence the effectiveness of green supply chain management. The study highlights the importance of tailoring green supply chain management initiatives to specific industry and regional contexts, providing actionable insights and policy recommendations for promoting sustainable development in the Carbon Trading Era.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

Robot-assisted Laparoscopic Ureteral Reimplantation in Pre-toilet Trained Children With Vesicoureteral Reflux

ObjectivesTo evaluate the outcomes of pre-toilet trained children undergoing RALUR for the treatment of primary VUR at our institution and compare these to an older cohort. Materials and MethodsThis retrospective study analyzed data from a single institution's registry, comparing outcomes between pre-toilet trained and toilet trained children who underwent RALUR for primary VUR. Preoperative parameters, surgical details, and postoperative outcomes were evaluated. ResultsThe study included 158 patients, with 24 in the pre-toilet trained group and 134 in the toilet trained group. Both cohorts exhibited similar demographics and preoperative characteristics. Operative times, complication rates, and surgical outcomes were comparable between the groups, despite the pre-toilet trained group presenting with more severe VUR grades. Incidence of febrile UTI after surgery and need for further intervention did not significantly differ between the cohorts. ConclusionThe current study demonstrates the feasibility, success, and safety of RALUR in pre-toilet trained compared to toilet-trained children and thus support the stance that it is a viable alternative to open surgery.

Operative Times and Outcomes of Complex Endovascular Repairs of Thoracoabdominal Aneurysms

IntroductionOwing to the significant morbidity and mortality of open thoracoabdominal aortic aneurysm surgery, complex endovascular repairs (eTAAA) have become increasingly common, but still carry substantial risk. These repairs require large bore access, with resultant pelvic and lower extremity ischemia. We therefore hypothesized that operative timing would be associated with outcomes, as efficient surgery would limit the ischemic time as well as anesthesia time. MethodsWe studied all eTAAA repairs (Crawford Types 1-3, 5) incorporating at least one branch vessel from 2014 to 2021 in the Vascular Quality Initiative, and categorized them into quartiles of total operating time. To account for variations in case complexity and intraoperative events, we performed a sub-analysis stratifying each surgeon by their median operating time. Multilevel logistic regression was employed to compare perioperative outcomes including mortality, thoracoabdominal life altering events (TALE:composite of perioperative death, stroke, permanent paralysis and/or dialysis), spinal cord ischemia (SCI), acute kidney injury (AKI), major adverse cardiac events (MACE), myocardial infarction, and dialysis. ResultsThere were 2,925 eTAAA repairs during the study period. Procedure times ranged from <204 minutes in the first quartile to >365 minutes in the fourth. Longer cases more commonly involved older patients who were more often female, and higher rates of prior stroke, and preoperative anemia. They involved larger, more extensive aneurysms, with higher rates of prior aortic surgery, and more commonly employed PMEGs or parallel grafting to incorporate more branch vessels. In addition, they were less often staged procedures, and used more spinal drains, femoral cutdowns, and upper extremity access. Operating time decreased as experience increased. In adjusted analyses, the odds of mortality and every morbidity studied increased stepwise with operating time, with 4 to 13-fold higher odds in the highest quartiles. Spinal cord ischemia had the strongest association with procedure times, with seven-fold higher odds (OR 7.2 [2.9-17.9], P<.001) of any SCI in the highest quartile compared to the lowest, and 13-fold higher odds of permanent SCI (OR 13.1 [3.9-44.7], P<.001). These results were consistent when surgeons were grouped into quartiles by their median operating times. Medium-term mortality was also higher in the upper quartile of operating time (HR 2.7 [1.4-5.1], P=.002). ConclusionLonger operating times for complex eTAAA repairs were associated with markedly higher rates of morbidity and mortality, especially spinal cord ischemia. These results emphasize the importance of expeditious repairs by experienced teams.

Effective integration of COVID-19 vaccination with routine immunization: A case study from Kinshasa, DRC

BackgroundIn response to the challenge of maintaining COVID-19 vaccination coverage amidst the pandemic, VillageReach, in collaboration with the Ministry of Public Health Prevention and Hygiene in Kinshasa, DRC, integrated COVID-19 vaccination with routine immunization services at two primary healthcare facilities. This initiative, launched in July 2022, represented the first of its kind in the DRC, aiming to assess the effectiveness and scalability of a multimodal vaccination approach. MethodsThrough a rapid appraisal involving key informant interviews and analysis of pre- and post-integration service delivery data, this case study explores the operational dynamics and outcomes of integrating COVID-19 and routine immunizations. ResultsResults demonstrated that the integrated approach not only maintained COVID-19 vaccine coverage but also significantly enhanced routine immunization uptake, particularly among under-immunized and zero-dose children. Overall, the vaccination sites, outreach, and integrated health facilities administered 229,983 (33 %) of COVID-19 vaccines in Kinshasa, of which 53 % were referred by community health workers. Additionally, 998 under-immunized children received routine immunizations, of whom 126 were zero-dose children. Key success factors included sustained community health worker engagement, neighborhood-specific strategies, accessible vaccination points, and robust data management. The findings suggest that such integrative strategies can effectively bolster immunization coverage in urban poor communities, offering valuable insights for similar initiatives in the DRC and beyond. ConclusionThis study advocates for sustained investment in innovative immunization models to strengthen primary healthcare systems post-pandemic.

Energy expenditure during physical work in cold environments: physiology and performance considerations for military service members.

Effective execution of military missions in cold environments requires highly trained, well-equipped, and operationally ready service members. Understanding the metabolic energetic demands of performing physical work in extreme cold conditions is critical for individual medical readiness of service members. In this narrative review, we describe 1) the extreme energy costs of performing militarily relevant physical work in cold environments, 2) key factors specific to cold environments that explain these additional energy costs, 3) additional environmental factors that modulate the metabolic burden, 4) medical readiness consequences associated with these circumstances, and 5) potential countermeasures to be developed to aid future military personnel. Key characteristics of the cold operational environment that cause excessive energy expenditure in military personnel include thermoregulatory mechanisms, winter apparel, inspiration of cold air, inclement weather, and activities specific to cold weather. The combination of cold temperatures with other environmental stressors, including altitude, wind, and wet environments, exacerbates the overall metabolic strain on military service members. The high energy cost of working in these environments increases the risk of undesirable consequences, including negative energy balance, dehydration, and subsequent decrements in physical and cognitive performance. Such consequences may be mitigated by the application of enhanced clothing and equipment design, wearable technologies for biomechanical assistance and localized heating, thermogenic pharmaceuticals, and cold habituation and training guidance. Altogether, the reduction in energy expenditure of modern military personnel during physical work in cold environments would promote desirable operational outcomes and optimize the health and performance of service members.

Comparison of radiation exposure and fluoroscopy time between minimally invasive common bile duct exploration and endoscopic retrograde cholangiopancreatography for choledocholithiasis

ImportanceRadiation exposure causes dose-dependent deleterious effects and efforts should be made to decrease patient exposure to ionizing radiation. Patients with choledocholithiasis are commonly exposed to ionizing radiation as fluoroscopy-guided interventions including minimally invasive common bile duct exploration (MICBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred treatment modalities for common bile duct (CBD) stone clearance. However, radiation exposure and fluoroscopy times have not been compared between these two treatment modalities. ObjectiveTo compare fluoroscopy time (FT) and radiation exposure (RE) between MICBDE and ERCP in patients with choledocholithiasis. DesignThis is a retrospective analysis of a prospectively maintained database of a single surgeon performing MICBDE at an academic referral center between May 2021 and June 2023 compared to a retrospective analysis of all ERCPs performed between January 2020 and February 2021. Patient demographics, procedural details, fluoroscopic details, and post operative outcomes were compared between the MICBDE and ERCP. SettingSingle institution academic referral center located in the American Southwest. Participants109 patients with choledocholithiasis were divided into 2 groups. 53 patients (48.62%) underwent ERCP, and 56 patients (51.38%) underwent MICBDE. Inclusion criteria were; all patients presenting with choledocholithiasis and subsequently underwent ERCP or MICBDE. Patients who underwent ERCP for non-choledocholithiasis related reasons were excluded. Main outcomes and measuresPrimary outcomes include FT measured in minutes and RE measured in milligray (mGy). Secondary outcomes were successful clearance of the common bile duct, complications, procedural time, and reinterventions. ResultsA significant difference (P<.001) between fluoroscopy times was identified between ERCP (3.1mins) and MICBDE (1.54mins). Median RE doses between the ERCP group (38 mGy) and the MICBDE group (38.41 mGy) were not statistically different (p=0.88). Technical success of CBD clearance was similar in both groups (91% in MICBDE group vs 93% in ERCP group; p=0.711). Conclusion and RelevanceAdvantages of MICBDE over ERCP include; treatment of choledocholithiasis at the time of cholecystectomy, which reduces the risk of additional anesthesia episodes and the introduces the potential for shorter hospital length of stay. This study shows that MICDBE has lower FT compared to ERCP and comparable RE. Given the advantages of MICBDE, it should be strongly considered at the time of laparoscopic cholecystectomy.

Association between helicobacter pylori infection and post operative outcomes after bariatric surgery

Association between helicobacter pylori infection and post operative outcomes after bariatric surgery