Safety Of Different Methods Research Articles

Device-based circumcision: advantages, choice of device and surgical technique

Introduction. Circumcision is one of the most common surgical procedures for men. WHO programs aimed at reducing HIV transmission have led to the development of various circumcision devices designed to standardize surgical techniques, reduce operating time and the number of complications.Objective. To examine available data on the efficacy and safety of different methods of device-based circumcision.Materials & methods. The results of a search in scientific databases such as eLibrary and PubMed were analyzed using the keywords: "circumcision", "circumcision device", and "phimosis". The search was conducted without regard to date or language of publication. After reviewing the literature, 25 articles were selected that best reflect the topic of device-assisted circumcision for further analysis.Results. Device-based circumcision can significantly reduce surgical time, regardless of the type of device used. Device-based circumcision is the safe treatment method; however, it may have a higher incidence of adverse events compared to the standard circumcision technique. The use of self-suturing devices is preferred over ring devices due to fewer complications, better cosmetic results, and greater patient satisfaction. The article is supplemented with a description of the surgical technique of various options for device-based circumcision.Conclusion. Device-based circumcision is effective and safe treatment method on an outpatient basis, which successfully competes with conventional circumcision of the foreskin.

Comparative analysis of the efficacy and safety of different methods for injecting polidocanol in the treatment of venous malformations.

To compare and analyze the efficacy and safety of different methods for injecting polidocanol in the treatment of venous malformations. The medical records of patients with venous malformations in our hospital from April 2021 to April 2023 were analyzed retrospectively, and they were divided into control group (n = 38) and observation group (n = 20) according to different treatment methods. Control group was injected with polidocanol under ultrasound guidance, while observation group was injected with polidocanol under digital subtraction angiography (DSA) monitoring. Therapeutic effects of observation group and control group after 3-6months of treatment were compared and analyzed, and complications that can be used to reflect the safety of treatment in two groups were collected and recorded. After treatment, the total effective rates of observation group and control group were 97.37% (37/38) and 75.00% (15/20) respectively, with significant differences (both p < .05). After 3-6months of treatment, 13 complications occurred in observation group, while 16 occurred in control group. The number of complications in observation group was 6, with an incidence rate of 15.78%; while that in control group was 9, with an incidence rate of 45.00%, with a significant difference (p < .05). There were no significant differences among other baseline data, age and complications between two groups (all p > .05). Injection of polidocanol in patients with venous malformations under DSA monitoring was more effective and safer.

Effectiveness and Safety of Different Methods of Assisted Fat Grafting: A Network Meta-Analysis.

Numerous studies have proposed the utilization of stromal vascular fraction (SVF), adipose-derived stem cells (ADSCs), and platelet products as auxiliary grafting techniques to improve the survival rate of fat grafts. This study aimed to evaluate the efficacy and safety of various fat grafting methods since 2010 through a network meta-analysis, aiming to identify the most effective technique for fat grafting. Clinic trials on assisted fat grafting were searched from Pubmed, Embase, Web of Science, and the Cochrane Library, spanning the period from January 1, 2010 to March 2024. The risk of bias in the included trials was meticulously assessed using the Cochrane risk of bias tool. The survival rate of fat grafts served as the primary evaluation metric for effectiveness, while complications were employed as the indicator for safety. The study incorporated 31 clinic trials, involving a total of 1656 patients. The findings indicated that the survival rate with assisted fat grafting significantly surpassed that of simple fat grafting (SUCRA, 10.43%). Notably, ADSC-assisted fat grafting exhibited the highest survival rate (SUCRA, 82.17%), followed by Salvia miltiorrhiza (SM)-assisted fat grafting (SUCRA, 69.76%). In terms of safety, the most prevalent complications associated with fat grafting were fat sclerosis and fat necrosis. Adc-assisted fat grafting was correlated with the lowest incidence of complications (SUCRA, 41.00%), followed by simple fat grafting (SUCRA, 40.99%). However, PRP-assisted (SUCRA, 52.86%) and SVF-assisted fat grafting (SUCRA, 65.14%) showed higher complication rates. Various methods of assisted fat grafting can significantly enhance the survival rate, but they often fail to effectively mitigate the incidence of complications. Compared to other methods, adipose mesenchymal stem cells-assisted fat grafting consistently yielded a higher survival rate of grafts and fewer complications. Consequently, this approach represents a relatively effective method for assisting in fat grafting at present. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intraperitoneal chemotherapy for peritoneal metastases of gastric origin: a systematic review and meta-analysis.

Gastric cancer with peritoneal metastases is associated with a dismal prognosis. Normothermic catheter-based intraperitoneal chemotherapy and normothermic pressurized intraperitoneal aerosol chemotherapy (PIPAC) are methods to deliver chemotherapy intraperitoneally leading to higher intraperitoneal concentrations of cytotoxic drugs compared to intravenous administration. We reviewed the effectiveness and safety of different methods of palliative intraperitoneal chemotherapy. Embase, MEDLINE, Web of Science and Cochrane were searched for articles studying the use of repeated administration of palliative intraperitoneal chemotherapy in patients with gastric cancer and peritoneal metastases, published up to January 2024. The primary outcome was overall survival. Twenty-three studies were included, representing a total of 999 patients. The pooled median overall survival was 14.5 months. The pooled hazard ratio of the two RCTs using intraperitoneal paclitaxel and docetaxel favoured the intraperitoneal chemotherapy arm. The median overall survival of intraperitoneal paclitaxel, intraperitoneal docetaxel and PIPAC with cisplatin and doxorubicin were respectively 18.4 months, 13.2 months and 9.0 months. All treatment methods had a relatively safe toxicity profile. Conversion surgery after completion of intraperitoneal therapy was performed in 16% of the patients. Repeated intraperitoneal chemotherapy, regardless of method of administration, is safe for patients with gastric cancer and peritoneal metastases. Conversion surgery after completion of the intraperitoneal chemotherapy is possible in a subset of patients.

Effectiveness and safety of different methods of removal of medium —sized benign colorectal polyps using cold snare polypectomy

Effectiveness and safety of different methods of removal of medium —sized benign colorectal polyps using cold snare polypectomy

Choice of topical substances in the conservative management of Exomphalos - A systematic review.

Exomphalos is a congenital anomaly found in 1/4500 newborns. Choice of non-operative management of exomphalos major unamenable to primary repair is controversial. This study aims at reviewing conservative management modalities and compare outcomes and complications. A systematic review was performed according to PRISMA guidelines of all English publications in MEDLINE and EMBASE databases. Search words were exomphalos OR omphalocoele AND conservative OR non-operative AND management. Studies were scrutinised for patient demographics, co-morbidities, mode of treatment, time to full feeds, time to full epithelialisation, length of stay, complications and mortality. Studies not specifically describing mode of management and/or describing primary or staged surgical repairs were excluded. Initial search resulted in 1243 studies. Forty-two studies were deemed suitable offering 822 patients for analysis after excluding duplicates and non-eligible studies. Management methods varied including painting with Alcohol, Mercurochrome, silver products, Povidone Iodine, honey and other materials. Mortality was mostly due to associated anomalies. There was mixed reporting of alcohol, silver, Povidone Iodine and mercury toxicity as well as infection during the course of treatment. This report has recognised the variations in topical substances employed for conservative management with no clear consensus. Reports on safety of different methods remain unclear.

Results of using transcatheter arterial embolization in gastroduodenal ulcer bleeding: a review of studies

The authors present the results of research comparing the efficacy and safety of different methods of hemostasis in patients with gastrointestinal ulcer bleeding. The work focuses on the possibilities of transcatheter arterial embolization (embolization of the syndrome-responsible arteries of the stomach and duodenum) in the treatment of this disorder. Objective. Based on information sources, to evaluate the potential of transcatheter arterial embolization in comparison with the results of surgical and endoscopic hemostasis in the management and prevention of recurrent gastroduodenal ulcer bleeding. Materials and methods. The authors analyzed data from 51 domestic and international information sources on the subject of this work. Results. Studies on the treatment of active ulcerative gastroduodenal bleeding refractory to endoscopic hemostasis, have demonstrated the advantage of transcatheter arterial embolization over surgical interventions in terms of the incidence of non-fatal surgical complications. Surgical interventions were associated with a lower incidence of recurrent bleeding compared to endovascular interventions. According to research results, there were no difference in overall mortality between the groups of endovascular and surgical hemostasis. The use of prophylactic transcatheter embolization of the syndrome-responsible artery in cases of ulcerative gastroduodenal bleeding in addition to effective primary endoscopic hemostasis showed promising results. In such cases, patients with initially high risk of hemorrhagic complications had significantly lower rate of recurrent bleeding, surgical complications, and mortality comparing to patients with effective primary endoscopic hemostasis but without subsequent transcatheter arterial embolization. Conclusion. Despite current advances in the field of surgery ulcerative gastroduodenal bleeding remains an acute medical and social problem that requires the search for new effective methods of hemostasis and prevention of recurrent hemorrhagic complications. In the majority of studies, transcatheter embolization of the syndrome-responsible arteries of the stomach and duodenum is used as such. Keywords: gastrointestinal ulcer bleeding, endoscopic hemostasis, transcatheter arterial embolization, prophylactic endovascular embolization

Management of shivering after spinal anesthesia in parturient

Aim: This study aimed to evaluate and compare the effectiveness and safety of different methods of shivering control in patients with spinal anesthesia during cesarean delivery in Al-Abbas, Obstetrics and Gynecology (Imam Al-Hujjah), and Al Kafeel hospitals in Karbala. Methods: This cross-sectional study was conducted on pregnant women who have delivered from 2016 to 2022 in Karbala city. More than 90% of cesarean delivery in Karbala were conducted in 3 hospitals including Imam Al-Hujjah hospital, Al-Abbas, and Al Kafeel. Patients were selected by a simple random method and the sample size for each hospital was defined with the proportion to size method. The researcher-made checklist was used to collect the data and data were extracted from medical documents of patients. In case of huge missing data in medical documents, the patient was excluded from the study, and another patient was selected by the same method. Result: In this study, 755 patients were included to the study. The mean age of participants was 24.48 ± 4.56 years. The incidence of shivering was 21.59% in participants, which were 31.34% in participants who received no intervention, warmed cover, and fluid therapy; and 18.05% in participants who received tramadol, and pethidine, or clonidine.

Efficacy and safety of ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography for treatment of rectal neuroendocrine tumors

Objective Rectal neuroendocrine tumors (R-NETs) usually invade the submucosa, and so complete resection is difficult. The treatment of choice for R-NETs ≤10 mm in size is endoscopic resection, but there is still controversy concerning the best endoscopic method. This study evaluated the efficacy and safety of ligation-assisted endoscopic submucosal resection combined with endoscopic ultrasonography (ESMR-LUS) for treatment of R-NETs. Methods We retrospectively analyzed the data of 101 patients with R-NETs ≤10 mm in size who underwent ESMR-LUS (n = 48) or conventional ligation-assisted endoscopic submucosal resection (ESMR-L; n = 53) between May 2019 and September 2021 at the 900th Hospital of Joint Logistics Support Force. Complete resection rate, pathological complete resection rate, procedure time, and adverse events were compared between the two groups of patients. Results The endoscopic complete resection rate was slightly higher in the ESMR-LUS group than in the ESMR-L group (100 vs. 96.2%, p = .496). The pathological complete resection rate was also slightly higher in the ESMR-LUS group (97.9 vs. 88.7%, p = .152), these findings, though statistically non-significant, have practical clinical significance. Margin involvement was less common in ESMR-LUS patients than in ESMR-L patients (1 vs. 6). Involvement of the lateral resection margin was found one patient in the ESMR-LUS group versus two patients in the ESMR-L group, and deep resection margin involvement in no patient in the ESMR-LUS group versus four patients in the ESMR-L group. Mean procedure time was longer in the ESMR-LUS group than in the ESMR-L group (11.08 ± 1.89 min vs. 9.38 ± 2.09 min, p = .061). Immediate bleeding occurred in two patients in the ESMR-LUS group vs. seven patients in the ESMR-L group. Two patients in the ESMR-L group also suffered perforation; both patients were successfully treated by endoscopy. Conclusions ESMR-LUS appears to be a safe and effective technique for removal of small rectal NETs confined to the submucosal layer without metastasis. Further studies are warranted to compare the efficacy and safety of different methods.

Пролонгована паравертебральна аналгезія для знеболювання у хворих після торакотомії

Актуальність. Торакотомія відноситься до одного з найбільш травматичних втручань в хірургії, що супроводжується вираженим гострим болем після операції та розвитком хронічного больового синдрому у віддаленому післяопераційному періоді. Мета дослідження. Порівняти ефективність та безпечність різних методів знеболювання хворих після торакотомії. Матеріали та методи. Після торакотомії 85 хворих було розподілено на три дослідні групи. Знеболювання проводили за допомогою пролонгованої паравертебральної аналгезії (ПВА) (19 хворих) і пролонгованої епідуральної аналгезії (ЕДА) (36 хворих) 0,2% розчином ропівакаїну зі швидкістю 6 мл/год (у паравертебральний або епідуральний простір). У контрольній групі (30 хворих) знеболювання проводилось внутрішньовенною, контрольованою пацієнтом аналгезією розчином морфіну. Як ад’ювантний анальгетик у всіх трьох дослідних групах використовували нестероїдний протизапальний препарат кеторолаку трометамін внутрішньом’язово. У ранньому післяопераційному періоді оцінювали рівень болю в стані спокою та під час фізичного навантаження дихальної мускулатури (виконання спірометрії), показники функції зовнішнього дихання (ФЗД), а також частоту та тип ускладнень застосованих методів знеболювання. У віддаленому післяопераційному періоді оцінювали частоту виникнення хронічного болю. Результати. У групах з пролонгованою ПВА і ЕДА інтенсивність больового синдрому протягом трьох діб післяопераційного періоду за візуальною аналоговою шкалою (ВАШ) у стані спокою була меншою порівняно з контрольною групою. У групі ПВА рівень болю був від 29,1 бала через чотири години після операції до 18,7 бала в кінці третьої доби; у групі ЕДА — від 24,2 до 20,3 бала відповідно; у контрольній групі — від 48,8 до 38,0 бала відповідно. Під час дослідження ФЗД інтенсивність болю в групах ПВА і ЕДА також була нижчою порівняно з контрольною групою і становила 33,8 бала в групі ПВА, 38,7 бала — в групі ЕДА, 61,2 — у контрольній групі. Частоту виникнення хронічного больового синдрому оцінювали через 6 місяців після операції. Було відібрано по 15 хворих із кожної групи. У контрольній групі хронічний больовий синдром розвинувся у 8 хворих (53 %), у групі ЕДА — у 5 хворих (33,3 %), у групі ПВА — у 3 хворих (20 %). Найменша кількість ускладнень і технічних невдач спостерігалась у групі ПВА. Висновки. У групі з пролонгованою ПВА порівняно з пролонгованою ЕДА рівень болю за ВАШ був нижчим, частота випадків хронічного болю меншою, а кількість побічних ефектів мінімальною. Пролонгована паравертебральна блокада у хворих після торакотомії дає змогу ефективно контролювати гострий післяопераційний біль та зменшує розвиток хронічного больового синдрому.

Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis

Background: Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. Study Design: Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Results: Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = −21.83, 95% CI [−34.76, −8.90]; MD = −23.8, 95% CI [−32.55, −15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = −18.74, 95% CI [−31.93, −5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). Conclusion: P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.

A MATLAB‐based educational platform for analysis of slope stability

AbstractThis study presents a computer‐aided educational platform, namely, ErosSSA (Eros‐Slope‐stability‐analysis) developed by the geotechnical group in the Hong Kong Polytechnic University, to provide civil engineering students and young industrial engineers a better understanding of the analysis of slope stability. The platform is developed under the MATLAB environment, with a clear framework and a graphical interface. Using this platform, the rotational landslides can be generally analyzed, considering a circular slip surface and the factors of safety defined with respect to basic and advanced methods with different force and/or moment equilibrium. Furthermore, the minimum factors of safety of different methods for a given slope can be determined. From the practical teaching of the ErosSSA in two courses for Bachelor and Master students, it was found that they were highly satisfied with the accuracy, reliability, and convenience of the ErosSSA according to their feedbacks to a questionnaire. These practical teaching experiences support the ErosSSA to be widely used as a suitable teaching platform in geotechnical engineering.

A comparative study on the construction methods of animal models of aortic arch dissection

Objective: To compare the effectiveness and safety of different methods to construct animal models of aortic arch dissection (AAD), and explore safe and effective methods for constructing AAD animal models. Methods: Twenty-four healthy mongrel dogs were divided into 4 groups by random number table (n=6). Group A: Venous incision needle high pressure water flow impact method; Group B: Venous incision needle non-high pressure water flow impact method; Group C: Transarterial sheath non-high pressure water flow impact method; Group D: Two-way balloon expansion combined with elastase perfusion method. Imaging examinations were performed immediately and 7 days after operation, aortic tissue biopsy and pathological staining were performed 15 days after operation to observe the formation of AAD. The operation time, aortic blood flow block time, model construction success rate, dissection tear length, postoperative survival rate and survival time of four groups of experimental dogs were collected to compare the effectiveness and safety of different construction methods. Results: There were no significant difference of the gender, age and weight between four groups of experimental dogs (all P>0.05). The operation time of four groups of experimental dogs were (111.6±8.0), (168.0±17.4), (164.4±13.9), (202.8±21.5)min, and the difference was statistically significant (F=39.973, P<0.001). The operation time of group A was significantly lower than group B, C and D (all P<0.001). The aortic blood flow block time of four groups of experimental dogs were (5.2±1.8), (19.6±3.8), (20.6±3.9), and (18.6±3.0) min, and the difference was statistically significant (all P<0.001). The aortic blood flow block time of group A was significantly lower than group B, C and D (F=27.598, P<0.001). The four groups of experimental dogs had 5, 5, 4, and 1 model were successfully constructed, respectively, and the difference was statistically significant (P=0.008). The successful rate of model construction in group A was significantly higher than that in group D (P=0.040). The dissection tear length of four groups were (14.4±3.0), (11.3±4.2), (7.0±2.3), (4.7±0.6) cm,and the difference was statistically significant (F=8.103, P=0.003). The dissection tear length of group A was significantly longer than group C, D (all P<0.05). The postoperative survival time were 15.0(10.0, 15.0), 5.0(3.0, 10.0), 3.5(1.5, 4.8), 10.0(2.8, 15.0) days, and the difference was statistically significant (χ2=7.825,P=0.036). The postoperative survival time of group A was significantly higher than group B, C (all P<0.05). There was no significant difference in the survival rate of the four groups (P=1.000). The pathological staining results showed that the elastic fiber at the tearing point of AAD was destroyed, and the elastic fiber on the outer wall of the false cavity was over-stretched, which was consistent with the pathological changes of aortic dissection. Conclusion: Transvenous incision needle high-pressure water flow impact modeling method is easy to operate. The aortic blood flow block time is short, the dissection tear length is wide, and the postoperative survival time is long, can be used as the preferred method of animal AAD model construction.

Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review.

Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators. We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews. Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized. In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

Comparison of different calcium supplementation methods in patients with osteoporosis.

The aim of the present study was to explore the clinical efficacy and safety of different methods of calcium supplementation in osteoporosis (OP). Patients with OP were divided into four groups, including the control, oral calcium supplementation, intravenous calcium supplementation and combined calcium supplementation groups. The duration of the calcium supplementation was 3-6 years. Medical records were collected and examined along with demographic data, the incidence of certain diseases and adverse reactions. All subjects in the three treatment groups exhibited statistically significant reductions in alkaline phosphatase (ALP) levels, visual analog score (VAS) and Oswestry Disability Index (ODI) compared with the respective pre-treatment values. Furthermore, compared with prior to treatment, the lumbar and hip bone mineral density (BMD) of patients receiving intravenous calcium supplementation was significantly increased. In addition, after treatment, the lumbar and hip BMD was significantly increased, whereas ALP levels, VAS and ODI were significantly decreased in the oral calcium supplementation group compared with the control group. Also, compared with the control and oral calcium supplementation groups, the BMD was significantly increased, whereas ALP, VAS, ODI, the rate of infection and tooth loss, the incidence of fragility fractures, joint replacement surgery, arrhythmia, lumbar disc herniation and cerebral infarction were significantly decreased in the two groups treated with intravenous calcium supplementation. The results of the present study may enable a better understanding of the effectiveness and safety of the different methods for supplementing calcium in OP.

A preliminary study of different methods of anesthesia for painless bronchoscopy

Objective: This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. Methods: A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. Results: The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B (P<0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance (P>0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain (P<0.05). However, there were no significant differences in the degree of cough and pain between group A and group B (P>0.05). Most patients in group C had no uncomfortable sensation during the operation (P<0.05), and the willingness to re-examination was significantly higher than that in group A and group B (P<0.05). Conclusion: Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.

New robust formulations for bond strength of FRP reinforcements externally glued on masonry units

The bond interface between fiber-reinforced polymer (FRP) and masonry units is one of the weakest links in tensile strengthened masonry structures. Several empirical formulae have been proposed for estimation of bond strength between FRP reinforcements and masonry units. However, the accuracy of existing formulae for predicting bond strength seems to be significantly limited. In the present study, the M5´ and Multivariate adaptive regression splines approaches are employed to predict the bond strength between FRP reinforcement and masonry units. To develop new models, a comprehensive database including 575 test series (230 distinctive specimens) is collected from different sources in the literature. The newly proposed formulations consider several preeminent parameters involved in the debonding process including the reinforcement width, the ratio between widths of FRP reinforcement and masonry unit, the tensile strength of substrate, the axial strength of reinforcement, and bond length. A comparative study is conducted to evaluate the performances of the developed models against the well-known equations. Results indicated that the proposed models remarkably outperform the existing equations in terms of accuracy. Furthermore, a sensitivity analysis is done to determine the most important parameters in predicting the bond strength. Finally, the safety of different methods is evaluated based on the demerit point classification scale.

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS).

IntroductionOptimal management of severe carotid in-stent restenosis remains unknown. Prevalence and risk factors of first and recurrent carotid in-stent restenosis in the multi-stent approach have not been established yet.AimTo evaluate the safety of different methods of endovascular treatment of carotid in-stent restenosis/recurrent restenosis and to establish its rate and risk factors.Material and methodsBetween January 2001 and June 2016, 2637 neuroprotected carotid artery stenting (CAS) procedures were performed in 2443 patients (men: 67.0%; mean age: 67.9 ±8.8 years, symptomatic: 45.5%). Doppler ultrasound (DUS) evaluation was performed at discharge, after 3–6 months, 12 months, and then annually. Peak systolic velocity of 2–3 and > 3.0 m/s as well as end diastolic velocity of 0.5–0.9 and > 0.9 m/s were DUS criteria for 50–69% and ≥ 70% carotid in-stent restenosis (ISR) respectively. For angiographically confirmed ≥ 70% stenosis balloon re-angioplasty was first line treatment.ResultsOut of 95 DUS detected > 50% ISR (95/2637; 3.6%), 53 were confirmed in angiography as ≥ 70% (53/2637; 2.0%, one total occlusion). All patients were treated with bare balloon (n = 19), drug-eluting balloon (n = 27) or stent-supported (n = 6) angioplasty. One procedure was complicated with stroke (1.9%). Angiographic diameter stenosis (DS) was reduced from 83 ±8.3% to 13 ±7.6% (p < 0.001). There were 13 cases of ≥ 70% recurrent ISR. Bilateral and high-grade stenosis were independent risk factors of restenosis. Initial Carotid Wallstent implantation was a risk factor of first and recurrent in-stent restenosis.ConclusionsEndovascular treatment of carotid in-stent restenosis is safe. Bilateral and high-grade carotid artery stenosis may increase the risk of restenosis. Initial Carotid Wallstent implantation may increase the risk of first and recurrent restenosis.

Pain relief for women undergoing oocyte retrieval for assisted reproduction.

Pain relief for women undergoing oocyte retrieval for assisted reproduction.

Surgery for trigger finger

Surgery for trigger finger