Severe Adhesions Research Articles

Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women: a randomized, controlled trial.

Intrauterine adhesion is a major cause of female reproductive disorders. Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth, no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far. To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate, we conducted this randomized controlled clinical trial. Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter (control group) from February 2016 to January 2020. The per-protocol analysis included 140 participants: 72 in bone marrow stem cells-scaffold group and 68 in control group. The ongoing pregnancy occurred in 45/72 (62.5%) participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group (28/68, 41.2%) (RR=1.52, 95%CI 1.08-2.12, P=0.012). The situation was similar in live birth rate (bone marrow stem cells-scaffold group 56.9% (41/72) vs. control group 38.2% (26/68), RR=1.49, 95%CI 1.04-2.14, P=0.027). Compared with control group, participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis. The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed. In conclusion, transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates, and this therapy was relatively safe.

Surgical Management of the Hostile Abdomen: A Comprehensive Current Review of Literature

This comprehensive review delves into the intricate landscape of surgical management in cases of a hostile abdomen. A hostile abdomen represents a formidable challenge characterized by factors such as severe adhesions, inflammation, abscesses, or the presence of foreign bodies, complicating surgical interventions. The preoperative phase is pivotal, requiring meticulous assessment and planning, often involving advanced imaging studies to anticipate potential complications. Surgeons must adapt to the unpredictable intraoperative challenges they encounter, such as dense adhesions and abscess drainage, employing skillful techniques to ensure patient safety. Minimally invasive approaches may be advantageous in select cases, minimizing surgical trauma and expediting recovery. Interdisciplinary collaboration among surgical specialties, anesthetists, radiologists, and nurses is essential to navigate these complex scenarios seamlessly. Potential complications, including prolonged operative times, increased blood loss, inadvertent injury, and postoperative infections, demand proactive management and comprehensive postoperative care. In conclusion, managing a hostile abdomen necessitates meticulous planning, adaptability, and interdisciplinary teamwork. Surgeons must navigate unpredictable intraoperative challenges while prioritizing patient safety and optimizing outcomes in this complex clinical entity.

Performance of carbide end mills coated with new generation nano-composite TiAlSiN in machining of austenitic stainless steel under near-dry (MQL) and flood cooling conditions

In the present study, a new generation nano-composite TiAlSiN coating has been deposited on 2-fluted carbide end mills using High Power Impulse Magnetron Sputtering (HiPIMS) in quadra-cathode target configuration. A highly smooth coating of about 3 μm thickness was realized and coated tools were subject to high-speed milling of austenitic stainless steel, which is otherwise known to cause severe diffusive wear on uncoated carbide tools. The effectiveness of TiAlSiN coating has been investigated on austenitic stainless steel under dry, wet (flood, 25 l/h), and near-dry (MQL, 250 ml/h) conditions. TiAlSiN coated tools experienced severe diffusive adhesion of work material on its cutting edge during dry machining. The near-dry approach with a cutting fluid consumption rate of only 250 ml/h was found to be a more effective, and greener approach. There was no sign of delamination of the coating under dry, flood, and near-dry environments. A maximum of 20 % reduction in cutting force and 45 % reduction in roughness (Ra) have been recorded in a near-dry environment compared to a flood environment. Performance of the HiPIMS deposited TiAlSiN coated tools have also been compared with that of commercial TiAlN and commercial TiAlSiN tools (deposited by DC Magnetron Sputtering) and found to be potentially more effective in milling of SS304 steel.

Synergetic Effects of Nanoscale ALD-HfO2 Coatings and Bionic Microstructures for Antiadhesive Surgical Electrodes: Improved Cutting Performance, Antibacterial Property, and Biocompatibility.

The high temperature induced by surgical electrodes is highly susceptible to severe surface adhesion and thermal damage to adjacent tissues, which is a major challenge in improving the quality of electrosurgery. Herein, we reported a coupled electrode with micro/nano hierarchical structures fabricated by depositing nanoscale hafnium oxide (HfO2) coatings on bionic microstructures (BMs) via laser texturing, acid washing, and atomic layer deposition (ALD) techniques. The synergistic effect of HfO2 coatings and BMs greatly enhanced the hemophobicity of the electrode with a blood contact angle of 162.15 ± 3.16°. Furthermore, the coupled surface was proven to have excellent antiadhesive properties to blood when heated above 100 °C, and the underlying mechanism was discussed. Further experiments showed that the coupled electrode had significant advantages in reducing cutting forces, thermal damage, and tissue adhesion mass. Moreover, the antibacterial rates against Escherichia coli and Staphylococcus aureus were 97.2% and 97.9%, respectively. In addition, the noncytotoxicity levels of HfO2 coatings were verified by cell apoptosis and cycle assays, indirectly endowing the coupled electrode with biocompatibility. Overall, the coupled electrode was shown to have broad potential for application in the field of electrosurgery, and this work could provide new insights into antiadhesion properties under high-temperature conditions.

Non-steroidal anti-inflammatory drugs reduce pleural adhesion in human: evidence from redo surgery

Non-steroidal anti-inflammatory drugs (NSAIDs) reduced pleural adhesion in animal studies, but its effect on human had not been studied. A retrospective study was carried out for patients with solitary pulmonary nodules without a pre-operative tissue diagnosis positive for malignancy. The impact of the use of NSAIDs after stage one wedge resection was assessed by the degree of pleural adhesions encountered during second-stage, redo completion lobectomy. From April 2016 to March 2022, 50 consecutive patients meeting the inclusion criteria were included, and 44 patients were selected for analysis after exclusion (Treatment group with NSAID: N = 27; Control group without NSAID: N = 17). The preoperative characteristics and the final tumor pathologies were similar between the groups. The use of NSAID was significantly associated with lower risk of severe pleural adhesions and complete pleural symphysis (risk difference = −29%, p = 0.03). After controlling the effect of tumor size and chest drain duration, only the use of NSAID was statistically associated with the lowered risk of severe pleural adhesions and complete pleural symphysis. No statistically significant effects of NSAID on operative time (p = 0.86), blood loss (p = 0.72), and post-operative length of stay (p = 0.72) were demonstrated. In human, NSAIDs attenuated the formation of pleural adhesions after pleural disruptions. Physicians and surgeons should avoid the use of NSAIDs when pleural adhesion formation is the intended treatment outcome.

Intraoperative Fluorescent Ureter Visualization in Complex Laparoscopic or Robotic-Assisted Gynecologic Surgery.

This study aimed to demonstrate the feasibility of ureteral navigation using intraoperative indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during complex laparoscopic or robot-assisted gynecologic surgery (LRAGS). Twenty-six patients at high risk of ureteral injury with complex pelvic pathology (CPP) due to pelvic organ prolapse (POP), multiple myomas, large intraligamentary or cervical myoma, severe pelvic adhesions, or cervical atresia underwent LRAGS. All patients underwent cystoscopic intraureteral ICG instillation before LRAGS and ureteral navigation under NIRF imaging intraoperatively. Both ureteral pathways were identified from the pelvic brim downwards through NIRF imaging in all patients, even though some were not visualized under the white light mode. The fluorescent ureters were visualized immediately after the beginning of surgery and typically lasted for >5 h during surgery. There were no cases of iatrogenic ureteral injury. The hemoglobin decrement was 1.47 ± 1.13 g/dL, and no transfusion was required. In our study, both ureters in all patients were identified with ICG-NIRF imaging during LRAGS, and these techniques made surgeries easier and safer. Despite the CPP, there was no ureteral injury or transfusion following surgery. Further prospective studies are needed to introduce intraoperative ureteral guidelines for ICG-NIRF imaging during LRAGS with CPP.

A Strong Adhesive Biological Hydrogel for Colon Leakage Repair and Abdominal Adhesion Prevention.

Colon leakage is one of the most severe complications in abdominal trauma or surgery cases. It can lead to severe abdominal infection and abdominal adhesions, resulting in prolonged hospital stays and increased mortality. In this study, a photosensitive hydrogel is proposed, which can swiftly form a strong adhesion coating on the damaged colon after UV irradiation, to realize quick cure and suture-free repair of colon leakage. The newly developed biological gel consists of hyaluronic acid methacryloyl (HAMA) and hyaluronic acid o-nitroso benzaldehyde (HANB) in the optimal ratio of 3: 1, which exerts both the rapid photocuring properties of HAMA and the strong tissue adhesion properties of HANB. HAMA/HANB shows excellent adhesion stability on wet surfaces, presenting controllable mechanical properties, ductility, adhesion stability, and chemical stability; it also evades foreign body response, which relieves the degree of abdominal adhesion. The underlying mechanism for HAMA/HANB promoting wound healing in colon leakage involves the reconstruction of the colon barrier, as well as the regulation of the immune reaction and neovascularization. In all, HAMA/HANB is a promising alternative suture-free approach for repairing colon leakage; it has a reliable healing effect and is expected to be extended to clinical application for other organ injuries.

Place of robotic surgery in completion lobectomy after anatomical segmentectomy.

Although segmentectomy is steadily increasing in early-stage non-small-cell lung cancer, recurrence in the ipsilateral lobe is also increasing. Completion lobectomy (CL) is a challenging procedure that has already been described in a few studies using video-assisted thoracic surgery or thoracotomy. In this study, we aimed to show the feasibility and safety of robot-assisted thoracic surgery in cases of CL. Among 2073 major resections performed between January 2018 and september 2022 in the Department of Thoracic Surgery at Nancy University Regional Hospital, we retrospectively included patients who underwent CL by robot-assisted thoracic surgery after previous segmentectomy for non-small-cell lung cancer. Data and perioperative results were described and analysed. Seventeen patients underwent CL with a median recurrence time after previous segmentectomy of 18 months [interquartile range (IQR): 12]. Four patients (23.5%) had a pulmonary artery injury that was controlled, and no conversion to open thoracotomy was needed. The operative time was 150 min (IQR: 20), and blood loss was 300 ml (IQR: 150). The median postoperative chest tube duration was 2 days (IQR: 1), and the length of hospital stay was 3 days (IQR: 3), with no postoperative deaths. Completion lobectomy is a challenging procedure due to severe adhesions surrounding vessels, which potentially could cause higher rate of PA bleeding than conventional surgeries. With experienced team and surgeons, CL with robotic surgery may be reported as a safe and feasible procedure.

Aborted living-donor liver transplantation in the real-world setting, lessons from 13 937 cases of Vanguard Multi-center Study of International Living Donor Liver Transplantation Group

There are exceedingly uncommon but clearly defined situations where intraoperative abortions are inevitable in living-donor liver transplantation (LDLT). This study aimed to summarize the cases of aborted LDLT and propose a strategy to prevent abortion or minimize donor damage from both recipient and donor sides. We collected data from a total of 43 cases of aborted LDLT out of 13 937 cases from 7 high-volume hospitals in the Vanguard Multi-center Study of the International Living Donor Liver Transplantation Group and reviewed it retrospectively. Of the 43 cases, there were 24 recipient-related abortion cases and 19 donor-related cases. Recipient-related abortions included pulmonary hypertension (n = 8), hemodynamic instability (n = 6), advanced hepatocellular carcinoma (n = 5), bowel necrosis (n = 4), and severe adhesion (n = 1). Donor-related abortions included graft steatosis (n = 7), graft fibrosis (n = 5), primary biliary cholangitis (n = 3), anaphylactic shock (n = 2), and hemodynamic instability (n = 2). Total incidence of aborted LDLT was 0.31%, and there was no remarkable difference between the centers. A strategy to minimize additional donor damage by delaying the donor’s laparotomy or trying to open the recipient’s abdomen with a small incision should be effective in preventing some causes of aborted LDLT, such as pulmonary hypertension, advanced cancer, and severe adhesions.

Left lower lobectomy without pericardial reconstruction in a patient with a congenital pericardium defect.

Pericardial defects are rare congenital disorders. We report a case of a left lower lobectomy in a patient with lung cancer, a congenital complete left-sided pericardial defect and severe pleural adhesions. The pleural adhesions between the epicardium and lungs were carefully dissected. A left lower lobectomy with mediastinal nodal dissection was performed under complete video-assisted thoracoscopic surgery without pericardial reconstruction. The patient remained asymptomatic for 20 months postoperatively. Careful dissection of severe adhesions is necessary in patients with severe cardiac pulsations.

Influences of B4C and carbon nanotubes on friction and wear performance of Cu base self-lubricating composite

Mechanical and friction performance of Cu base composites strengthened by B4C and carbon nanotubes (CNTs) were investigated. The CNTs vary between 2 vol% −6 vol% and B4C proportion is a set number 2 vol%. SEM, EDS and TEM were applied to characterize the polished composite surface, worn surface, cross section of friction layer, and debris. The wear mechanisms of all samples were explored. Compared with pure copper, both the physical and wear properties of the composite are improved. The composite containing 4 vol% CNTs and 2 vol% B4C has the lowest, steadiest friction coefficient and the highest wear resistance among all materials. This is attributed to combining effects of B4C and CNTs with the proper proportion. It not only enhances the composite’s mechanical properties, but promotes a continuous and uniform self-lubrication layer forming between friction pairs during the wear process. The wear mechanisms of pure Cu and composites (2, 4, 6 vol% CNTs) are severe plastic deformation and adhesion, abrasive wear, slight abrasive wear, abrasive and slight adhesive wear, respectively.

Prevention of intrauterine adhesions.

Intrauterine adhesions are a serious complication that occurs after intrauterine procedures, most often in connection with pregnancy. Manifestations such as amenorrhea, pelvic pain, and infertility for a woman, especially in reproductive age, are serious and together with intrauterine adhesions we call them Asherman's syndrome. Primary prevention after intrauterine procedures is important. Published studies show that the use of hyaluronic acid gel, especially after abortions, leads to the prevention of moderate and severe intrauterine adhesions and also increases the pregnancy rate.

Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report

BackgroundGranulomatous inflammation results from various causes including infections and allergic reactions. It can appear as high signal intensity in T2-weighted or contrast-enhanced T1-weighted magnetic resonance imaging (MRI). Here, we describe a case of granulomatous inflammation looking like a hematoma on an ascending aortic graft in MRI.Case presentationA 75-year-old female was undergoing assessment for chest pain. She had a history of hemi-arch replacement for aortic dissection 10 years earlier. The initial chest computed tomography and subsequent chest MRI were suggestive of a hematoma, implying a pseudoaneurysm of the thoracic aorta, which is associated with high mortality in reoperation. Through redo median sternotomy, severe adhesion was found in the retrosternal space. A sac in the pericardial space contained yellowish and pus-like material, confirming that there was no hematoma around the ascending aortic graft. The pathologic finding was chronic necrotizing granulomatous inflammation. Microbiological tests including polymerase chain reaction analysis were negative.ConclusionOur experience indicates that an MRI finding of a hematoma at the site long after cardiovascular surgery suggests that there may be granulomatous inflammation.

MenSCs Transplantation Improve the Viability of Injured Endometrial Cells Through Activating PI3K/Akt Pathway.

Endometrial injury is one of the leading causes of female infertility and is caused by intrauterine surgery, endometrial infection, repeated abortion, or genital tuberculosis. Currently, there is little effective treatment to restore the fertility of patients with severe intrauterine adhesions and thin endometrium. Recent studies have confirmed the promising therapeutic effects of mesenchymal stem cell transplantation on various diseases with definite tissue injury. The aim of this study is to investigate the improvements of menstrual blood-derived endometrial stem cells (MenSCs) transplantation on functional restoration in the endometrium of mouse model. Therefore, ethanol-induced endometrial injury mouse models were randomly divided into two groups: the PBS-treated group, and the MenSCs-treated group. As expected, the endometrial thickness and gland number in the endometrium of MenSCs-treated mice were significantly improved compared to those of PBS-treated mice (P < 0.05), and fibrosis levels were significantly reduced (P < 0.05). Subsequent results revealed that MenSCs treatment significantly promoted angiogenesis in the injured endometrium. Simultaneously, MenSCs enhance the proliferation and antiapoptotic capacity of endometrial cells, which is likely contributed by activating the PI3K/Akt signaling pathway. Further tests also confirmed the chemotaxis of GFP-labeled MenSCs towards the injured uterus. Consequently, MenSCs treatment significantly improved the pregnant mice and the number of embryos in pregnant mice. This study confirmed the superior improvements of MenSCs transplantation on the injured endometrium and uncovered the potential therapeutic mechanism, which provides a promising alternative for patients with serious endometrial injury.

A lightweight SSV2-YOLO based model for detection of sugarcane aphids in unstructured natural environments

Accurate, rapid, and smart pest recognition and detection are important for crop protection and management. Existing deep learning-based pest detection algorithms often require high computing resources and computational memory. In addition, detection of small and high-density pests (e.g., sugarcane aphids (SCAs)) in unstructured natural environments still remains challenging due to the small target size, natural illumination, and background noises. Here, we developed a lightweight SSV2-YOLO (Stem-ShuffleNet V2-YOLOv5s) model based on YOLOv5s (You Only Look Once, version 5, small) for SCA detection by reconstructing the backbone network with Stem and ShuffleNet V2 and adjusting the neck network width. We further refactored the feature level, data augmentation method, and loss function to improve detection performance for small, high-density, and overlapping targets. The newly developed SSV2-YOLO model was trained and tested using a mobile phone SCA image dataset (n = 860) covering both uniform and unstructured natural environments. Compared with the original YOLOv5s, SSV2-YOLO significantly reduced model complexity, e.g., reduced parameter number (by 95.1%), model size (by 92.5%), and floating point of operations (by 81.6%), and showed increased detection speed (GPU by 31.6% and CPU by 81.8%) and improved accuracy (by 2.5%). SSV2-YOLO also outperformed the best state-of-the-art algorithms for SCA detection under severe adhesion and unstructured farmland conditions. We found 640 × 640 as the best image pixel resolution to improve model detection performance without affecting model size. Our study showed that SSV2-YOLO has clear advantages in terms of accuracy, efficiency, and lightweight, which can be potentially used for the automatic detection of SCAs on mobile devices. The evaluation code and dataset are available at https://github.com/weiyuexu/SCAs-SSV2-YOLO.

Buried calculi within the coronal sulcus in a circumcised patient.

British Journal of Hospital MedicineEarly view Images in MedicineBuried calculi within the coronal sulcus in a circumcised patientKarl H Pang, Giuseppe Fallara, Aiman Haider, Asif Muneer, Hussain M AlnajjarKarl H PangDivision of Surgery and Interventional Science, University College London, London, UKSearch for more papers by this author, Giuseppe FallaraDepartment of Urology, King's College Hospital NHS Foundation Trust, London, UKSearch for more papers by this author, Aiman HaiderDepartment of Histopathology, University College London Hospitals NHS Foundation Trust, London, UKSearch for more papers by this author, Asif MuneerDivision of Surgery and Interventional Science, University College London, London, UKInstitute of Andrology, University College London Hospitals NHS Foundation Trust, London, UKDepartment of Surgical Biotechnology, University College London, London, UKNIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UKSearch for more papers by this author, Hussain M AlnajjarCorrespondence to: Hussain M Alnajjar; E-mail Address: [email protected]Division of Surgery and Interventional Science, University College London, London, UKInstitute of Andrology, University College London Hospitals NHS Foundation Trust, London, UKSearch for more papers by this authorKarl H Pang; Giuseppe Fallara; Aiman Haider; Asif Muneer; Hussain M AlnajjarPublished Online:20 Jun 2023https://doi.org/10.12968/hmed.2022.0558AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Ali MA, Oyortey MA, Donkor YO et al.. Penile skin bridge multiple liathiasis, a diagnosis made in a complication of circumcision in a 24 year old young adult: case report. Urol Case Rep. 2021;38:101742. https://doi.org/10.1016/j.eucr.2021.101742 Crossref, Medline, Google ScholarSkrodzka M, Britnell W, Ayers J et al.. Restoration of the lost obscured coronal sulcus: a novel surgical technique for penile lichen sclerosus with severe preputial adhesions. Eur Urol. 2020;78(5):750–756. https://doi.org/10.1016/j.eururo.2020.04.040 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 20 June 2023 Information© MA Healthcare LimitedPDF download

Robotic-assisted mitral valve surgery without aortic cross-clamping: a safe and feasible technique.

The primary objective of this study was to evaluate the safety and feasibility of robotic-assisted mitral valve surgery without aortic cross-clamping. From January 2010 to September 2022, 28 patients underwent robotic-assisted mitral valve surgery without aortic cross-clamping in our center using DaVinci Robotic Systems. Clinical data during the perioperative period and early outcomes of the patients were recorded. Most patients were in New York Heart Association (NYHA) class II and III. Mean age and EuroScore II of the patients were 71.5 ± 13.5 and 8.4 ± 3.7 respectively. The patients underwent either mitral valve replacement (n = 16, 57.1%) or mitral valve repair (n = 12, 42.9%). Concomitant procedures were performed including tricuspid valve repair, tricuspid valve replacement, PFO closure, left atrial appendage ligation, left atrial appendage thrombectomy and cryoablation for atrial fibrillation. Mean CPB times were 140.9 ± 44.6 and mean fibrillatory arrest duration was 76.6 ± 18.4. Mean duration of ICU stay was 32.5 ± 28.8 h and mean duration of hospital stay 9.8 ± 8.3 days. One patient (3.6%) underwent revision due to bleeding. New onset renal failure was observed in one (3.6%) patient and postoperative stroke in one (3.6%) patient. Postoperative early mortality was observed in two (7.1%) patients. Robotic-assisted mitral valve surgery without cross-clamping is a safe and feasible technique in high-risk patients undergoing redo mitral surgery with severe adhesions as well as in primary mitral valve cases that are complicated with ascending aortic calcification.

Nonintubated versus Intubated Lung Volume Reduction Surgery in Patients with End-Stage Lung Emphysema and Hypercapnia.

Lung volume reduction surgery (LVRS) represents an important treatment option in carefully selected patients with end-stage lung emphysema. The aim of this study was to assess the efficacy and safety of nonintubated LVRS compared to intubated LVRS in patients with preoperative hypercapnia and lung emphysema. Between April 2019 and February 2021, n = 92 patients with end-stage lung emphysema and preoperative hypercapnia undergoing unilateral video-assisted thoracoscopic LVRS (VATS-LVRS) performed in epidural anesthesia and mild sedation (nonintubated, group 1) or conventional general anesthesia (intubated, control, group 2) were prospectively enrolled in this study. Data were retrospectively analyzed. In all patients, low-flow veno-venous extracorporeal lung support (low-flow VV ECLS) was applied as a bridge through LVRS. Ninety-day mortality was considered as the primary outcome. Secondary endpoints included: chest tube duration, hospital stay, intubation and conversion to general anesthesia. Intergroup analysis showed no significant difference between the baseline data and patients' demographics. N = 36 patients underwent nonintubated surgery. VATS-LVRS under general anesthesia was performed in n = 56 patients. The mean duration of postoperative VV ECLS support was 3 ± 1 day in group 1 compared to 4 ± 1 in group 2. The 90-day mortality rate was 3% in group 1 compared to 7% in group 2. In group 1, all chest tubes were removed 5 ± 1 day (range 4-32 days) and 8 ± 1 day (range 4-44 days) in the control group after the surgery (p < 0.02). Prolonged chest tube therapy (>8 days) was observed in n = 3 patients in group 1 and n = 11 patients in the control group. The mean ICU stay was 4 ± 1 days in group 1 compared to 8 ± 2 days in the control group (p = 0.04). The mean hospital stay was significantly shorter in the nonintubated group 1 (6 ± 2 days vs. 10 ± 4 days, p = 0.01). Conversion to general anesthesia was necessary in one patient due to severe pleural adhesions. Nonintubated VATS-LVRS in patients with end-stage lung emphysema and hypercapnia is effective and well tolerated. Compared to general anesthesia, a reduction in mortality, chest tube duration, ICU and hospital stay and lower rate of prolonged air leak was observed. VV ECLS increases intraoperative safety and mitigates postoperative complications in such "high-risk" patients.

Intraductal papillary mucinous neoplasm of the accessory pancreatic duct in the pancreas uncinate process: A case report.

Intraductal papillary mucinous neoplasms (IPMN) of the accessory pancreatic duct (APD) are very rare and their clinical significance is not known. Here, we describe a case of IPMN originating in a branch of the duct of APD within the uncinate process of the pancreas, which initially presented with acute pancreatitis. A 70-year-old man visited our medical center presenting with acute pancreatitis around the head and uncinate process of the pancreas. Computer tomography scans revealed the presence of a 35-mm cystic mass-like lesion within the pancreas uncinate process communicating with a branch of the APD. The patient was diagnosed with APD-IPMN in the pancreas uncinate process accompanied by acute pancreatitis. Conservative management of the acute pancreatitis relieved his symptoms, while duodenum-preserving partial pancreatic head resection (DPPHR-P) was performed to treat the APD-IPMN. Intraoperative exploration showed the presence of severe adhesions within the uncinate process of the pancreas and that the tumor's "peduncle" - a branch of the duct of APD - was saddling just at the front of the main pancreatic ducts. Thus, surgical removal of the tumor required special handling of the region between the main duct (MD) and APD to protect the integrity of the main pancreatic ducts. Finally, a 35*30*15 mm IPMN was successfully removed and the MD was preserved combined with ligation from the root of the APD of the pancreas. The drainage volume of the ventral tube increased by around 20-fold in 24 hours on the fourth day after surgery. The presence of high amylase levels in the drainage discharge (40713.5 U/L) led to the diagnosis of postoperative pancreatic fistula (POPF). The drainage volume remained high for 3 days. The patient was discharged and POPF was successfully managed through endoscopic pancreatic duct stenting. APD-IPMN in the pancreas uncinate process has its own characteristics of localized pancreatitis, and MD-preserving DPPHR-P not only protects the exocrine and endocrine functions of the pancreas, but it also protects the physiological and anatomical integrity. The appearance of POPF after DPPHR-P may be managed by endoscopic pancreatic duct stenting.

Dynamic behavior of biological droplets on heated, superhydrophobic microstructured surfaces

Severe adhesion of biological fluids occurs on surgical electrodes due to a temperature-induced physical mechanism. By constructing surface microstructures and improving their hydrophobicity, it becomes a favorable choice for electrode anti-adhesion, but the related mechanisms are still not fully understood. Herein, we investigated the dynamic behavior of water and biological droplets on superhydrophobic microstructured surfaces (SMSs) heated over 100 ℃. The design inspiration of SMSs is derived from purple orchid leaves with excellent self-cleaning properties. The SMSs with Cassie-Baxter and Cassie impregnating states were selected and a flat surface was employed for comparison. Results show that the SMSs with the Cassie-Baxter state could reduce the Leidenfrost point to form a pseudo-Leidenfrost effect for water droplets. Furthermore, the dynamic evolution mechanism of plasma droplets on heated surfaces was first proposed, including base shrinkage, coagulation growth, and cap convergence. For the SMSs with the Cassie-Baxter state, the heat was carried away by vapor from the cavities at the contact interface, so that the growth height of the coagulation was lower than that of other surfaces. Additionally, the mentioned SMSs exhibited outstanding anti-adhesion performance and thermal stability. This study may contribute to understanding the anti-adhesion mechanism of surgical electrodes at the microscopic level.