Shorter Operation Research Articles

Application of 3D‑printed porous titanium interbody fusion cage vs. polyether ether ketone interbody fusion cage in anterior cervical discectomy and fusion: A systematic review and meta‑analysis update.

The present study aimed to compare the differences between 3D-printed porous titanium and polyether ether ketone (PEEK) interbody fusion cages for anterior cervical discectomy and fusion (ACDF). Literature on the application of 3D-printed porous titanium and PEEK interbody fusion cages for ACDF was searched in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang and VIP databases. A total of 1,181 articles were retrieved and 12 were finally included. The Cochrane bias risk assessment criteria and Newcastle-Ottawa scale were used for quality evaluation and Review Manager 5.4 was used for data analysis. The 3D cage group was superior to the PEEK cage group in terms of operative time [mean difference (MD): -7.68; 95% confidence interval (CI): -11.08, -4.29; P<0.00001], intraoperative blood loss (MD: -6.17; 95%CI: -10.56, -1.78; P=0.006), hospitalization time (MD: -0.57; 95%CI: -0.86, -0.28: P=0.0001), postoperative complications [odds ratio (OR): 0.35; 95%CI: 0.15, 0.80; P=0.01], C2-7 Cobb angle (MD: 2.85; 95%CI: 1.45, 4.24; P<0.0001), intervertebral space height (MD: 1.20; 95%CI: 0.54, 1.87; P=0.0004), Japanese Orthopaedic Association Assessment of Treatment (MD: 0.69; 95%CI: 0.24, 1.15; P=0.003) and visual analogue scale score (MD: -0.43; 95%CI: -0.78, -0.07; P=0.02). The difference was statistically significant, while there was no significant difference between the two groups in terms of fusion rate (OR: 1.74; 95%CI: 0.71, 4.27; P=0.23). The use of 3D-printed porous titanium interbody fusion cage in ACDF has the advantages of short operation time, less bleeding loss, shorter hospitalization time and fewer postoperative complications. It can better maintain the cervical curvature and intervertebral height, relieve pain and accelerate postoperative functional recovery.

Clinical outcomes of a modified ophthalmic viscosurgical device-free implantable collamer lens implantation.

To investigate the efficacy and safety of a modified dual-incision ophthalmic viscosurgical device-free (OVD-free) method for implantable collamer lens (ICL) implantation in high myopic eyes. A total of 68 participants were enrolled in this prospective randomized clinical trial, including 33 in the OVD-free group and 35 in the standard group. Operation time and intraocular pressure (IOP) at 2 hours postoperatively were recorded. Visual acuity, refractive power, IOP, corneal endothelium parameters, and anterior segment parameters were assessed at 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. Postoperative subjective visual quality at 3 months was recorded through a Quality of Vision (QoV) questionnaire. No significant differences in visual acuity, refractive outcomes, and corneal endothelial parameters were found, while the operation time was significantly shorter in the OVD-free group. Both groups showed a significant increase in IOP at 2 hours after surgery, but the increase in the OVD-free group was significantly smaller than that in the standard group. In addition, the frequency of ring-shaped dysphotopsia in the OVD-free group (15.15%) was significantly lower than that in the standard group (40%), and the severity and annoyance of this symptom were also significantly lower in the OVD-free group. The modified OVD-free ICL implantation is a safe, effective, and predictable method for myopia correction, which could be a better choice for short surgery time, better subjective visual perception, and low occurrence of IOP elevation.

Two-dimensional identification of time-varying batch nonlinear processes with input dead-zone nonlinearity

ABSTRACT In the time dimension, the batch process with input dead-zone nonlinearity often has the characteristics of short operation time and time-varying process parameters. A two-dimensional recursive least squares (2D-RLS) identification method for time-varying nonlinear systems with input dead zone is proposed. By mining system dynamic information from the time direction of the same batch and different batch directions, the identification parameters are updated. The proposed two-dimensional identification strategy converts the time-varying parameter estimation problem of time dimension into the equivalent time-invariant parameter estimation problem of batch dimension. Sufficient production data in batch dimension ensure that the proposed identification algorithm can eliminate the influence of random measurement noise. The identification strategy with unequal length of batch data is also given. The convergence of the proposed algorithm is analysed. Finally, numerical simulation and experimental tests are used to verify the effectiveness and superiority of the proposed algorithm.

Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study

Background: The complication intensity of short- and long-term anesthesia during different surgeries depends upon the age, medical history and general lifestyle of a patient. Aims and objectives: The aims and objectives of present study were to evaluate the risks associated with general anesthesia during various surgical procedures. Methodology: Current comparative cross-sectional study was conducted in ICU, general surgery and gynecology units of Ghurki Trust and Teaching Hospital from July 2023 to February 2024. Total 100 patients of appendectomy and hysterectomy were selected as study subjects and divided into two groups. In Group-A (short surgery group) 65patients with appendectomy and in Group-B (Long surgery group) 35 women patients with hysterectomy were included. All of the clinical and demographic data were recorded on MS Excel and SPSS version 2024 were used to process, analyze, and distribute the data as needed and graph pad prism was used to plot graphical data representation. Results: The study identified a significant association between anesthesia duration and increased postoperative complications, notably in patients aged 51-55 years. Enhanced risks included postoperative pain, nausea, and respiratory distress, emphasizing the need for tailored anesthesia strategies based on surgical length and patient demographics. Conclusion: General anesthesia is largely safe but linked to some complications, necessitating innovative improvements and further research with larger sample sizes for enhanced safety.

Is young adult idiopathic scoliosis a distinct clinical entity from adolescent idiopathic scoliosis? a Systematic Review and Meta-analysis comparing pre-operative characteristics and operative outcomes.

This study aims to conduct a systematic review of the literature comparing pre-operative, intraoperative, and post-operative characteristics between adolescent idiopathic scoliosis (AIS) and young adult idiopathic scoliosis (YAdIS) patients. Following PRISMA guidelines, we conducted a search of the PubMed/Medline, EMBASE, and Cochrane Central databases to identify full-text articles in the English-language literature. Our inclusion criteria were studies that compared preoperative, intraoperative, and postoperative characteristics between AIS and YAdIS patients. We performed a meta-analysis reporting mean difference (MD) for continuous variables and Odds ratios (ORs) to assess differences in postoperative complications. Seven studies consisting of 1562 patients were included in the meta-analysis. The AIS group exhibited less intraoperative bleeding and shorter surgical procedures, with a mean difference between groups of 122.3ml (95% CI 46.2-198.4, p = 0.002) and 28.7min (95% CI 6.5-50.8, p = 0.01), respectively. Although the preoperative Cobb angle did not differ between groups (p = 0.65), patients with AIS achieved superior postoperative deformity correction, with a mean difference of 7.3% between groups, MD -7.3 (95% CI -9.7, -4.8, p < 0.00001), and lower postoperative Cobb angles of the major curve, MD 4.2 (95% CI 3.1, 5.3, p < 0.00001). YAdIS patients were fused, on average, 0.2 more vertebral levels than AIS patients, MD 0.2 (95% CI 0.01, 0.5, p = 0.04). AIS patients experienced a significantly shorter length of stay after the surgical procedure, with an MD of 0.8days (95% CI 0.1, 1.6, p = 0.02). No significant difference was found between groups in terms of complications (p = 0.19). YAdIS should be regarded as a distinct surgical entity, characterized by increased bleeding, longer surgical duration, greater deformity correction challenges, and the need for fusion of additional vertebral levels compared to AIS. Surgeons should be mindful of these differences and discuss them with patients and their families, especially in cases where the correction of the AIS deformity is delayed and there is a high risk of progression after skeletal maturity. Further research is needed to explore alternative surgical techniques and enhance outcomes for YAdIS patients.

Thermal-hydraulic and structural analyses of an additive manufactured panel mock-up for Wendelstein7-X

After the successful short pulse operation phase 1 (OP1) of the stellarator Wendelstein 7-X with maximal plasma energies of 200 MJ, the upcoming long pulse OP2 aims at stepwise higher energies up to 18 GJ. A series of the stainless steel wall protection panels is positioned behind the divertor pumping gaps for average stationary heat loads of 100 kW/m². These panels were produced by electron beam welding of stainless steel parts to build the housing of the cooling channels. This technology was more demanding than foreseen due the complicated 3D weld seams required by the shaping of the panels. An innovative technology which is more adapted to the panel geometry is additive manufacturing. It intends to bring significant advantages by printing the housing as a single piece without welds.The paper introduces the thermal-hydraulic and structural analyses of an additive manufactured panel mock-up performed with ANSYS V2022R2. The purpose of the calculation is to compare the thermal, hydraulic and structural performance of the improved design based on additive manufacturing and the present one. The welding process dictated the design of the cooling channel that induced local recirculation areas, additional local pressure drops, non well cooled areas for weld seams integration. In addition the weld strength assessment required special codes and methods, which cost more time and efforts. Without these constraints, additive manufacturing offers the opportunity of more freedom for the design of the cooling channel to reach better heat transfer performance of the panel.

A novel technique for thulium laser enucleation of the prostate: anterior releasing with ThuLEP (ARTh technique)

Thulium laser enucleation of the prostate (ThuLEP) is a highly effective approach to the treatment of benign prostatic hyperplasia. We present here a description of the “ARTh Technique” and the benefits it offers in terms of improved visualization, short operation times, and easy recognition of the dissection plane, describing specifically the anterior release (AR) technique using ThuLEP(Th). Included in this retrospective study were 32 consecutive patients operated on between January 2022-November 2022. Parameters were measured before and after the procedure: the International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), post-void residual urine(PVR) prostate-specific antigen(PSA), prostate volume, operation-time, morcellation-time, catheterization-time and presence of transient urinary incontinence, and compared. The median age of patients undergoing enucleation of the prostate using the ARTh technique was 64 years (range: 44–83). The median prostate volume of the patients was 83.5 ml(50–128 ml), preoperative-IPSS was 24.8(15–33), postoperative-IPSS was 7(5–11), preoperative-Qmax was 8.1 ml/Sects. (5–11.5 ml/sec), postoperative-Qmax was 26.9 ml/Sect. (20.8–34 ml/sec), preoperative-PVR was 145 ml(75–258 ml), postoperative-PVR was 36.2 ml(0–66 ml), total operation time was 51.4 min(28–82 min), enucleation time was 36.9 min(19–51 min) and morcellation time was 15.3 min(8–27 min). The ARTh technique is a safe procedure that allows the surgeon to easily recognize and adhere to the defined dissection plane, thus decreasing operation times, significantly reducing the rate of postoperative transient urinary incontinence (TUI).

A Novel Nomogram to Predict Prognosis in Elderly Early-Stage Hepatocellular Carcinoma Patients After Ablation Therapy.

Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer. Early diagnosis is crucial for improving prognosis. Elderly HCC patients often have underlying liver diseases such as chronic hepatitis and cirrhosis, leading to impaired liver function and suboptimal liver reserve. Radiofrequency ablation (RFA) has rapidly become one of the most important methods for treating early-stage hepatocellular carcinoma (EHCC) due to its advantages, including minimal trauma, short operation time, less intraoperative bleeding, quick postoperative recovery, cost-effectiveness, and few postoperative-complications. However, the prognostic model for early recurrence after local ablation in elderly EHCC patients has not been widely evaluated. We have developed a prognostic model for the recurrence of local RFA in elderly EHCC patients. This is expected to provide a new early warning system for preventing early recurrence in elderly EHCC patients, prolonging patient's life, and improving overall quality of life. In this study, we included 661 EHCC patients who underwent local ablation, dividing them into a Primary cohort and a Validation cohort in a 7:3 ratio. We characterized the cohorts and utilized the primary cohort to develop a prognostic nomogram model for recurrence after local ablation in elderly EHCC patients. Additionally, the validation cohort was used to assess the potential of the nomogram as a non-invasive biomarker for post-ablation recurrence in EHCC. The user-friendly nomogram incorporates common clinical variables including gender, BCLC stage, tumor number, tumor size, red blood cell (RBC), gamma-glutamyl transferase (GGT), and prothrombin time activity (PTA). The nomogram constructed using the identified seven variables exhibits robust discriminatory capabilities, favorable predictive performance, and noteworthy clinical utility. We developed a user-friendly nomogram based on the BCLC stage classification, which may provide prognostic assessments for elderly EHCC patients at 1, 3, and 5 years post-RFA.

Combined hysteroscopic Bigatti shaver (IBS) and resectoscope removal of a heterotopic cesarean scar pregnancy in the first trimester

To report a case of heterotopic cesarean scar pregnancy reduction using a combined hysteroscopic integrated Bigatti shaver (IBS) and resectoscope with the preservation of a normal gestational sac in the uterine cavity under simultaneous transabdominal ultrasound guidance. Video article. University-affiliated hospital. A 30-year-old woman, G5P2A2L2, with two previous cesarean deliveries and a history of fertility problems, was admitted with a heterotopic cesarean scar pregnancy at 7+2 gestational weeks. Ultrasound examination showed a dichorionic diamniotic pregnancy. The first gestational sac (1.7 × 1.7 × 0.6 cm) was located in the previous hysterotomy scars, with a thin layer of myometriummeasuring 0.2 cm in thickness and a rich blood supply. The second chorionic sac (2.8 × 2.4 × 1.8 cm) was observed at the uterine fundus. Normal cardiac activity and yolk sacs were observed in both gestational sacs. The couple strongly desired to preserve the intrauterine pregnancy. After Institutional Review Board approval was obtained, a hysteroscopic IBS combined with a bipolar resectoscope was used to remove the heterotopic cesarean scar pregnancy while preserving the intrauterine gestational sac under simultaneous transabdominal ultrasound guidance. The heterotopic cesarean scar pregnancy was completely resected using hysteroscopy, and the gestational sac in the uterine cavity was successfully preserved. Trophoblastic tissue was confirmed using histopathological examination. The patient had an unremarkable postoperative recovery. Subsequent serial ultrasonography confirmed a single ongoing pregnancy with normal growth parameters and a normal placental site. The inability of an IBS to perform coagulation can be offset by its combination with the bipolar resectoscope. Hysteroscopic IBS combined with resectoscope to remove a heterotopic cesarean scar pregnancy offers a short operation time and minimum blood loss. It could be an optimized approach for the management of heterotopic cesarean scar pregnancy in the first trimester when an intrauterine pregnancy needs to be preserved.

Comparative study of minimally invasive titanium elastic nail and steel plate on the treatment of fracture of tibiofibular fracture in adults

To compare the clinical outcomes of using elastic intramedullary nail and plate to fix fibular fracture. The 60 patients with tibiofibular fractures admitted from January 2015 to December 2022 were divided into two groups:intramedullary nail group and plate group, 30 cases each, intramedullary nail group was treated with elastic intramedullary nail fixation group, plate group was treated with steel plate and screw fixation group. Intramedullary nail group, there were 18 males and 12 females, aged from 22 to 75 years old with an average of (39.4±9.8) years old, including 24 cases of traffic accidents injury, 6 cases of falling injury, 23 cases of closed fractures, 7 cases of open fractures. Steel plate group, there were 15 males and 15 females, aged from 24 to 78 years old with an average of (38.6±10.2) years old. The 22 cases were injured by traffic accident, 8 cases were injured by falling. The 24 cases were closed fractures and 6 cases were open fractures. The operation time, intraoperative bleeding, American Orthopedic Foot and Ankle Society (AOFAS) ankle and hind foot scores, clinical healing time of fibula and the incidence of wound complications were compared between the two groups. The patients in both groups were followed up for 6 to 21 months, with an average of (14.0±2.8) months. Compared with plate group, intramedullary nail group had shorter operative time, less bleeding, shorter clinical healing time of fibula, and lower infection rate of incision, and the difference was statistically significant (P<0.05). There were 2 cases of delayed healing in intramedullary nail group, 1 case of nonunion in plate group, and 2 cases of delayed healing in plate group, and there was no statistically significant difference between the two groups (P>0.05). In the last follow-up, according to the AOFAS scoring standard, the ankle function in intramedullary nail group was excellent in 17 cases, good in 12 cases, fair in 1 case, with an average of (88.33±4.57) points, while in plate group, excellent in 16 cases, good in 10 cases, fair in 4 cases, with an average of (87.00±4.14) points;There was no statistical difference between the two groups (P>0.05). Elastic intramedullary nail has the advantages of short operation time, less intraoperative bleeding, short fracture healing time and less incision complications in the treatment of fibular fracture, which is worthy of clinical application.

Clinical application of indocyanine green fluorescence navigation technique in laparoscopic common bile duct exploration for complex hepatolithiasis

BackgroundThis study investigated the clinical application of the indocyanine green (ICG) fluorescence navigation technique in bile duct identification during laparoscopic common bile duct exploration (LCBDE) for complex hepatolithiasis.MethodsEighty patients with complex hepatolithiasis were admitted to our department between January 2022 and June 2023 and randomly divided into control and observation groups. The control group underwent conventional LCBDE, while the observation group underwent LCBDE guided by ICG fluorescence.ResultsIntraoperatively, the observation group had shorter operation and search times for the common bile duct (CBD), as well as reduced intraoperative blood loss and fewer complications, such as conversion to laparotomy and various injuries (gastroduodenal, colon, pancreatic, and vascular) than the control group, with statistical significance (P < 0.05). Postoperatively, the observation group had lower rates of postoperative bile leakage, abdominal infection, postoperative hemorrhage, and residual stone than the control group. Additionally, the observation group demonstrated significantly shorter times for resuming flatus, removal of the abdominal drainage tube, and hospitalization than the control group, with statistical significance (P < 0.05).ConclusionICG fluorescence navigation technology effectively visualizes the bile duct, improves its identification rate, shortens the operation time, prevents biliary tract injury, and reduces the occurrence of complications.

Comparison of Clinical Effects of Intramedullary Nail Internal Fixation and Traditional Steel Plate Internal Fixation in the Treatment of Zhang-Hou Fracture

&amp;lt;i&amp;gt;Objective: &amp;lt;/i&amp;gt;The objective of this study was to analyse and compare of the clinical effects of two surgical methods in the treatment of Zhang-Hou fracture; &amp;lt;i&amp;gt;Method&amp;lt;/i&amp;gt;: A total of 34 patients with Zhang-Hou fracture diagnosed in our hospital from 2020.08 to 2022.06 were reviewed. Among them, 17 patients were treated with tibial intramedullary nail internal fixation and 17 patients with traditional steel plate internal fixation. The blood loss, operation time, fracture healing time, excellent rate of affected limb function and postoperative complications were compared between the two groups. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: The operation time, intraoperative blood loss and fracture healing time were shorter in the intramedullary nail group, and the excellent rate of limb function in the intramedullary nail group was higher than that in the plate group 6 months after operation, but there was no significant difference between the two groups 12 months after operation. All the patients in the intramedullary nail group hadn’t serious complications after operation. Among the 17 patients in the plate group, 1 patient had wound infection and 1 patient had delayed fracture healing. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: In the clinical treatment of Zhang-Hou fracture, tibial intramedullary nail internal fixation not only has the advantages of short operation time, less trauma and quick recovery after operation, but also has better functional recovery of the affected limb and less postoperative complications. However, clinicians&amp;apos; learning curve of tibial intramedullary nail internal fixation is relatively long.

Prediction of remaining surgery duration in laparoscopic videos based on visual saliency and the transformer network.

Real-time prediction of the remaining surgery duration (RSD) is important for optimal scheduling of resources in the operating room. We focus on the intraoperative prediction of RSD from laparoscopic video. An extensive evaluation of seven common deep learning models, a proposed one based on the Transformer architecture (TransLocal) and four baseline approaches, is presented. The proposed pipeline includes a CNN-LSTM for feature extraction from salient regions within short video segments and a Transformer with local attention mechanisms. Using the Cholec80 dataset, TransLocal yielded the best performance (mean absolute error (MAE)=7.1min). For long and short surgeries, the MAE was 10.6 and 4.4min, respectively. Thirty minutes before the end of surgery MAE=6.2min, 7.2 and 5.5min for all long and short surgeries, respectively. The proposed technique achieves state-of-the-art results. In the future, we aim to incorporate intraoperative indicators and pre-operative data.

Determination of six halogenated solvent residues in olive oil by headspace gas chromatography

The residual amount of halogenated solvents in olive oil is an important indicator of its quality. The National Olive Oil Quality Standard GB/T 23347-2021 states that the residual amount of individual halogenated solvents in olive oil should be ≤0.1 mg/kg and that the total residual amount of halogenated solvents should be ≤0.2 mg/kg. COI/T.20/Doc. No. 8-1990, which was published by the International Olive Council, describes the standard method used for the determination of halogenated solvents in olive oil. Unfortunately, this method is cumbersome, has poor repeatability and low automation, and is unsuitable for the detection and analysis of residual halogenated solvents in large quantities of olive oil. At present, no national standard method for determining residual halogenated solvents in olive oil is available in China. Thus, developing simple, efficient, accurate, and stable methods for the determination of residual halogenated solvents in olive oil is imperative. In this paper, a method based on automatic headspace gas chromatography was established for the determination of residual halogenated solvents, namely, chloroform, carbon tetrachloride, 1,1,1-trichloroethane, dibromochloromethane, tetrachloroethylene, and bromoform, in olive oil. The samples were processed as follows. After mixing, 2.00 g (accurate to 0.01 g) of the olive oil sample was added into a 20 mL headspace injection bottle and immediately sealed for headspace gas chromatography analysis. Blank virgin olive oil was used to prepare a standard working solution and the external standard method for quantification. The solvents used in the preparation of halogenated solvent standard intermediates were investigated and methanol was selected as a replacement for N,N-dimethylacetamide to prepare a halogenated solvent standard intermediate owing to its safety. The effects of different injection times (1, 2, 3, 4, 5, 6 s), equilibration temperatures (60, 70, 80, 90, 100, 110, 120 ℃), and equilibration times (4, 5, 8, 10, 20, 30, 40 min) of the headspace sampler on the detection of the residual amounts of the six halogenated solvents were investigated. The optimal injection time and equilibration temperature were 3 s and 90 ℃, respectively. The method demonstrated good analytical performance for the six halogenated solvents when the equilibration time was 30 min. A methodological study was conducted on the optimized method, and the results showed that the six halogenated solvents exhibited good linear relationships in the range of 0.002-0.200 mg/kg, with correlation coefficients of ≥0.9991. The limits of detection (LODs) and quantification (LOQs) of 1,1,1-trichloroethane and bromoform were 0.0006 and 0.002 mg/kg, respectively. The LODs and LOQs of chloroform, carbon tetrachloride, dibromochloromethane, and tetrachloroethylene were 0.0003 and 0.001 mg/kg, respectively. The average recoveries under different spiked levels were 85.53%-115.93%, and the relative standard deviations (n=6) were 1.11%-8.48%. The established method was used to analyze 13 olive oil samples available in the market. Although no halogenated solvents were detected in these samples, a limited number of samples does not represent all olive oils. Hence, monitoring residual halogenated solvents in olive oil remains necessary for its safe consumption. The LOQs of the method for the six halogenated solvents were significantly lower than that of the COI/T.20/Doc. No. 8-1990 standard method (0.02 mg/kg). In addition, the developed method can be conducted under short operation times with high precision and degree of automation as well as good accuracy. Thus, the proposed method is suitable for the determination and analysis of the residues of the six halogenated solvents in large batches of olive oil samples.

Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy.

To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection. The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups. The operation time (210.43±57.56 vs. 281.97±65.89, t =5.887, P <0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t =4.791, P <0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t =5.713, P <0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t =3.681, P <0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t =3.721, P <0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t =4.553, P <0.05), incidence rate of complications (43.33% vs. 82.86%, χ 2 =11.075, P <0.05) in group A were lower than those in group B ( P <0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t =4.331, P <0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t =4.863, P <0.05). For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.

Analysis of the Curative Effect of Metatarsal Sinus Incision and "L"-shaped Incision in the Treatment of Calcaneal Fractures

Objective To compare the clinical efficacy of sinus tarsi incision and traditional operation in the treatment of calcaneal fractures. Methods A total of 46 patients with calcaneal fracture admitted to Jianli People's Hospital from June 2020 to January 2022 were included, including 37 males and 9 females. 23 patients in the control group were treated with "L" incision, and 23 patients in the experimental group were treated with tarsal sinus incision. The length of hospitalization, operation time an, surgical incision length, grainage volume, complication of the two groups were recorded respectively. The results of Bohler Angle and Gissane Angle were measured before and after operation. Results The operation time of the test group is shorter than that of the control group. Compared with the operation time of the two groups, the difference is statistically significant (P&lt;0.01). The postoperative drainage flow of the test group is less than that of the control group. The contrast difference between the two groups in the operation area is statistically significant (P&lt;0.01), and the length of the surgical incision in the test group is shorter than that of the control group. The length of the surgical incision is statistically significant compared with the length of the two groups (P&lt;0.01). The number of days of hospitalization in the test group is shorter than the number of days in the control group, but there is no statistical significance (P&gt;0.05). The patient's pre-operative Bohler angle measurement result and the Gissane angle measurement knot. The difference has no statistical significance (P&gt;0.05). Bohler Angle in both control group and experimental group was significantly higher after surgery than before surgery (P &lt; 0.01), and Gissane Angle was significantly lower after surgery than before surgery (P &lt; 0.01). However, there was no significant difference in Bohler Angle and Gissane Angle between the two groups before and after surgery (P &gt; 0.05). The complication rate of control group was higher than that of experimental group, but there was no significant difference between the two groups (χ2=0.357, P &gt; 0.05). Conclusion For Sanders II and III calcaneal fractures, the "L" incision is like the sinus tarsi incision. However, the incision of tarsal sinus has the advantages of small trauma, short operation time and good recovery of patients.

Effective dose of intranasal remimazolam for preoperative sedation in preschool children: a dose-finding study using Dixon's up-and-down method.

Most preschool children are distressed during anesthesia induction. While current pharmacological methods are useful, there is a need for further optimization to an "ideal" standard. Remimazolam is an ultra-short-acting benzodiazepine, and intranasal remimazolam for pre-induction sedation may be promising. This study included 32 preschool children who underwent short and minor surgery between October 2022 and January 2023. After pretreatment with lidocaine, remimazolam was administered to both nostrils using a mucosal atomizer device. The University of Michigan Sedation Score (UMSS) was assessed for sedation 6, 9, 12, 15, and 20min after intranasal atomization. We used Dixon's up-and-down method, and probit and isotonic regressions to determine the 50% effective dose (ED50) and 95% effective dose (ED95) of intranasal remimazolam for pre-induction sedation. Results: Twenty-nine pediatric patients were included in the final analysis. The ED50 and ED95 of intranasal remimazolam for successful pre-induction sedation, when processed via probit analysis, were 0.65 (95% confidence interval [CI], 0.59-0.71) and 0.78mg/kg (95% CI, 0.72-1.07), respectively. In contrast, when processed by isotonic regression, they were 0.65 (95% CI: 0.58-0.72mg/kg) and 0.78mg/kg (95% CI: 0.69-1.08mg/kg), respectively. At 6min after intranasal remimazolam treatment, 81.2% (13/16) of "positive" participants were successfully sedated with a UMSS ≧ 1. All the "positive" participants were successfully sedated within 9min. Intranasal remimazolam is feasible for preschool children with a short onset time. For successful pre-induction sedation, the ED50 and ED95 of intranasal remimazolam were 0.65 and 0.78mg/kg, respectively.

Treatment Efficacy of CT-Guided Percutaneous Kyphoplasty Combined with Three-Dimensional Coordinate Guidance System on Osteoporotic Vertebral Compression Fracture

Purpose: To investigate the clinical effect of percutaneous kyphoplasty (PKP) guided by computed tomography (CT) combined with the three-dimensional coordinate guidance system on the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: 32 cases of OVCF in the elderly admitted to our hospital from October 2019 to March 2021 underwent CT-guided PKP combined with the three-dimensional coordinate guidance system, and 36 vertebrae were treated. The patients’ VAS pain scores (visual analog scale) and ODI (Oswestry disability index) were observed after surgery, and the paired t-test was used to compare these indexes. Results: The 36 vertebrae that were treated with CT-guided PKP combined with the three-dimensional coordinate guidance system underwent unilateral pedicle puncture according to the path planned by CT images. With the ideal position of the puncture needle and a high success rate of puncture, the puncture time was 1.2–2.6 minutes, with an average of about 1.5 minutes; the injected bone cement ranged from 3 to 5.5 mL, with an average of 4.2 mL, and there were no spinal nerve injuries or leakage of the cement in the canal. VAS score decreased from 7.65 ± 0.60 before the operation to 2.59 ± 0.28 one day after the operation (P &lt; 0.01); ODI decreased from 62.3 ± 2.18 before the operation to 27.91 ± 1.32 after the operation (P &lt; 0.01). Conclusion: The application of CT-guided PKP combined with the three-dimensional coordinate guidance system has the advantages of accurate puncture, short operation time, less intraoperative bleeding, and low complications. This treatment is safe, reliable, and satisfactory for patients, and is worthy of clinical promotion.

Comparison of bolus dose administration of propofol and dexmedetomidine for incidence of emergence delirium in pediatric patients undergoing surgery with general anesthesia: A randomized, double-blind trial

Abstract Background and Aims: Emergence delirium (ED) during the postanesthesia recovery phase presents significant challenges, especially among pediatric patients, with incidence rates spanning from 2% to 80%. This study sought to assess and compare the effectiveness of propofol and dexmedetomidine in addressing ED in pediatric patients undergoing sevoflurane anesthesia. The primary aim was to ascertain the prevalence of ED in both treatment cohorts, while secondary outcomes encompassed postoperative pain, hemodynamic responses, and the occurrence of complications. Material and Methods: Eighty children aged 2–6 years scheduled for short infraumbilical surgeries under general anesthesia were recruited in this trial. Propofol (1 mg/kg) or dexmedetomidine (0.3 μg/kg) was administered 10 min before completion of surgery. The Paediatric Anaesthesia Emergence Delirium scale was employed to evaluate ED every 5 min following extubation, wherein a score exceeding 12 was indicative of ED. Postoperative sedation was assessed using the Ramsay Sedation Scale, while pain levels were determined through the Face, Legs, Activity, Cry, and Consolability (FLACC) score. Any potential complications were closely monitored. Results: The incidence of ED at extubation was 2.50% and 70% in group D and P, respectively, and the trend of lower ED incidence was consistently observed at 5, 10, 15, and 30 min postextubation. The relative risk ratio at extubation was 4.103 (95% confidence interval: 2.49–6.76), highlighting a significant reduction of 4.1 times in the risk of ED when dexmedetomidine was administered. The dexmedetomidine group exhibited a lower incidence of postoperative pain. Conclusion: In comparison to propofol, dexmedetomidine demonstrated superior efficacy in reducing ED and postoperative pain in pediatric patients during general anesthesia, when administered before completion of surgery.

Occurrence, distribution and sources of microplastics in typical marine recirculating aquaculture system (RAS) in China: The critical role of RAS operating time and microfilter

Industrial mariculture, a vital means of providing high quality protein to humans, is a potential source of microplastics (MPs) which have recently received increasing attention. This study investigated the occurrence and distribution of microplastics in feed, source water and recirculating aquaculture system (RAS) with long & short operating times as well as in fish from typical industrial mariculture farms in China. Results showed that microplastics occurred in all samples with the average concentration of 3.53 ± 1.39 particles/g, 0.70 ± 0.17 particles/L, 1.53 ± 0.21 particles/L and 2.21 ± 0.62 particles/individual for feed, source water, RAS and fish, respectively. Microplastics were mainly fiber in shape, blue in color and 20–500 μm in size. Compared with short operated RAS, long operating time led to higher microplastic concentration in RAS, especially that of microplastic in 20–500 μm, granular and blue. Regardless of short or long operating time, microplastics in RAS mainly gathered in culture tank, tank before microfilter and fixed-bed biological filter, and the microfilter removed efficiently the microplastic with the shape of film, granule, fragment as well as those with size > 1000 μm. As for the polymer types, polyamide (PA, 71.9 %) and polyethylene terephthalate (PET, 65.7 %) dominated in feed and source water, respectively, which may be the reason for the high proportion of PA (38.8 % and 26.4 %) and PET (31.8 % and 30.2 %) in RAS and fish. In addition, polypropylene (PP) was also detected in RAS (18.7 %) and fish (22.6 %), indicating that other plastic facilities such as PP brush carrier also made a contribution. Positive matrix factorization (PMF) model revealed three sources of MP in RAS, namely plastic facilities, industrial sewage and plastic packaging products. Our results provided a theoretical basis for the management of MP in RAS.