Technical Ease Research Articles

Prospective Harmonization, Common Data Elements, and Sharing Strategies for Multicenter Pre-Clinical Traumatic Brain Injury Research in the Translational Outcomes Project in Neurotrauma Consortium.

Effective team science requires procedural harmonization for rigor and reproducibility. Multicenter studies across experimental modalities (domains) can help accelerate translation. The Translational Outcomes Project in NeuroTrauma (TOP-NT) is a pre-clinical traumatic brain injury (TBI) consortium charged with establishing and validating noninvasive TBI assessment tools through team science. Here, we present practical approaches for harmonization of TBI research across five centers providing needed vocabulary and structure to achieve centralized data organization and use. This includes data sharing as an essential step that enables validating data between domains, evaluating reproducibility between sites, and performing multimodal analyses. As part of this process, TOP-NT (1) produced a library of TBI-relevant standard operating procedures to coordinate workflow, (2) aligned 481 pre-clinical and clinical common data elements (CDEs), and (3) generated 272 new pre-clinical TBI CDEs. This consortium then (4) connected diverse data types to validate assessments across domains and to allow multivariable TBI phenotyping. Lastly, TOP-NT (5) specified technical quality controls for pre-clinical studies. These harmonization tools can facilitate reproducibility in team science, help distinguish a wide injury spectrum from technical variability, apply quality-controls, and ease higher level data analyses. TOP-NT uses three rat TBI models across four sites. Each site collects primary outcome measures, including magnetic resonance imaging (MRI) protocols and blood biomarkers of neuronal and glial injury, validated by histopathology and behavioral outcomes. Collected data are organized using the 481 TOP-NT pre-clinical CDEs, covering surgical, behavioral, biomarker, MRI, and quantitative histopathological methods. We report data curation steps suited for data storage using the Open Data Commons for TBI as a centralized data repository, allowing unbiased cross-site analysis. This approach leads to introducing a higher level, syndromic understanding of TBI signatures. TOP-NT authors outline a semantic and structural framework suggesting strategies for robust pre-clinical research in multicenter trials to improve translatability for TBI assessments. [Figure: see text].

Preferences for Inguinal Hernia Repair in Infants: A Survey of the Eastern Pediatric Surgery Network.

Laparoscopic inguinal hernia repair (IHR) is being performed more frequently in children, but few studies have evaluated surgical practice patterns in infants. In this study, we surveyed pediatric surgeons within a regional consortium to assess current preferences for IHR strategy in infants. We hypothesized that early-career pediatric surgeons would prefer laparoscopic IHR over open IHR in this patient population. A Qualtrics survey addressing surgeon preferences for IHR was distributed to 160 pediatric surgeons at 19 member institutions affiliated with the Eastern Pediatric Surgery Network. Surgeons were stratified by self-reported number of years in attending practice. Responses were compared using t-tests and chi-square tests wherever appropriate. Ninety-eight surgeons responded to the survey (61% response rate; two incomplete responses were excluded). Forty respondents (41.7%) had 0-10ys of experience, 26 (27.1%) had 10-20ys of experience, and 30 (31.2%) had over 20 ys of experience. Over 90% of early-career surgeons reported a preference for laparoscopic IHR in infants, compared to less than 50% of mid-career surgeons and less than 20% of late-career surgeons (P<0.001). Respondents preferring laparoscopic IHR most commonly cited inherent assessment of the contralateral side, confirmation of hernia before repair, and technical ease of the laparoscopic approach as factors contributing to their preference. The majority of early-career pediatric surgeons prefer laparoscopic IHR over open IHR in infants, representing a substantial shift away from what is traditionally regarded as the gold standard open technique. Larger studies are needed to compare long-term outcomes after laparoscopic and open IHR in infants.

Extension-block pinning versus custom-made plate fixation technique: A comparison of two methods in the treatment of osseous mallet finger injuries.

Mallet finger injuries, characterized by a flexion deformity caused by trauma to the extensor mechanism at the base of the distal phalanx, can lead to significant functional impairment if not treated appropriately. Surgical interventions for osseous mallet finger injuries often include techniques such as extension-block pinning and perioperative modifying plate fixation. When comparing these two methods, it is critical to assess factors such as technical ease, perioperative considerations, and postoperative outcomes. This study aims to compare these two techniques to provide valuable insights into the optimal surgical approach for treating osseous mallet finger injuries, improving patient care and outcomes. From 2017 to 2022, a retrospective study of 89 patients with Doyle classification type IVB and IVC mallet finger injuries was conducted. The patients were divided into two groups using a surgical technique called block randomization. Group 1 included 46 patients treated with the extension-block pinning fixation technique, while Group 2 comprised 43 patients treated with the perioperative modifying plate fixation technique. Observations included nail deformities and dorsal prominence at the distal interphalangeal (DIP) joint. All patients were deemed eligible for surgical intervention due to the time elapsed since injury or ineffectiveness of prior conservative treatment. No significant differences in patient demographics were observed between the two groups. While Crawford classification and pain scores showed no significant differences between the groups (p>0.05), the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score and time to return to work significantly favored Group 2, which underwent perioperative modifying plate fixation (p<0.05). Extension-block pinning is noted for its simplicity and favorable postoperative range of motion outcomes. In contrast, perioperative modifying plate fixation enhances stability and mechanical performance, positively impacting overall functional recovery. The choice between these techniques should consider procedural simplicity, perioperative demands, mechanical efficiency, and postoperative functional outcomes.

Effect of pig breeding scale on manure resource utilization-The moderating effect based on technology cognition.

The utilization of manure resources is an important measure to promote the development of agricultural green low-carbon cycle and solve the challenges associated with the current large-scale development of the livestock and poultry breeding industry. Based on the survey data of pig farmers in Qingdao, Shandong Province, China, this paper constructs a theoretical analysis framework of pig breeding scale and technical cognition on the utilization behavior of livestock and poultry manure resources of pig farmers. The binary Logit model and the moderating effect model are used to deeply explore the scale effect of breeding scale on the utilization behavior of pig farmers' manure resources, and the moderating effect of technical cognition on the influence of breeding scale on the utilization behavior of manure resources. First, at the present stage, pig farmers show certain differences in the resource utilization of manure. Due to the differences in the personal characteristics, family characteristics, and breeding characteristics of pig farmers, the influencing factors of resource utilization of pig farmers of different scales are different; Second, the scale of pig breeding has a significant positive promoting effect on the resource utilization of manure, increasing the probability of pig farmers to treat manure, guiding retail and small-scale farmers to moderately expand the scale of breeding, gradually moving to large-scale breeding, realizing centralized management and resource utilization of manure, and reducing the unit cost of manure treatment. Third, technical ease of use has a positive regulatory effect on pig breeding scale and manure resource utilization behavior. When pig farmers perceive that the technology of manure resource utilization is easy to use, they will increase the probability of participating in the resource utilization of manure, reduce the environmental pollution caused by improper disposal of manure, and promote the low-carbon and circular development of livestock and poultry industry. Based on the above findings, this paper aims to provide practical enlightenment for policy makers and researchers to strengthen the environmental governance and sustainable development of livestock industry.

Robotic versus open pancreatoduodenectomy for periampullary neoplasm: a propensity matched analysis of peri-operative and oncologic outcomes.

Though open pancreatoduodenectomy (OPD) is the gold standard, robotic pancreatoduodenectomy (RPD) is on the rise due to its technical ease with robotic armamentarium and claim to decrease morbidity in the perioperative period. This study compares the perioperative and oncologic outcomes of RPD performed for periampullary neoplasms (PANs) with OPD. This is a retrospective study conducted from January 2018 to December 2023 for all the patients who underwent either OPD or RPD for PANs. Demographic, peri-operative outcomes and oncological parameters [disease-free survival (DFS) and overall survival (OS)] were analysed and compared. The two groups were matched using 1:1 propensity score matching (PSM) to reduce the risk of confounding. A hundred patients were analysed (30 in RPD and 70 in OPD), and both groups were similar in demographic characteristics. Post-operative morbidity in terms of clinically relevant pancreatic fistula, post-pancreatectomy haemorrhage, delayed gastric emptying and overall Clavien-Dindo ≥ Grade 3 complications were similar in both groups. Surgical site infection (SSI) was significantly higher in the OPD group compared to RPD (31.4% vs. 6.7, p = 0.008); however, the median postoperative hospital stay was similar in both groups. After PSM (26 patients in each group), the RPD group had significantly more operative time (480min vs. 360min, p = 0.007) less blood loss (250ml vs. 400ml, p = 0.004), and similar SSI [2(7.7%) vs. 6(23.1%), p = 0.178). The R0 resection rate, lymph nodal yield, lymph nodal positivity, DFS and OS were similar in both groups. The robotic approach for PD is technically safe and feasible with equivalent resection quality and oncological outcomes compared to the open approach. RPD has equivalent postoperative morbidity, DFS and OS.

Perspectives on Telemedicine Visits Reported by Patients With Cancer

The COVID-19 pandemic catalyzed rapid adoption of telemedicine visits for cancer care delivery. However, patients' experiences with telemedicine remain poorly understood. To understand patients' satisfaction with telemedicine visits at a comprehensive cancer center. This survey study included patients with cancer at a US cancer center between 2020 and 2023. Eligible patients completed surveys in English conducted after their first telemedicine appointment via an online patient portal. Data were analyzed between January and June 2024. Patient surveys about telemedicine experiences, with a specific comparison with an in-person visit. Structured items elicited satisfaction with the specific visit, preferences for future use of telemedicine, and technical ease of use; unstructured free-text responses were also elicited. Proportion of patients who indicated that telemedicine visits were superior or preferred to in-person visits. Secondary outcomes included multivariable analysis of barriers to telemedicine use and variations in patient experiences by demographic characteristics over the observation period, and free-text analysis of unstructured responses describing the telemedicine experience using the BERTopic algorithm and a language model. A total of 27 435 telemedicine users completed surveys from May 2020 to October 2023 (median [IQR] age, 65 [55-72] years; 15 072 female [54.9%]; 1771 Asian [6.7%], 1339 Black [5.1%], 22 742 White [85.9%]). Overall, 18 025 of 24 418 patients (73.8%) rated their first telemedicine visit as good as or better than an in-person visit, and 4606 (18.9%) rated it superior to an in-person visit. The proportion of patients rating a telemedicine visit superior to an in-person visit evolved from 17% in 2020 to 20% in 2023. Structured questions revealed a positive view of telemedicine, while free-text analyses highlighted issues with technology. In this survey study of perspectives on telemedicine visits, a large majority of patients at a comprehensive cancer center expressed satisfaction with telemedicine visits in proportions that remained consistent beyond the end of the pandemic. These findings challenge health care systems to integrate telemedicine into routine cancer care and to overcome remaining technical challenges and barriers to ease of use.

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.

B-100 Utilization and Performance of Monospot and Epstein-Barr Virus Antibody Profile Testing for Diagnosis of Infectious Mononucleosis in Adolescents and Adults

Abstract Background Epstein-Barr virus (EBV) antibody profile, which includes IgM and IgG antibodies against EBV viral capsid antigen (VCA), IgG antibodies against early antigen (EA) and nuclear antigen (EBNA), is recommended by the CDC for diagnosing infectious mononucleosis (IM) and differentiating acute versus past infection. Conversely, the monospot test, which detects reactive heterophile antibodies, is not recommended by the CDC due to its low sensitivity in young children and non-specific nature. However, monospot tests remain widely used, especially as point-of-care testing at emergency department visits, likely related to their technical ease, rapid turnaround, and low cost. In this study, we compared the utilization and performance of the monospot test and EBV profile for the diagnosis of primary IM in adolescent and adult patients. Methods A retrospective review was conducted on consecutive monospot tests (Acceava Mono Cassette, Abbott) and EBV profiles (multiplex assay on Bioplex analyzer, Bio-Rad) performed between August 16, 2020, and August 15, 2021 in our hospital system. Cases with concurrent monospot and EBV profile testing were evaluated for qualitative agreement between the two methods. A chart review was conducted for cases with discrepant results between monospot and EBV antibody profile tests to assess the performance of these two methods. The final EBV infection status for each case was determined by clinical manifestation, relevant lab findings, and EBV profile results. Results A total of 1,524 monospot tests were performed, with an overall positive rate of 12.4%. The majority of tests were from the emergency departments (ED, 47.5%) and outpatient settings (48.7%), with inpatient tests comprising 3.8%. Notably, the positive rate was highest among outpatients (13.4%), followed by ED patients (12.3%), and lowest among inpatients (1.5%). In contrast, 3,769 EBV profile tests were performed, yielding an overall VCA IgM positive rate of 11.8% and 2.9% equivocal cases. Outpatient settings accounted for the majority of EBV profile tests (81.5%), followed by inpatients (16.2%) and ED patients (2.3%). Inpatients also exhibited a lower positive rate (7.5%) than ED (13.1%) or outpatients (13.1%). Among 364 cases concurrently tested by both the mono spot and the EBV profile, the negative agreement between the two tests was 97.7%, while the positive agreement was 52.8%. Discrepancies included 8 monospot-positive but VCA IgM-negative cases and 58 VCA IgM-positive but monospot-negative cases. Chart review revealed that monospot and EBV profiles missed 4 and 40 cases of primary IM, respectively. Additionally, 7 cases of past EBV infection exhibited prolonged VCA IgM positivity, and 2 cases of VCA IgM were falsely positive, likely due to cross-reaction with cytomegalovirus or B. burgdorferi IgM. Sensitivity/specificity for EBV profile and monospot were 96.4%/97.4% and 64.0%/100.0%, respectively. Conclusions The EBV profile demonstrates high sensitivity and specificity and is suitable as the primary test for diagnosing IM. While the monospot test exhibits good specificity, its lower sensitivity necessitates further testing with the EBV profile, particularly for patients with a high suspicion of IM, to avoid missed diagnoses.

Страх красоты

The article discusses the problem of rejecting the image of beauty in modern dance. It is indicated that the theme of despair, fear, violence and depression begins to dominate in modern dance since its inception in the 20s of the last century. The characteristic features of movements and plasticity in expressionist dance, in the school of M. Graham, are described: broken vertical, inwardly turned chest and feet, sharpness and convulsiveness of movements, blows aimed at oneself, etc. The article consistently examines the possible causes of this trend, such as technical ease and accessibility, lower energy cost of ‘sad dances’, as well as the opportunity to demonstrate originality, nonconformism, express social protest, etc. There is an opinion that the expression of pathological motives, negative feelings, fears in art contributes to the liberation from their destructive effect in real life. This approach is questioned, because there is also a reverse mechanism: as a result of viewing relevant plots (for example, scenes of violence), infection with emotions occurs, role models arise, and the thresholds of what is permissible decrease. Along with criticism of a number of trends in contemporary art, the importance of the concept of ugliness for culture is emphasized. Meeting one’s own infirmity and imperfection, be that physical, psychological or moral, plays an essential role in the spiritual development of a person. However, modern art, including the dance performances considered, follow the path of establishing ugliness as a new norm and cultivate the perverted reality of the ‘sick’ creativity of a disintegrating personality. The expression of beauty, on the contrary, is characteristic of an integral personality striving for perfection and praising life.

New Diagnostic Strategy for Onychomycosis: First-Line Utilization of DermaGenius® PCR and Calcofluor Microscopy Combined with Selective Culturing.

Onychomycosis (OM) is a widespread infection requiring prolonged treatment with potential side effects. Diagnostic certainty is therefore essential before initiating antifungal therapy. Molecular biology has already shown benefits in reducing the time to diagnosis, providing technical ease, and increasing sensitivity for the respective species that molecular tests can detect. Nevertheless, causative agents are numerous, and culture remains essential, particularly for detecting non-dermatophytes mold infections. This study compared the performance of three different diagnostic strategies: conventional culture technique, the multiplex DermaGenius® 2.0 PCR (DG), and a mixed PCR/culture algorithm guided by the result of direct examination with calcofluor (DEC). The mixed algorithm (MA) prioritizes DG PCR and DEC as the primary diagnostic tools, supplemented by selective sample inoculation when mycelial elements are visualized in DEC and when DG PCR fails to detect any fungus or identifies a fungus with morphology differing from that observed in DEC (filamentous fungi versus yeasts). With only 13% of samples requiring inoculation, MA emerged as the most effective strategy, demonstrating significantly higher sensitivity (98.18%; p < 0.001) compared to single-method approaches (78.18% for DG PCR alone and 74.55% for culture alone) while maintaining a specificity comparable to DG PCR (100%). This new approach saves time in result delivery, requires fewer human resources, and increases diagnostic accuracy to better meet the needs of clinicians.

Nanosuspension as a Novel Nanovehicle for Drug Delivery: A Recent Update on Patents and Therapeutic Applications

Abstract: Solubility is a critical factor for the therapeutic action of drugs and does not depend on the administration of routes. Various conventional methods are used to enhance the solubility of the drug, which show limited applicability. Nanotechnology is used to improve the solubility and bioavailability of drugs that belong to BCS classes II and IV. Nanosuspension is the dispersion of pure drug nanoparticles in aqueous with a minimum amount of surfactant, stabilizing the formula-tion. Various techniques, such as the bottom-up approach, dissocubes, nanopure, nanoedge, nano-jet process, supercritical fluid, dry co-grinding, milling media, and nanoprecipitation, have been used to formulate nanosuspension. Nanosuspension can be administered orally, inhalation, trans-dermal, ocular, injectable, topical, and pulmonary. To resolve the problem of solubility and stabil-ity, nanosuspension has received much attention because of its technical simplicity, cost-effectiveness, and ease of significant scale-up. Nanosuspension can control particle size surface charge properties and release the drug at specific sites at an optimal rate. Recently, more than 100 patents have been published on nanosuspension. This review article covers the different prepara-tion methods, formulation composition, marketed products, characterization, and recent patents on nanosuspension. The various benefits and evaluation of the parameters of nanosuspension are discussed briefly. This patent-based review will enhance the knowledge of control drug delivery and related patents on nanosuspension.

Clinical evaluation on the use of a new accessory device for Fox plane.

Evaluate the assimilation capacity and ease of handling of the Fox plane accessory by dentistry students, through a questionnaire about the experience in using this device compared to the conventional one. Its intention is to minimize possible interpretation errors and challenges that the traditional method determines. After approval by the Research Ethics Committee, registration at Sistema Nacional de Informações sobre Ética em Pesquisa/National Information System on Research Ethics (SISNEP) and signing of the free and informed consent form, 51 undergraduate students treating patients in need of complete dentures at Instituto de Ciência e Tecnologia/Institute of Science and Technology (ICT) Unesp in São José dos Campos completed a questionnaire to evaluate the technical ease of use and provider acceptance. The obtained data were submitted to statistical analysis, evaluating technical ease and acceptance by operators. The results were analyzed using descriptive and inferential statistics using the Jamovi 2.2.5 software. From the responses, the frequency was obtained for each question in the questionnaire, then the weighted mean was calculated, average rating and percentage. With the results of these analyses it was possible to measure the level of satisfaction of the participants in relation to the use of the device. It was concluded that most students have difficulty using the conventional Fox plane and that the accessory facilitated the process of determining the superior orientation plane, and its ease of use.

COMPARISON OF TOTAL EXTRAPERITONEAL (TEP) AND EXPANDED VIEW TOTAL EXTRAPERITONEAL (eTEP) METHODS AT INGUINAL HERNIA REPAIR

Abstract Background Laparoscopic hernia repair has been accepted as first-line treatment for inguinal hernia by major surgical institutions today, with low complication and recurrence rates. The aim of this prospective clinical study, we compared two different laparoscopic approaches in terms of technical ease, patients' early postoperative quality of life, pain management, complication and early recurrence rates. Method Patients with inguinal hernia who were planned to undergo laparoscopic hernia repair were randomized and operated with total extraperitoneal repair (TEP) and extended view total extraperitoneal repair (eTEP) methods in July and August 2023. During the postoperative follow-up, 24th-hour pain scores and 24th-hour quality of life scores were noted with a visual analogue scale (VAS) and quality of recovery test (QoR T15). At the 1st week outpatient clinic follow-up, their pain scores were questioned with VAS. They were checked by physical examination for complications or early recurrence. Patients were called for follow-up at the 1st and 3rd months after the surgery. Results The number of fixative staples was significantly higher in TEP group (p &amp;lt; 0.001). The operation time was significantly shorter in eTEP group (p: 0.031). Time to return to work was significantly longer in TEP group (p: 0.024). VAS scores on the 1st postoperative day were found to be significantly lower in eTEP group (p &amp;lt; 0.001), no significant difference was detected in the 1st week scores. The QoR test scores on the first postoperative day were significantly higher in eTEP group (p:0.006). The difference between number of patients with seroma, ecchymosis or hematoma was not significant in two groups. Conclusions Both methods we used did not make a significant difference in the incidence of complications. On the other hand, we revealed that eTEP method may be more advantageous in terms of ease of surgery, patients' quality of life in the early period.

A Comparative Study of Functional Outcomes in Unstable Pelvic Ring Fractures Treated With Internal Fixator (INFIX) With and Without Sacroiliac Joint Screw Fixation.

Introduction Despite constituting only 3-8% of orthopedic trauma cases, pelvic injuries are associated with high mortality rates, emphasizing the critical need for stable fixation rather than merely anatomical alignment. The use of an anterior, subcutaneous, internal pelvic fixator (INFIX), a novel technique, has shown promise in treating these injuries. Posterior pelvic ring injuries are challenging because they require a significant level of surgical training and technical expertise, and each treatment method has disadvantages. The aim of this study is to compare the clinical and biomechanical outcomes of INFIX with and without sacroiliac screw fixation for unstable pelvic fractures. Methods and methodology Retrospectively, we selected 20 patients with unstable pelvic ring injuries who had come to a high-volume tertiary care hospital and medical college in the state of Maharashtra, India. All the patients were operated on with INFIX; 10 with a sacroiliac joint screw and 10 without a sacroiliac joint screw. We followed up with the patients for six months and evaluated them according to the Majeed score. Results Functional outcomesdiffered little between INFIX patients operated on with and without a sacroiliac joint screw. However, morbidity, hospital stay, the need for ICU, radiation exposure, and technical ease of surgery were improved in INFIX patients without the sacroiliac screw procedure. We noted an average Majeed score of 78 in the INFIX-alone group and 77.2 in the group that received INFIX with a sacroiliac joint screw. Six months after the surgery, the patients showed signs of a stable bony union, had achieved a full range of motion, and reported no problems in their day-to-day work. Conclusion Although this was a short-term study, we conclude that INFIX without a sacroiliac joint screw showed a comparable functional outcome compared to INFIX with a sacroiliac joint screw. Patients with INFIX alone showed better results; they had reduced surgical time, reduced radiation exposure, and less evidence of neurological harm to the L5-S1 nerve root. The procedure was less complicated and easier for surgeons to learn. Its simplicity and speed were especially beneficial for obese patients.

Hidden Port Site Incisions for Robotic Foregut and Hepatopancreatobiliary Operations: A Cosmetically Superior Approach.

While the widespread adoption of minimally invasive surgery has led to improved cosmesis for abdominal operations, visible scars on the abdomen may still have a negative psychosocial impact on patients, especially for those with poor healing. We have developed a cosmetically favorable, safe, and easily adaptable robotic technique for common foregut and hepatopancreatobiliary procedures with hidden incisions at the level of the pubic hairline to minimize visibility. This technique monopolizes on the unique advantages of the robotic platform to maximize cosmetic outcome while maintaining clinical outcomes and technical ease. Herein we describe how to accomplish this technique for three different procedures: anti-reflux operation, distal pancreatectomy, and small bowel resection. In our experience, this technique of hiding port site incisions at the level of the pubic hairline can be easily adopted for improved patient quality of life and cosmesis. We especially recommend this technique in patients with a history of hypertrophic or keloid scars.

Evaluation of antimicrobial susceptibility tests for Acinetobacter and Pseudomonas species using disks containing a high dose of meropenem

The emergence and dissemination of carbapenem-resistant species of Acinetobacter and Pseudomonas have become a serious health concern. Routine antimicrobial disk susceptibility tests in clinical laboratories cannot distinguish between isolates that are highly carbapenem-resistant and those that are moderately carbapenem-resistant. The present study describes antimicrobial susceptibility tests using disks containing high doses (1000 μg) of meropenem. The diameters of inhibition zones were significantly negatively correlated with the MICs of Pseudomonas and Acinetobacter species for meropenem (R2: 0.93 and 0.91, respectively) and imipenem (R2: 0.75 and 0.84, respectively). Double disk synergy tests using clavulanic acid or sodium mercaptoacetate can detect ESBL or MBL producers. Susceptibility tests using disks containing high doses of meropenem can easily detect highly carbapenem-resistant isolates in a quantitative manner. These disks may be useful in bacteriological laboratories because of their technical ease, stability, and relatively low cost.

Physiological and Anesthetic Considerations of Safe and Optimal Pneumoperitoneal Pressures for Laparoscopic Surgeries in Children.

In the era of minimally invasive surgeries, pediatric laparoscopic surgeries are now becoming the standard of care. In this study, we aim to determine the safe and optimal pneumoperitoneal pressures (PPs) for laparoscopic surgery in children aged 1-5 years, along with the technical ease for the surgeon. Prospective, randomized, single-blinded study was conducted at SGPGI Lucknow. Children aged 1-5 years were randomized into Group I (n = 24): PP = 6-8 mmHg and Group II: (PP) = 9-10 mmHg. Hemodynamic, ventilatory, and blood gas changes were measured before CO2 insufflation (T0), 20 min after insufflation (T1), before desufflation (T2), and 10 min after desufflation (T3). Surgeon's technical ease of surgery, postoperative pain, the requirement of rescue analgesia, time to resume feeding, and complications were recorded and analyzed. Paired t-test, Mann-Whitney test, and Wilcoxon signed-rank test were used for nonparametric/parametric data. Chi-square/Fisher's test was used for nominal data. Partial pressure of CO2 (PaCO2) was significantly higher in Group II at T1, T2, and T3, requiring frequent changes in ventilatory settings. Postoperative pain scores were higher in Group II at 1, 6, and 12 h, requiring rescue analgesia. Surgeon's scores and hemodynamics were similar in both groups. Higher PP in Group II caused significant changes in PaCO2, end-tidal CO2, and postoperative pain requiring rescue analgesia, but blood gas changes were clinically insignificant and there were no significant changes in hemodynamic parameters. Since the surgeon's ease of performing surgery was similar in both groups, we recommend that laparoscopy in children aged 1-5 years can be started with lower PPs of 6-8 mmHg, which can be increased if needed based on the surgeon's comfort and the patient's body habitus.

Optimizing ankle-brachial index measurement for peripheral arterial disease screening in mobile clinics

ObjectiveMultidisciplinary mobile clinics (MMCs) provide a robust venue to provide health care access and peripheral arterial disease (PAD) screening to underserved populations. The ankle-brachial index (ABI) can facilitate PAD diagnosis; however, traditional supine ABI measurements may be challenging technically in a mobile outreach clinic with limited infrastructure, whereas seated ABI offers technical ease. In this study, the usefulness and feasibility of performing supine ABI, seated ABI, and seated ABI with a calculation to account for seated hydrostatic pressure (seated-adjusted ABI) were compared in a mobile outreach setting. MethodsProspective data were collected from patients at five independent MMCs focused on diabetic foot and PAD screening with ABI for underserved communities. Three techniques were used to measure the ABI: seated ABI, seated-adjusted ABI using a formula to account for hydrostatic ankle pressure, and traditional supine ABI using a foldable massage table that is 5% of the cost of a medical stretcher. Comparative analysis was performed using the Student t test analysis and one-way analysis of variance. The frequency of completed seated ABI, seated-adjusted ABI, and supine ABI examinations performed at independent MMCs was quantified to determine feasibility. ResultsIn 166 individuals experiencing homelessness or housing instability who were screened over the course of five MMCs, 89 underwent PAD screening with ABI. Of the patients screened, 38 patients had seated, seated-adjusted, and supine ABIs measured (43% of total number of patients undergoing any ABI measurement). PAD (ABI < 0.9) was identified in one patient using all three ABI methods. Noncompressible ABI (ABI ≥ 1.3) were identified in 32 patients (32/38 [84%]) screened with seated ABI. Of these 32 patients, 24 (75%) continued to have noncompressible ABIs using seated-adjusted ABI. Of these 24 patients, 4 (17%) continued to have noncompressible ABI using supine ABI. The average seated ABI significantly differed from supine ABI (1.34 vs 1.14; P < .0001). The average seated ABI also significantly differed from seated-adjusted ABI (1.34 vs 1.29; P = .026). The average seated-adjusted ABI significantly differed from supine ABI (1.29 vs 1.14; P = .0204). ConclusionsWe found that seated and seated-adjusted ABI are grossly inaccurate and more often lead to falsely elevated noncompressible ABI (32/38 [84%] and 24/38 [75%], respectively) compared with supine ABI (6/38 [16%]). We recommend using supine ABI on patients for PAD screening. Supine measurement is technically feasible in outreach mobile clinics using a transportable folding massage table and is a more accurate tool for PAD screening.

User Interface Experience Analysis of PMB Online Buddhi Dharma Using System Usability Scale

In the era of advanced digital technologies, the admission process for new students (PMBs) has become a critical aspect of education. To streamline and expedite this process, educational institutions are increasingly utilizing online enrollment applications. One such application, PMB Online Buddhi Dharma, plays a crucial role in this context. However, the success of these applications is not solely determined by technical ease; user experience, particularly the User Interface (UI), plays a pivotal role in influencing user satisfaction and efficiency. This study employs the System Usability Scale (SUS) method to comprehensively analyze the UI of the PMB Online Buddhi Dharma application, providing insights into usability and user satisfaction. Drawing from previous studies utilizing SUS in similar contexts, the research aims to contribute to the development and enhancement of the application's UI. This research evaluates too the effectiveness of Buddhi Dharma University's PMB Online in meeting the digital registration needs of prospective students, emphasizing ease of use and user acceptance. Through the SUS method, the study assesses user satisfaction and ease of use, obtaining an average SUS score of 78 from 30 respondents. This score categorizes Buddhi Dharma University Online PMB as "good," indicating a commendable level of acceptance from users, predominantly prospective students. The research concludes with implications for the application's further improvement and development, emphasizing the importance of user-friendly interfaces in digital admission processes.

Comparison of Arterial and Venous Interposition Grafting for Arterial Defects in a Rat Model.

Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery. Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats. After sectioning one femoral artery a segment of the contralateral femoral artery or vein was obtained. The time was recorded per graft and patency tested 10 minutes following grafting by an independent assessor. Each surgeon also completed a questionnaire detailing regular microsurgical volume, technical ease, and conceptual preference for either graft. Time for arterial interposition (median time 51.7 minutes) was longer than venous grafting (median time 45.9 minutes, p = 0.075). Arterial grafts were more likely to be patent or questionably patent (odds ratio [OR] = 6.77, p = 0.031). All surgeons found arterial interposition grafting technically easier and preferred it conceptually. Improvements were noted in patency rates (OR = 11.29, p = 0.018) and avoidance of anastomotic leak (OR = 0.19, p = 0.029) when surgeons performed moderate levels or greater of microsurgery within their regular practice. Greater immediate patency was noted with arterial interposition grafting in a rodent model when compared to venous grafting, although procedural time was greater. All surgeons found arterial grafting technically easier. Arterial microvascular grafting may be useful in the setting of digital replantation or revascularization with an arterial defect.