Average Volume Research Articles

Viscosity and structure correlation mechanism of Fe[sbnd]Cr[sbnd]C melt based on MD simulation

The viscosity of FeCCr melt affects the mass transfer behavior during steelmaking processes. Reasonable regulation of viscosity can improve production efficiency. There is a close relationship between melt viscosity and structure. Therefore, it is of great theoretical significance to analyze the correlation between viscosity and structure of chromium-containing iron melt for the optimization of the whole metallurgical process. This study experimentally investigated the viscosity of FeCCr melt and utilized molecular dynamics simulation to analyze the formation and growth behavior of atomic clusters, revealing the correlation mechanism between structure and viscosity. As the Cr content increased from 11 % to 13 %, the melt viscosity increased by 10.05 %. At a temperature range from 1773 K to 1473 K, the viscosity reached a maximum of 15.5 mPa·s, representing a 40.9 % increase. Simulation results indicated that CrC clusters within the melt act as intermediaries, connecting with CrFe and FeC clusters to form FeCrC clusters. The key influence of increased Cr content on viscosity lies in promoting the generation of FeCrC multicomponent clusters, while the key influence of temperature reduction lies in promoting cluster growth. With the increase in Cr content, the number of clusters at 1773 K increased from 154 to 175, and the average volume of clusters increased from 212 Å3 to 224 Å3. When the temperature decreased from 1773 K to 1473 K, the number of clusters increased by 51.2 %, and the average volume of clusters increased by 18.75 %. In comparison, the thermal state change had a greater impact on clusters, where temperature reduction led to rapid cluster growth, reduction of free volume within the melt, and ultimately resulted in increased viscosity due to the combined effects.

Coil-assisted ethanol embolization of traumatic arteriovenous fistulas: a 10-year retrospective study

PurposeThis study aimed to evaluate the efficacy and safety of ethanol embolization in treating traumatic arteriovenous fistulas (TAVFs).Materials and methodsFrom March 2012 to April 2020, 42 consecutive patients (29.9 ± 15.1 years, range: 3–68 years) with peripheral TAVFs underwent ethanol embolization. All patients underwent clinical and imaging follow-ups (40.0 ± 25.9 months, range: 3–90 months). The mean time to onset of symptoms after trauma was 5.4 ± 5.9 months (range: 0.5–30 months). Among the patients, 27 (64.3%) reported that the TAVFs occurred after blunt trauma, 10 (23.8%) presented after penetrating trauma (with 4 patients involving penetration by infusion indwelling needles), and 3 (7.1%) had a history of surgery. Treatment effects, devascularization rates, and complications were evaluated at follow-ups conducted at 1–3 month intervals.ResultsSeventy-one embolization procedures were performed, with a mean of 1.6 ± 0.7 procedures per patient. Thirty-four patients received coil-assisted ethanol embolization. Absolute ethanol was used in all procedures, with an average volume of 7.1 ± 4.2 ml per procedure (range: 1–18 ml); 28 patients (28/42, 66.7%) received coil embolization in 36 procedures (36/71, 50.7%). Upon re-examination, 39 patients (92.9%) achieved 100% devascularization; of these, 29 patients (74.4%) with Schobinger stage II TAVFs improved to stage I or became asymptomatic. Overall, 30 cases (66.7%) achieved a complete response, while the other 12 cases (33.3%) showed a partial response. In addition, no major complications were observed postoperatively, apart from minor complications.ConclusionsCoil-assisted ethanol embolization can effectively manage TAVFs with an acceptable risk of mild complications.

A review of diamond dosimeters in advanced radiotherapy techniques.

This review article synthesizes key findings from studies on the use of diamond dosimeters in advanced radiotherapy techniques, showcasing their applications, challenges, and contributions to enhancing dosimetric accuracy. The article explores various dosimeters, highlighting synthetic diamond dosimeters as potential candidates especially due to their high spatial resolution and negligible ion recombination effect. The clinically validated commercial dosimeter, PTW microDiamond (mD), faces limitations in small fields, proton and hadron therapy and ultra-high dose per pulse (UHDPP) conditions. Variability in reported values for field sizes 2 2 is noted, reflecting the competition between volume averaging and density perturbation effects. PTW's introduction of flashDiamond (fD) holds promise for dosimetric measurements in UHDPP conditions and is reliable for commissioning ultra-high dose rate (UHDR) electron beam systems, pending the clinical validation of the device. Other advancements in diamond detectors, such as in 3D configurations and real-time dose per pulse x-ray detectors, are considered valuable in overcoming challenges posed by modern radiotherapy techniques, alongside relative dosimetry and pre-treatment verifications. The studies discussed collectively provide a comprehensive overview of the evolving landscape of diamond dosimetry in the field of radiotherapy, and offer insights into future directions for research and development in thefield.

Analisis Penetapan Harga Jual Produk dan Volume Penjualan: Studi Kasus pada Rumah Makan Raja Ayam Kota Gorontalo

This research aims to determine the selling price of products at the Raja Ayam Restaurant in Gorontalo City and to determine the sales volume of products at the Raja Ayam Restaurant in Gorontalo City. The research method uses a survey method. The primary data source in this research is the owner of Raja Ayam Restaurant, Gorontalo City. The data obtained will be presented in tabular form and analyzed descriptively. The results of the research show that the product selling price at the Raja Ayam Restaurant in Gorontalo City is determined by calculating all costs which consist of fixed costs and variable costs. Raja Ayam Restaurant in Gorontalo City uses a selling price method that involves a mark-up of 30% of the total production costs. Thus, the selling price of the product is calculated by adding 30% of the total production costs. This strategy provides clarity in determining prices and includes the desired profit elements. In the main menu of Rumah Makan Raja Ayam, the price of each package or size of chicken is determined by applying a certain mark-up above the purchase price. By using the Mark-Up Pricing Method, these prices cover the profits desired by business actors and provide an overview of the pricing strategy used in the Raja Ayam business in Gorontalo City. The average sales volume of Rumah Makan Raja Ayam reaches around 1,229 packages of chicken every month, with sales of around 40 packages per day. The net income earned every month reaches Rp. Rp. 29,388,093.18, and daily net income is Rp. 979,603.11. Stable sales volume and good income reflect the positive performance and operational success of Rumah Makan Raja Ayam in Gorontalo City.

Spatio-Temporal Distribution of Water Availability in Marshyangdi Basin: Hydrological Model Development

This Study has developed a hydrological model for the Marshyangdi river basin in Western Nepal, showing considerable potential for developing water resources and overall national prosperity. The model is also used to characterise hydrology and assess the availability of water resources across different spatial and temporal dimensions, hence improving our comprehension of water availability and its possible applications. The newly developed hydrological model in the Soil and Water Assessment Tool (SWAT) replicates the mean flows, hydrological pattern, and flow duration curve at the basin and 54 sub-basin outputs. Additionally, the model undergoes calibration and validation, employing Sufi-2 to fine-tune hydrological parameters. Based on the data generated by the model, the annual average precipitation (P) in the Marshyangdi basin is projected to be 1843 mm. Approximately 17.88% of the average yearly rainfall is lost via evapotranspiration; however, this varies significantly across different locations and time periods. Contrasting the two, the mountains have a higher moisture level than the Himalayan regions. The predicted average annual flow volume at the basin outflow is 9467.423 million cubic metres (MCM). Examining water shortages, finding regions with excess water, and developing solutions to address the competing needs of agriculture, industry, urban areas, and ecosystems are advantageous. Therefore, this method may improve the effectiveness of strategic planning and the long-term management of water resources.

Evaluation of self-repair efficiency of polymers containing microcapsules using optical coherence tomography

Self-healing polymers are used to improve the durability and strength of materials and provide them with a longer service life. The authors propose a new optical method for evaluating the self-repair efficiency in polymers containing microcapsules. The non-destructive method measures spatial profiles of a hole series obtained after a material puncture. Spatial images of holes acquired by optical coherence tomography were processed to get a surface profile. The reduction of the average volume or depth of the holes compared to the reference material allows self-healing efficiency calculation. For the presented method, tests were carried out to measure the self-repair efficiency of test materials with 5% and 10% mass of repair capsules compared to Ethe reference polymer without capsules. The volumetric efficiencies of self-repair obtained from 30 holes of each material, acquired 8 h after the puncture, were computed as 51.6% and 58.3% for the two repaired material types, respectively.

Cyclone-coalescence separation technology for enhanced droplet removal in natural gas purification process

Natural gas is increasingly recognized as a clean energy source due to its high quality, low pollution levels, and abundant availability. However, certain gas fields contain complex components that require purification for efficient transportation and utilization. Addressing these issues involves efficient gas–liquid separation technology. Existing gas–liquid separation units face challenges such as efficiency, liquid entrainment, energy consumption, and the need for consumable replacement. This study focuses on a novel cyclone-coalescence separator that combines centrifugal and coalescence principles. Implemented in a high-acid natural gas purification plant in China, the cyclone-coalescence separator demonstrated efficiency primarily influenced by gas velocity and diameter. Optimal performance was observed with a 75 mm diameter reactor at velocities of 8–12 m s−1, achieving a peak efficiency of 96%. The hydrophilic glass fiber with a monofilament structure can coalesce droplets effectively. In practical industrial use, under operational conditions, the hydrocyclone's liquid discharge rate is 89.6 kg·h−1 with an inlet concentration of 382.7 g·m3. Over a 400-h cycle, the cyclone-coalescence separator demonstrated superior separation performance with an average liquid discharge volume of 9.09 mg·kg−1, compared to 4.93 mg·kg−1 for the precision filter. This successful industrial implementation presents a promising approach to natural gas purification.

Holistic life cycle cost analysis of road bridges with non-metallic reinforcement

Corrosion-related damage due to exposure to environmental conditions is the main cause of costs in the maintenance of transport infrastructure. Because of its high corrosion resistance and the associated higher durability, non-metallic reinforcement offers great potential for preventing such damage, thus reducing maintenance costs. In this article, potential savings for an integral road bridge are studied through a holistic life cycle cost (LCC) analysis considering four different reinforcement materials (steel, glass, basalt, carbon). A fair comparison is enabled by a material-specific design, the calculation of maintenance and user costs and the consideration of the respective disposal scenario. Moreover, environmental costs are recognised by carbon pricing based on life cycle analysis (LCA). The influence of individual parameters is quantified by means of a sensitivity analysis and the probability of savings is studied by Monte Carlo simulation. It is shown that higher investment costs for non-metallic reinforcement can be compensated by lower user costs. This is mainly due to shorter maintenance periods, as less time is required for repair action, whereby potential savings in user costs are particularly evident if the traffic route below the bridge is not disrupted. It is concluded that even from today's perspective, the use of glass and basalt fibre-reinforced polymer (FRP) reinforcement in highway bridges with average traffic volumes very likely offers an economic advantage over corrosion-prone reinforcing steel.

Influence of Molasses and Caesalpinia spinosa Meal Inoculums on Biogas Production from Cattle Manure

The management of organic waste through anaerobic digestion is an alternative to energy recovery. This research focused on evaluating the production of biogas with different inoculums. For this purpose, two types of systems were implemented—one used a heating system controlled by an STC-1000 thermostat, while the other used a solar heating system under a polycarbonate parabolic trough. The experiment was carried out at laboratory level with 3 L PET bottle biodigesters and the biogas produced was collected with the water displacement technique in 3 L bottles, calibrated every 50 mL, over 43 days. Inoculums of the following manure concentrations were used: water (1:5, 1:2, 1:3) mixed with Caesalpinia spinosa meal and molasses. The results determined that the thermostat-controlled heating system generated 69.6 mL/day of biogas while the other system produced 610.9 mL/day. On the other hand, the T1 treatment with a manure:water ratio of 1:5 and molasses and Caesalpinia spinosa meal inoculums in both systems had a higher average biogas volume. In terms of methane (CH₄), the highest value of 76.9% was obtained through the T1 treatment under the controlled heating system. This allows the production of biogas with a high concentration of methane, which in future applications can be utilized for residential or industrial purposes, promoting economic, social and environmental development. Since the main challenge in the production of biogas is to reduce the digestion time, which is influenced by the temperature of the site, two types of inoculums with a low cost and easy access were used.

Novel single-cell measurements suggest irreversibly sickled cells are neither dense nor dehydrated

In sickle cell anemia, deoxygenation causes erythrocytes to distort, while reoxygenation permits them to recover a normal biconcave disk shape. Irreversibly sickled cells (ISCs) remain distorted when reoxygenated and have been thought to have among the highest intracellular hemoglobin concentrations of the sickle red cell population and therefore the greatest vulnerability to vasoocclusion. Using a new optical method, which we describe, we have made precise measurements of the intracellular hemoglobin concentration, and intracellular O2 saturation, of ISCs, as well as oxygenated sickle cells with a normal biconcave disc shape, and cells with shapes distorted by the sickle fibers they contain. This method also provides good estimates of cell volumes, and hemoglobin per red cell. The concentration distribution of the ISCs is found to be similar to normal, discoid cells. Average ISC volumes exceed their discoid counterparts, with a much broader distribution, arguing against dehydration as their origin. The concentration distribution of the polymer-laden sickled cells is significantly higher in mean value, and their volume distributions indicate some dehydration. Previous assumptions about ISCs may have thus been colored by the presence of sickle cells that did contain polymer, and that true ISCs may be much more benign than once thought, which underscores the importance of accurate measurement on individual cells. This method could be used to follow changes in individual cell properties under various specific perturbations, and where characterization by flow cytometry is infeasible.

Insular Gliomas. Experience in a Latin American Center and Assessment of Variables Related to Surgical Management and Prognosis

To describe our experience in the resection of gliomas involving the insula and analyze the variables implicated in the management and prognosis of these tumors. This retrospective, single-center, analytic study included a cohort of 83 patients who underwent surgery for insular gliomas by the same surgeon in a third-level Argentine center, in the period between 2010 and 2023. We analyzed the population's demographic, clinical, and radiologic features and surgical variables associated with postoperative results and prognosis using multivariate regression analysis. A total of 53 patients (54% men) were included, with a mean follow-up of 40.7 months. The mean age at surgery was 41 years (range, 21-73) and 66.1% corresponded to low-grade gliomas (LGGs). Seizures were the initial symptom in most cases. There was evidence of tumor extension over the insula to the temporal or/and frontal lobe in 64.2% of patients. An extent of resection >90% was achieved in 62.3% of cases (27% of gross total resection), with an average resected volume of 89.4%. Awake craniotomy was indicated in 47% of patients and intraoperative magnetic resonance imaging was performed in 24%. Recurrence was observed in 44% of patients, with a mean progression-free survival of 31 months (42 months in LGG and 10 months in high-grade glioma [HGG]). Nine patients underwent reoperation. By the time of 2 years, survival was 100% for LGG and 46% for HGG, whereas 4-year overall survival was 92% for patients with LGG and 15.4% for those with HGG. Surgery for insular gliomas is a complex task that needs to be managed with adequate preoperative and intraoperative assessment to achieve maximum safe resection with low morbidity for better functional and oncologic outcomes. Adequate anatomic understanding, radiologic analysis, awake craniotomy, and cortical and subcortical mapping are paramount to pursue this aim.

Black Tea Jelly Candy (Camellia Sinensis) to Increase Salivary Volume in Elderly: Preliminary Research

Background: Physiological changes in the elderly include decreased saliva production that causes dry mouth, difficulty in chewing and swallowing. Chewing gum and candies with a chewy texture like jelly can help stimulate the salivary glands. Black tea contains some phenolic and flavonoid compounds that have antioxidant properties that can increase the saliva flow rate. Objective: To determine the gap in saliva volume of elderly subjects before and after chewing black tea jelly candy compared to the saliva production when subjects chewed non-black tea candies and the control group (no treatment). This study also determined the prevalence of xerostomia in subjects. Materials and Methods: This field experiment was conducted using a Randomized Controlled Clinical Trials design with a pretest-posttest control group design. 30 elderly subjects aged 45-90 years in the Tresna Werda Budi Mulia 1 Nursing home, Jakarta were selected based on the predetermined inclusion criteria. They signed the informed consent and answered the Summated Xerostomia Inventory Questionnaire (SXI). Salivary volume before and after chewing black tea jelly candy was measured using a measuring cup. Statistical tests consisting of Oneway ANOVA and Dependent T-Test were performed to analyze the data. Results: The prevalence of elderly who complaining of xerostomia in this research was 40%. There was a significant gap in saliva volume between the three groups with p = 0.002 (P<0.05). An increase in saliva volume in the black tea jelly candy treatment group was identified. The average volume before intervention in the black tea jelly candy treatment group was 1.26 mL and after the intervention was 2.15 mL. Conclusion: Chewing black tea jelly candy increase the saliva volume in elderly subjects.

Surface and average volume temperature measurements in semitransparent media based on multispectral thermotransmittance

Temperature plays an essential role in maintaining the performance of microsystems, which calls for three-dimensional mapping of heat sources, hot spots and thermal properties. In this context, infrared (IR) thermography provides information for opaque materials but faces limitations when applied to semitransparent samples such as microfluidic chips or semiconductor materials in the IR range. In this article, we present temperature maps obtained for the surface and average volume of two semitransparent samples with a detection limit of 1 K. To achieve such measurements, we demonstrated that thermotransmittance signals can be decomposed into two parts: the first originating from interfaces and the second originating from the volume. We quantified the contributions of both components by combining contactless measurements with a heat transfer model. We then validated the method using two Borofloat glass samples with different thicknesses. We were able to discriminate the contributions of surface and volume temperatures by performing spectroscopic thermotransmittance measurements at wavelengths ranging from 3100 to 3400 nm due to the different spectral behaviors of these two components. This new technique is an important improvement for temperature measurements using IR cameras in semitransparent media.

Silymarin mitigates toxic effects of cyclophosphamide on testicular tissue and sperm parameters in mice

Cyclophosphamide, a chemotherapy drug, increases oxidative stress in sperm and testicular tissue. This study evaluated the effect of silymarin, a potent antioxidant, on the quality of sperm and testicular tissue in mice treated with cyclophosphamide. NMRI adult male mice were divided into four groups: control; cyclophosphamide (intraperitoneal injection, 100 mg/kg, once a week); cyclophosphamide + silymarin; and silymarin (intraperitoneal injection, 200 mg/kg, every other day). After a 35-day treatment period, the caudal region of the epididymis was examined for sperm parameters, the right testis was used for stereological studies, and the left testis was used to assess biochemical factors. The data were statistically analyzed using SPSS software, one-way ANOVA and Tukey's test. In the cyclophosphamide group, there was a significant reduction in the mean total volume of testicular tissue, the average volume of seminiferous tubules and their components, and the average volume of interstitial tissue. Additionally, there was a notable decrease (p < 0.001) in the average number of Leydig cells, Sertoli cells, and sperm parameters. The mean concentration of testosterone hormone (p < 0.05) and total antioxidant capacity (TAC) level (p < 0.01) also significantly decreased, while the malondialdehyde (MDA) level increased significantly (p < 0.05). However, these adverse changes were mitigated in the cyclophosphamide + silymarin group compared to the cyclophosphamide group. Our results showed that silymarin as an antioxidant can mitigate the adverse effects of cyclophosphamide on testicular tissue and sperm parameters.

VOLUME REPLENISHMENT BY BOLUS LIQUID INFUSION: WHATROLE IN THE ACUTE MANAGEMENT OF INTRADIALYTIC HYPOTENSION (IDH)?

Introduction: Intradialytic hypotension (IDH) is a common complication associatedwith high morbidity and mortality in hemodialysis patients. Its management isprimarilypreventive, but if itoccurs, itrequires urgent measuresincluding volume infusion of solute to restore volemia. The objective of ourworkis to evaluate the role of bolus liquid infusion for the acute management of IDH. Materials and Methods: This is a retrospectivestudyconductedfromJanuary 2017 to December 2021 at the hemodialysis center of the militaryhospital in Agadir involving 90 chronichemodialysis patients. Volume replenishment to treat IDH wascarried out by infusing an online bolus liquid. Results and Discussion: Weanalyzed 30,689 sessions. IDH with or withoutsymptomswasfoundin 19.6% of cases. 14% of sessions with IDH required bolus infusion (27% of total sessions) with an average volume injected of 26315 ± 1622 ml. Factorsassociatedwith bolus administration includedadvancedage (643 ± 127 vs. 61.6 ± 12.7 years, P&lt;0.001), femalesex (H/F ratio of 0.5 vs. 1.1, P&lt;0.001), diabetes (47.4% vs. 44%, P&lt;0.001), lowpre-dialyticnatremia (134 ± 14 vs. 136 ± 10 mmol/l, P&lt;0.001), and underestimated dry weight (70.6 ± 12.5 vs. 73 ± 14.2 kg, P&lt;0.001). Sessions with bolus infusion werecharacterized by a low total effective UF volume (2000 ± 870 ml vs. 2285.8 ± 854.8, P&lt;0.001), shorter duration withpremature session disconnection (209 ± 25 min vs. 235 ± 7 min, P=0.02), and loweraveragedialysatetemperature (P&lt;0.001). The final relative blood volume washigher (87 ± 9 vs. 82 ± 9, P&lt;0.001) favoring the risk of overloadassociatedwith bolus infusion. Conclusion: Despiteadvances in hemodialysis, IDH remains a common per-dialytic incident. Our study highlights the importance of close monitoring of hemodynamicparametersduringhemodialysis sessions to prevent IDH, actearly, and avoidliquid bolus administration associatedwith the risk of overload.

Predictive factors of facial nerve function after medium/large vestibular schwannoma surgery: relationships between time of surgery, dimensions and size of resection

BackgroundVestibular schwannomas (VS) are slowly growing tumor, deriving from the vestibular component of cranial nerve VIII. Primary treatment modalities include microsurgery, radiosurgery, a combination of microsurgery and radiosurgery, and conservative treatment. The management of VS is a matter of debate, particularly in case of small tumors (less than 2 cm in diameter size).MethodsWe performed an institutional retrospective review of a consecutive series of 28 surgically treated patients suffering from VS, operated in our institution. Patients were assigned on the ground of the preoperative imaging in two groups: tumors with major diameter of extra-meatal portion measuring ≥ 3 cm (Group I, 16 patients) and tumors with major diameter < to 3 cm (Group II, 12 patients).ResultsThe total amount of 18/28 patients were females; the average age was 60.1 years. The average duration of the preoperative symptoms was 25.2 months, while the average interval between the diagnosis and surgical treatment was 8.68 months. The average preoperative volume was, respectively, for Group I and II tumors of 14.35 cm3 and 3.73 cm3. Age was associated to the duration of the preoperative symptoms (r = − 364; p = 0.044), with the probability to develop a complication (p = 0.031) and preoperative low HB score (r = − 324; p = 0.040). The presence of hypoacusis as preoperative symptom was strongly associated to a lesser postoperative maximum diameter and smaller residual disease (p = 0.014). Group I had a significantly longer hospitalization period in respect to Group II (p = 0.001) that impacted negatively to postoperative performance status (r = 0.368, p = 0.042).ConclusionsWe confirmed the strong association between age and size of the lesion and the clinical results, where larger lesions in older patients are more prone to complications than smaller in young patients. We found that the patients presenting hypoacusis at onset were associate to lesser preoperative FN impairment outlining a possible differential involvement of the CN related to the internal meatus. We also introduce the strong association of Koos grade with postoperative performance status, hospitalization and facial nerve functionality.

The tribological properties and synergistic lubrication mechanism of MoS2/AlOOH nanosheets as lubricant additives

The MoS2/AlOOH nanocomposites were prepared through a facile one-pot hydrothermal method and subsequently employed as lubricating oil additives to improve the tribological properties of PAO4 base oil. The structure, composition, morphology, tribological properties, and lubrication mechanism of the MoS2/AlOOH nanocomposites have been investigated. The results demonstrated that the in-situ assembly of MoS2 on the surface of AlOOH change their microstructure, resulting in enhanced dispersion and a reduction in friction and wear. At 0.5 wt% concentrations of MoS2/AlOOH nanocomposites, the average COF, WSD, and wear volume were decreased by 50.47 %, 42.34 %, and 86.57 % compared to base oil, respectively. Moreover, the tribological behaviors of the PAO4 containing MoS2/AlOOH nanocomposites under various conditions were explored as well. Furthermore, based on the analysis of micromorphology and composition of wear surfaces, a synergistic lubrication mechanism for MoS2/AlOOH nanocomposites has been proposed, which involves the formation of a tribochemical film composed of Fe2O3, Fe3O4, MoS2, and Al2O3 and demonstrates remarkable capabilities in reducing friction and wear. This research might provide new insight into enhancing the tribological properties of MoS2-based additives through the composite method and promote the application of MoS2/AlOOH nanocomposites as additives.

LAPAROSCOPIC TECHNIQUE FOR MEASURING THE ESOPHAGEAL HIATUS AREA

Introduction. The measurement of the esophageal hiatus (EH) area is critical for the choice of the method of hernioplasty for EH hernias. Aim. The objective of this study was to develop a laparoscopic method and tools for measuring the EH area and to compare it with existing methods in type III paraesophageal hernias (PEH). Materials and methods. Laparoscopic hernioplasty was performed on 63 patients with type III PEH – 41.3% males and 58.7% females, with an average age of 53.8±10.8 years, at the surgical clinic of the Bogomolets National Medical University. Irreducible PEH was present in 54 (85.7%) patients, partially reducible in 9 (14.3%). Cardia-fundal PEH was found in 42 (66.7%) patients, subtotal in 20 (31.7%), and total in 1 (0.6%) patient. The average volume of the hernial sac, according to multispiral computed tomography (MSCT), was 235±130.7 cm³ (ranging from 90 cm³ to 863 cm³). In all patients, the EH area was measured using the developed laparoscopic method (DLM) and tools; the Granderath method; the rhomboid area determination method (RAD); and MSCT. The authors evaluated the differences in the mean value and mean percentage difference (MPD) of EH area measurements between the mentioned methods. Results. The esophageal hiatus area measured using the DLM was statistically smaller than that measured by MSCT: 9.66±0.22 cm² versus 13.01±3.04 cm², respectively, and larger than the measurements from the Granderath method and the RAD: 8.16±1.71 cm² and 8.72±1.67 cm², respectively. The MPD between the MSCT data and the Granderath and RAD methods were 40.1±7.5% and 68.8±9.6%, respectively; between MSCT and DLM, it was 28.8±7.4%. The percentage difference in the esophageal hiatus area between the MSCT data and DLM, MSCT and Granderath, and MSCT and RAD showed a significantly positive correlation with the volume of the hernial sac, respectively r=0.687, r=0.601, and r=0.579. This indicates that with an increase in the volume of the hernial sac, the esophageal hiatus area calculated by MSCT increases compared to the intraoperative methods, likely due to the influence of the hernial contents on the area of the hernial orifice. Conclusions. The proposed laparoscopic method for measuring the area of the EH involves the use of a developed device that facilitates the removal of hernial contents from the hernial orifice, placing a ruler in their plane as a reference, transmitting the image to a computer, and calculating the area taking into account the individual shape characteristics. This method provides more accurate data compared to other intraoperative techniques and MSCT. Using the proposed laparoscopic technique for measuring the EH area will allow for a more thorough assessment of the indications for different hernioplasty options, considering the area of the hernial defect.

UK Trainee Experience with WALANT - An Audit of 102 Cases.

Background: WALANT has gained much popularity in recent years, especially with COVID-19. However, a recent survey of the American Society for Surgery of the Hand membership (i.e. attendings/consultants) showed that only 17% were exposed to WALANT during residency or fellowship training. There is much interest in WALANT from trainees, but interpretation of the type and volume to be administered is highly varied. Methods: The aims of this study were (1) to survey a group of plastic surgery trainees in the UK about their knowledge of WALANT formulas, and (2) to compare trainee logbook records of WALANT procedures (if available) with published data from the UK. Results: All trainees were familiar with the 'standard' WALANT formula (1% lidocaine, 1:100,000 adrenaline ± 8.4% NaHCO3) described by Lalonde. However, because of local formularies, rather than 1:100,000 adrenaline, all used 1:200,000 adrenaline as it comes premixed in the UK. Other formulas used by UK trainees included 0.5% bupivacaine + 1:200,000 adrenaline, and mixing 1% lidocaine + 1:200,000 adrenaline with 1% lidocaine 1:1. In comparing available trainee WALANT records with published UK data, the average volume of WALANT used was 6.6 mls in the current study versus 12.9 mls for similar procedures (wound debridement and skin closure ± local flap, digital nerve repair, fingertip reconstruction, thenar injuries, phalangeal fracture and single digit extensor repair); specifically, for single digit flexor tendon repairs, this was 10 mls versus 16.3 mls. Conclusions: While the British Society for Surgery of the Hand (BSSH) have developed official guidance for the use of WALANT in the UK, it appears there remains much variation in interpretation and hence, application. Comparison of trainee logbook records of common hand surgery procedures suggests that most can be done with much less WALANT administered than previously reported, with safe and reproducible results. Level of Evidence: Level IV (Therapeutic).

Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series.

Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention.