Gravitational Autoreposition for Staged Closure of Omphaloceles

Abstract Introduction Management strategies for large omphaloceles remain controversial. In this study, we discuss the use of GRAVITAS (gravitational autoreposition sutures), the method used at our institution when successful primary closure is deemed questionable. Patient's primary clinical course and long-term outcomes were analyzed. Materials and Methods This is a single-center retrospective analysis of all consecutive patients with omphaloceles treated between 1997 and 2018. Decision for GRAVITAS was made when the defect was estimated too large for primary closure. Traction sutures were placed in the fascia surrounding the defect and then suspended from the top of the incubator to allow gravitational autoreposition of the herniated organs. Ventilation and muscle relaxation were maintained until secondary closure, which was performed after the obtruding viscera had been reduced by repeated adjustment of the suture's tension. Data are presented as mean ± standard deviation. Results Out of 49 patients with omphaloceles, 12 were treated with GRAVITAS, 33 underwent primary closure, and 4 were treated using Schuster's technique. Mean time to secondary closure after GRAVITAS was 7 ± 10 days. In nine of the patients who had isolated omphalocele, secondary closure was achieved after 4 ± 2 days. Ventilation time was 5 ± 2 days, and time to full feeds was 18 ± 16 days. In three patients (one with Fallot's tetralogy, one with Cantrell's pentalogy, and one with lung hypoplasia), abdominal closure was achieved after 17 ± 15 days. Due to cardiorespiratory comorbidity, ventilation time was >30 days. Five patients received initial closure of the skin and secondary fascial closure after 18 ± 15 months. One patient with prior fascial closure underwent later repair of an abdominal wall hernia. During follow-up (30 ± 35 months), one patient with gastrointestinal obstruction due to adhesions required laparotomy, and one patient with gastroesophageal reflux disease underwent fundoplication. Conclusion GRAVITAS is a feasible method for staged closure of large omphaloceles when successful primary closure is deemed questionable.

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Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

Panorama brasileiro de tungstênio (w) entre os anos de 2008 e 2014 ◽

10.32749/nucleodoconhecimento.com.br/health/anesthesia-for-rabbits ◽

2020 ◽

pp. 151-158

Author(s):

Rafael Antonio Caldart Bedin ◽

Maisa Schultz ◽

Antonio Bedin

Keyword(s):

Muscle Relaxation ◽

Anesthetic Management ◽

Laboratory Animals ◽

Average Weight ◽

Anesthetic Induction ◽

Anesthetic Agents ◽

Reasonable Degree ◽

Bioethical Debate ◽

Precordial Stethoscope

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

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Connecting Crop Nutrient Use Efficiency to Future Soil Productivity

10.24047/bc10248 ◽

2018 ◽

Vol 102 (4) ◽

pp. 8-10

Author(s):

Fernando García ◽

Andrés Grasso ◽

María González Sanjuan ◽

Adrián Correndo ◽

Fernando Salvagiotti

Keyword(s):

Nutrient Management ◽

Nutrient Use Efficiency ◽

Management Strategies ◽

Crop Productivity ◽

Soil Productivity ◽

Nutrient Use ◽

Grain Crop ◽

Wide Scale ◽

Use Efficiency

Trends over the past 25 years indicate that Argentina’s growth in its grain crop productivity has largely been supported by the depletion of the extensive fertility of its Pampean soils. Long-term research provides insight into sustainable nutrient management strategies ready for wide-scale adoption.

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Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

Journal of Neurosurgery ◽

10.3171/2019.2.jns182604 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1675-1682 ◽

Cited By ~ 5

Author(s):

Jin Wook Kim ◽

Hee-Won Jung ◽

Yong Hwy Kim ◽

Chul-Kee Park ◽

Hyun-Tai Chung ◽

...

Keyword(s):

Adjuvant Treatment ◽

Management Strategies ◽

Local Tumor Control ◽

Tumor Control ◽

Years Of Experience ◽

Local Tumor ◽

Long Term Outcomes ◽

Single Institution ◽

Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

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Investigation of a New Approach to Predict Water Quality Extremes with a Case Study of Chemical Determinands in Stream Water

Water Science & Technology ◽

10.2166/wst.1991.0137 ◽

1991 ◽

Vol 24 (6) ◽

pp. 25-33

Author(s):

A. J. Jakeman ◽

P. G. Whitehead ◽

A. Robson ◽

J. A. Taylor ◽

J. Bai

Keyword(s):

Water Quality ◽

Stream Water ◽

Probability Distributions ◽

Management Strategies ◽

Hybrid Modelling ◽

Trend Model ◽

Environmental Extremes ◽

Modelling Approach

The paper illustrates analysis of the assumptions of the statistical component of a hybrid modelling approach for predicting environmental extremes. This shows how to assess the applicability of the approach to water quality problems. The analysis involves data on stream acidity from the Birkenes catchment in Norway. The modelling approach is hybrid in that it uses: (1) a deterministic or process-based description to simulate (non-stationary) long term trend values of environmental variables, and (2) probability distributions which are superimposed on the trend values to characterise the frequency of shorter term concentrations. This permits assessment of management strategies and of sensitivity to climate variables by adjusting the values of major forcing variables in the trend model. Knowledge of the variability about the trend is provided by: (a) identification of an appropriate parametric form of the probability density function (pdf) of the environmental attribute (e.g. stream acidity variables) whose extremes are of interest, and (b) estimation of pdf parameters using the output of the trend model.

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Contributions to Management Strategies in the NE Atlantic Regarding the Life History and Population Structure of a Key Deep-Sea Fish (Mora moro)

Biology ◽

10.3390/biology10060522 ◽

2021 ◽

Vol 10 (6) ◽

pp. 522

Author(s):

Régis Santos ◽

Wendell Medeiros-Leal ◽

Osman Crespo ◽

Ana Novoa-Pabon ◽

Mário Pinho

Keyword(s):

Population Structure ◽

Life History ◽

Deep Sea ◽

Management Strategies ◽

Size Composition ◽

Large Size ◽

The Common ◽

Fishing Impacts ◽

Sea Fish

With the commercial fishery expansion to deeper waters, some vulnerable deep-sea species have been increasingly captured. To reduce the fishing impacts on these species, exploitation and management must be based on detailed and precise information about their biology. The common mora Mora moro has become the main deep-sea species caught by longliners in the Northeast Atlantic at depths between 600 and 1200 m. In the Azores, landings have more than doubled from the early 2000s to recent years. Despite its growing importance, its life history and population structure are poorly understood, and the current stock status has not been assessed. To better determine its distribution, biology, and long-term changes in abundance and size composition, this study analyzed a fishery-dependent and survey time series from the Azores. M. moro was found on mud and rock bottoms at depths below 300 m. A larger–deeper trend was observed, and females were larger and more abundant than males. The reproductive season took place from August to February. Abundance indices and mean sizes in the catch were marked by changes in fishing fleet operational behavior. M. moro is considered vulnerable to overfishing because it exhibits a long life span, a large size, slow growth, and a low natural mortality.

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Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽

10.1136/openhrt-2020-001440 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001440

Author(s):

Shameer Khubber ◽

Rajdeep Chana ◽

Chandramohan Meenakshisundaram ◽

Kamal Dhaliwal ◽

Mohomed Gad ◽

...

Keyword(s):

Coronary Artery ◽

Surgical Management ◽

Medical Management ◽

Cox Regression ◽

Artery Bypass ◽

Management Strategies ◽

Coronary Artery Aneurysms ◽

Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

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Tracking Changes on Soil Structure and Organic Carbon Sequestration after 30 Years of Different Tillage and Management Practices

Agronomy ◽

10.3390/agronomy11020291 ◽

2021 ◽

Vol 11 (2) ◽

pp. 291

Author(s):

Ramón Bienes ◽

Maria Jose Marques ◽

Blanca Sastre ◽

Andrés García-Díaz ◽

Iris Esparza ◽

...

Keyword(s):

Triticum Aestivum ◽

Organic Carbon ◽

Management Practices ◽

Management Strategies ◽

Triticum Aestivum L ◽

Field Trials ◽

Conventional Tillage ◽

Soil Parameters ◽

Wilting Point

Long-term field trials are essential for monitoring the effects of sustainable land management strategies for adaptation and mitigation to climate change. The influence of more than thirty years of different management is analyzed on extensive crops under three tillage systems, conventional tillage (CT), minimum tillage (MT), and no-tillage (NT), and with two crop rotations, monoculture winter-wheat (Triticum aestivum L.) and wheat-vetch (Triticum aestivum L.-Vicia sativa L.), widely present in the center of Spain. The soil under NT experienced the largest change in organic carbon (SOC) sequestration, macroaggregate stability, and bulk density. In the MT and NT treatments, SOC content was still increasing after 32 years, being 26.5 and 32.2 Mg ha−1, respectively, compared to 20.8 Mg ha−1 in CT. The SOC stratification (ratio of SOC at the topsoil/SOC at the layer underneath), an indicator of soil conservation, increased with decreasing tillage intensity (2.32, 1.36, and 1.01 for NT, MT, and CT respectively). Tillage intensity affected the majority of soil parameters, except the water stable aggregates, infiltration, and porosity. The NT treatment increased available water, but only in monocropping. More water was retained at the permanent wilting point in NT treatments, which can be a disadvantage in dry periods of these edaphoclimatic conditions.

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More than 50 long-term effects of COVID-19: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-95565-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sandra Lopez-Leon ◽

Talia Wegman-Ostrosky ◽

Carol Perelman ◽

Rosalinda Sepulveda ◽

Paulina A. Rebolledo ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Management Strategies ◽

Original Data ◽

Long Term Effects ◽

Pooled Prevalence ◽

Attention Disorder ◽

Initial Recovery ◽

Meta Analyses

AbstractCOVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

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Long term follow-up of inguinal endometriosis

BMC Women s Health ◽

10.1186/s12905-021-01235-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

BoRan Mu ◽

ZhiQiang Zhang ◽

Chongdong Liu ◽

Kunning Zhang ◽

ShuHong Li ◽

...

Keyword(s):

Management Strategies ◽

Uterosacral Ligament ◽

Round Ligament ◽

Pelvic Endometriosis ◽

Ovarian Endometriosis ◽

Hernia Sac ◽

Peritoneal Endometriosis ◽

Long Term Follow Up ◽

The Right

Abstract Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.

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