scholarly journals Endoscopic vein harvesting Impact of learning curve on results and rehabilitation

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Alessandro Piccardo ◽  
Luigi Martinelli ◽  
Giancarlo Passerone
Keyword(s):  
Learning Curve ◽  
Left Internal Mammary Artery ◽  
Consecutive Series ◽  
Short Term ◽  
Mean Velocity ◽  
Reliable Technique ◽  
Endoscopic Vein Harvesting ◽  
The Mean ◽  
The Impact ◽  
Vein Harvesting

Background: The tendency of modern surgery is towards the reduction of invasiveness. The aim of this study is to evaluate the impact of the learning curve, the reliability, the short term results and the advantages in terms of rapid rehabilitation of endoscopic vein harvesting (EVH) in a consecutive series of 20 patients operated on of aorto-coronary bypass surgery. Methods: Between February and June 2005, 20 patients between 61 e 82 years of age underwent EVH with the use of Vasoview® 5 (Guidant Corporation, Indianapolis, USA). To evaluate the impact of learning curve on the total operative time, patients were divided in 4 chronologically consecutive groups (G1, G2, G3, G4). Intraoperative characteristics and short term results were evaluated. Results: The mean velocity and the mean time of harvesting in G4 were 0,68 cm/min and 45 min. respectively, similar to the time required for a scheletonized left internal mammary artery harvesting. In the first 5 patients 2 conversions were required, one of them related to the EVH technique. No bleeding, functional impairment or infective complications are reported. Active mobilization was possible in every case in the first post-operative day. Conclusions: EVH is a reliable technique and the learning curve can be limited to the first 5 cases. The foreseeble reduction of infectious complications, the absence of pain and the immediate mobilization of the leg allow a rapid and effective rehabilitation.

scholarly journals Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiao-Lei Fan ◽  
Jian Wang ◽  
De-Hua Zhang ◽  
Feng Mao ◽  
Yi Liao ◽  
...  
Keyword(s):  
Grip Strength ◽  
Skeletal Maturity ◽  
Kirschner Wire ◽  
Intramedullary Fixation ◽  
Dash Score ◽  
Reliable Technique ◽  
Dorsal Angulation ◽  
Neck Fracture ◽  
The Mean ◽  
The Impact

Abstract Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV.

Production Forecasting with the Interwell Interference by Integrating Graph Convolutional and Long Short-Term Memory Neural Network

2021 ◽  
pp. 1-17
Author(s):  
Enda Du ◽  
Yuetian Liu ◽  
Ziyan Cheng ◽  
Liang Xue ◽  
Jing Ma ◽  
...  
Keyword(s):  
Neural Network ◽  
Short Term Memory ◽  
Short Term ◽  
Term Memory ◽  
Production Forecasting ◽  
Temporal Correlations ◽  
Proposed Model ◽  
The Mean ◽  
Long Short Term Memory ◽  
The Impact

Summary Accurate production forecasting is an essential task and accompanies the entire process of reservoir development. With the limitation of prediction principles and processes, the traditional approaches are difficult to make rapid predictions. With the development of artificial intelligence, the data-driven model provides an alternative approach for production forecasting. To fully take the impact of interwell interference on production into account, this paper proposes a deep learning-based hybrid model (GCN-LSTM), where graph convolutional network (GCN) is used to capture complicated spatial patterns between each well, and long short-term memory (LSTM) neural network is adopted to extract intricate temporal correlations from historical production data. To implement the proposed model more efficiently, two data preprocessing procedures are performed: Outliers in the data set are removed by using a box plot visualization, and measurement noise is reduced by a wavelet transform. The robustness and applicability of the proposed model are evaluated in two scenarios of different data types with the root mean square error (RMSE), the mean absolute error (MAE), and the mean absolute percentage error (MAPE). The results show that the proposed model can effectively capture spatial and temporal correlations to make a rapid and accurate oil production forecast.

scholarly journals Balance Tests in Pre-Adolescent Children: Retest Reliability, Construct Validity, and Relative Ability

2020 ◽  
Vol 17 (15) ◽  
pp. 5474
Author(s):  
Vedrana Sember ◽  
Janja Grošelj ◽  
Maja Pajek
Keyword(s):  
Construct Validity ◽  
Mean Amplitude ◽  
Body Sway ◽  
Mean Velocity ◽  
Eyes Closed ◽  
Relative Ability ◽  
Balance Tests ◽  
Balance Ability ◽  
The Mean ◽  
The Impact

Balance is an essential prerequisite for the normal physical development of a child. It consists of the ability to maintain the body’s centre of mass over its base of support, which is enabled by automatic postural adjustments, and maintain posture and stability in various conditions and activities. The present study aimed to determine the measurement characteristics (reliability and concurrent validity) and the relative ability of balance tests and different motor tests in healthy 11-year-olds. We also evaluated the impact of vision on balance ability. Our results showed high interrater reliability (from 0.810 to 0.910) and confirmed the construct validity of the included balance tests. Girls performed significantly better than boys in laboratory tandem stance in following balance components: total sway path with eyes open (BSEO) (t = 2.68, p = 0.01, effect size (ES) = 0.81), total body sway with eyes closed of centre of pressure (CoP) displacement in the a-p direction (BSEC) (t = 1.86, p = 0.07, ES = 0.57), mean velocity of CoP displacements (VEO) (t = 2.67, p = 0.01, ES = 0.83), mean amplitude of CoP displacements in the a-p direction (AapEO) (t = 3.38. p = 0.00, ES = 1.01) and in mean amplitude of CoP displacements in the m-l direction (AmlEO) (t = 3.68, p = 0.00, ES = 1.19). With eyes closed, girls performed significantly better (t = 2.28, p = 0.03, ES = 0.70) than boys did in the mean amplitude of COP displacements in the a-p direction (AapEO) and significantly better (t = 2.37, p = 0.03, ES = 0.71) in the mean amplitude of COP displacements in the m-l direction (AmlEC). Insignificant correlations between different balance tests, except for a correlation between the flamingo test and one-leg stance on a low beam (r = 0.558, p < 0.01), show that each test assesses different aspects of balance ability; therefore, balance cannot be assessed with a single test.

scholarly journals A comprehensive review on learning curve associated problems in endoscopic vein harvesting and the requirement for a standardised training programme

2016 ◽  
Vol 11 (1) ◽  
Author(s):  
Bhuvaneswari Krishnamoorthy ◽  
William R. Critchley ◽  
Rajamiyer V. Venkateswaran ◽  
James Barnard ◽  
Ann Caress ◽  
...  
Keyword(s):  
Learning Curve ◽  
Training Programme ◽  
Comprehensive Review ◽  
Endoscopic Vein Harvesting ◽  
Vein Harvesting

scholarly journals Short course pre-operative ferrous sulphate supplementation – is it worthwhile in patients with colorectal cancer?

2010 ◽  
Vol 92 (7) ◽  
pp. 569-572 ◽  
Author(s):  
Martha Quinn ◽  
Robert J Drummond ◽  
Fiona Ross ◽  
Juliette Murray ◽  
John Murphy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ferrous Sulphate ◽  
Blood Film ◽  
Transfusion Rate ◽  
Short Term ◽  
Historical Cohort ◽  
Short Course ◽  
The Mean ◽  
The Impact

INTRODUCTION Pre-operative anaemia is well recognised in patients presenting with colorectal cancer (CRC). While the benefits of long-term FeSO4 supplementation on Fe deficiency anaemia are well established, it is not known if short-course supplementation (2–3 weeks) impacts significantly on pre-operative haemoglobin (Hb) levels. This study examines the impact of short-term, oral FeSO4 supplementation on patients undergoing surgery for CRC. PATIENTS AND METHODS All patients with CRC presenting to a single surgeon were included. At diagnosis, baseline Hb and blood film were checked on all patients who then received 200 mg tds of FeSO4. Haemoglobin was rechecked pre-operatively and daily postoperatively. Patients requiring pre-operative blood transfusions were excluded from analysis. RESULTS Between 1 January 2004 and 31 December 2006, 117 patients were identified, 14 of whom were excluded. Patients received a median of 39 days’ treatment with FeSO4. Fifty-eight (56.3%) patients were anaemic at presentation gaining a mean of 1.73 g/dl (P < 0.001) from short-course FeSO4 supplementation. Right-sided tumours (lower mean Hb at presentation; P = 0.008) responded more to FeSO4 when compared to left-sided tumours (P < 0.017). Increase in Hb was unrelated to pathological stage. The transfusion rate for all curative resections was 0.69 units/patient. For the historical cohort (patients undergoing curative resection between 1 January 2001 and 31 December 2003), the mean transfusion rate fell from 1.69 units/patient. CONCLUSIONS Routine short-course supplementation with iron offers improved pre-operative Hb prior to surgery in CRC, especially in right-sided lesions and those with presenting anaemia.

scholarly journals Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon

2017 ◽  
Vol 11 (11) ◽  
pp. E409-13 ◽  
Author(s):  
Anthony F. Adili ◽  
Julia Di Giovanni ◽  
Emma Kolesar ◽  
Nathan C. Wong ◽  
Jen Hoogenes ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Surgical Margin ◽  
Margin Status ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
The Mean ◽  
The Impact

Introduction: Since its introduction, robot-assisted laparoscopic radical prostatectomy (RARP) has gained widespread popularity, but is associated with a variable learning curve. Herein, we report the positive surgical margin (PSM) rates during the RARP learning curve of a single surgeon with significant previous laparoscopic radical prostatectomy (LRP) experience.Methods: We performed a prospective cohort study of the first 400 men with prostate cancer treated with RARP by a single surgeon (BS) with significant LRP experience. Our primary outcome was the impact of case timing in the learning curve on margin status. Our analysis was conducted by dividing the case numbers into quartiles (Q1‒Q4) and determining if a case falling into an earlier quartile had an impact on margin status relative to the most recent quartile (Q4).Results: The Q1 cases had an odds ratio for margin positivity of 1.74 compared to Q4 (p=0.1). Multivariate logistic regression did not demonstrate case number to be a significant predictor of PSM. The mean Q1 operative time was 207.4 minutes, decreasing to 179.2 by Q4 (p<0.0001). The mean Q1 estimated blood loss was 255.1 ml, decreasing to 213.6 by Q4 (p=0.0064). There was no change in length of hospitalization within the study period.Conclusions: Even when controlling for copredictors, a statistically significant learning curve for PSM rate of a surgeon with significant previous LRP experience was not detected during the first 400 RARP cases. We hypothesize that previous LRP experience may reduce the RARP PSM learning curve.

Assessing the Effect of Short and Long-Term Hydroxyurea Treatment on Cerebral Hemodynamics in Children with Sickle Cell Anemia Using Quantitative MRI: Preliminary Findings

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4090-4090
Author(s):  
Przemyslaw Kosinski ◽  
Paula Croal ◽  
Jackie Leung ◽  
Suzan Williams ◽  
Andrea Kassner
Keyword(s):  
Endothelial Dysfunction ◽  
Sickle Cell ◽  
Cerebral Hemodynamics ◽  
Short Term ◽  
Transfusion Therapy ◽  
Off Label ◽  
Blood Disorder ◽  
The Mean ◽  
The Impact

Abstract Introduction: Sickle Cell Disease (SCD) is an inherited blood disorder, afflicting 1 in 400 African Americans, clinically characterized by hemolytic anemia, painful vaso-occlusive crises and endothelial dysfunction resulting in chronic organ damage.1 Hydroxyurea (HU) is a myelosuppressive agent that has been shown to reduce the number of vaso-occlusive crises, acute chest syndromes, blood transfusions and hospital admissions and is currently being investigated as an alternative to transfusion therapy for primary stroke prevention.2,3 HU's protective properties are primarily thought to be a result of its ability to increase HbF levels, which reduces sickle hemoglobin polymerization.4 However, HU requires a minimum of 3-6 months for sufficient HbF induction and previous studies have shown improved clinical performance well before a detectable rise in HbF.3,4 The HbF-independent clinical improvement is hypothesized to be a result of HU acting as a nitric oxide (NO) donor, a potent vasodilator, whose bioavailability is reduced in SCD.5,6 Reduced NO has a direct effect on the dilation of cerebral vessels, which warrants investigation into the impact of HU treatment length on cerebral hemodynamics. To assess cerebral hemodynamics we obtained dynamic MR measurements of cerebrovascular reactivity (CVR), which reflect the capacity of vascular endothelia to dilate in the presence of a vasoactive stimulus. In addition, we also obtained CBF data using arterial-spin labelling (ASL) to assess its relationship to CVR. We hypothesized that CVR will be higher in long-term HU-treated patients compared to short-term HU-treated patients. Furthermore, we hypothesized that CBF will be inversely correlated with CVR and will be lower in patients on long-term HU compared to short-term HU-treated patients. Methods: 21 Patients (11M/10F; avg age 14±2.45) with no history of stroke, were imaged on a 3T MRI system. 15 patients were on HU for more than 1 year (long-term) and 6 were on HU less than 5 months (short-term). The hematocrit of both groups was similar. CVR data of the entire brain was obtained using a standard blood-oxygen-level-dependent (BOLD) MRI sequence in combination with a CO2 breathing challenge. CO2 was delivered via a re-breathing mask in 4 alternating cycles of 40 mmHg PETCO2 for 60 seconds and 45mmHg PETCO2 for 45 seconds. Correlations of voxel-based BOLD changes to end-tidal CO2 waveforms were analyzed using FSL v4.1 and yielded CVR maps that were co-registered to anatomical images. CBF was obtained with a standard pulsed ASL protocol and was quantified from the mean signal difference between ASL tag and control images using a kinetic model. The Student's t-test was used to assess whether the mean global CVR and CBF were significantly different (p<0.05) between patients on short-term and long-term HU treatment. Results: Global CVR was significantly higher in long-term HU-treated patients compared to short-term HU-treated patients (p=0.034) [Figure 1]. However, global CBF was significantly higher in long-term HU-treated patients compared to short-term HU-treated patients (p=0.032) [Figure 2]. Conclusions: As expected, long-term HU-treated patients had higher CVR compared to the short-term HU-treated patients. This could be due to the rise in HbF which reduces sickling, thereby buffering the impact of hemolysis-associated endothelial dysfunction thereby increasing NO more compared to the short-term group. However, CBF in long-term HU-treated patients was significantly higher compared to the short-term treated patients. This was unexpected and not in line with our previous studies, which have shown that CVR is inversely correlated with CBF, both in children with SCD as well as healthy controls, which is characteristic of functioning endothelia. The increase in both CVR and CBF in long-term HU-treated patients may indicate an uncoupling of CVR and CBF, which could be exacerbated with continued treatment and should be monitored. However, further studies are needed to verify this. Figure 1. Effect of HU treatment on CVR Figure 1. Effect of HU treatment on CVR Figure 2. Effect of HU treatment on CBF Figure 2. Effect of HU treatment on CBF References 1. Switzer J, et al. Lancet Neurol. 2006;5:501-5012. 2. Rodgers GP, et al. N Engl J Med. 1990; 322:1037–1045. 3. Charache S, et al. N Engl J Med. 1995;332:1317– 1322. 4. Halsey C, et al. Br J Haematol. 2003;120: 177-186. 5. Nahavandi M, et al. Hematology. 2000;5:235–239. 6. Morris C, et al. J Pediat Hematol Onc. 2003;28:629-634. Disclosures Off Label Use: Hydroxyurea is FDA approved for adults with HbSS. However, it is prescribed off-label at the Hospital for Sick Children for children with HbSS. .

Defining the Learning Curve for Robotic-Assisted Endoscopic Harvesting of the Left Internal Mammary Artery

2013 ◽  
Vol 8 (5) ◽  
pp. 353-358 ◽  
Author(s):  
Jonathan M. Hemli ◽  
Lucas W. Henn ◽  
Christopher R. Panetta ◽  
Jenny S. Suh ◽  
Scott R. Shukri ◽  
...  
Keyword(s):  
Learning Curve ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Learning Curves ◽  
Coronary Surgery ◽  
Harvest Time ◽  
Robotic Assisted ◽  
Internal Mammary ◽  
The Mean ◽  
Robotic Instruments

Objective Robotic-assisted techniques are continuing to cement their role in coronary surgery, particularly in facilitating the endoscopic harvesting of the left internal mammary artery (LIMA), regardless of how the subsequent bypass grafting is performed. As more surgeons attempt to become trained in robotic-assisted procedures, we sought to better define the learning curve associated with robotic-assisted endoscopic LIMA harvest. Methods Between January 2011 and July 2012, a total of 77 patients underwent robotic-assisted minimally invasive direct coronary artery bypass surgery at our institution. The LIMA was harvested endoscopically in all patients, using standard robotic instruments, followed by direct grafting to anterior wall myocardial vessels via a small thoracotomy. Intraoperative times for various components of the procedure were collated and analyzed. Results The mean ± SD time taken to insert and position the ports for the robotic instruments was 3.9 ± 1.4 minutes. The mean ± SD LIMA harvest time was 31.8 ± 10.1 minutes, and the mean ± SD total robotic time was 44.2 ± 12.9 minutes. All time variables consistently continued to decrease as the experience of the operating surgeon increased, with the greatest magnitude of improvement being evident within the first 20 cases. The logarithmic learning curves for LIMA harvest time and total robot time during our entire experience were both calculated as 90%, correlating to an expected 10% improvement in performance for each doubling of cases completed. Conclusions Coronary surgeons can rapidly become proficient in robotic-assisted endoscopic LIMA harvest, with significant improvement in operative times evident within the first 20 cases completed. These data may be useful in designing appropriate training programs for newer surgeons seeking to gain experience in robotic-assisted coronary surgery.

Evaluating the impact of an international short-term medical mission through diabetic glycemic control

2018 ◽  
Vol 41 (4) ◽  
pp. 815-820
Author(s):  
John C Mach ◽  
Hope Barone ◽  
Christopher Boni ◽  
Humberto Jimenez ◽  
Michael Tinglin
Keyword(s):  
Disease Burden ◽  
Prospective Observational Study ◽  
Glucose Monitoring ◽  
Phone Call ◽  
Short Term ◽  
Education Medical ◽  
The Mean ◽  
The Impact ◽  
Diabetic Care

AbstractBackgroundThis prospective observational study evaluated the impact of a primary care-based, international, short-term medical mission’s (STMM) impact on diabetes disease burden as represented through reductions in hemoglobin A1C (HbA1c).MethodsFrom November 2016 to May 2017, we tracked the HbA1c’s of diabetic individuals in Dajabon, Dominican Republic through care provided by Waves of Health (WOH). Participants were provided counseling, glucose monitoring equipment, a 6-month supply of anti-diabetic medications, and received a ‘check-in’ phone call at 3 months. HbA1c’s were re-measured at 6-month follow up. We hypothesized WOH diabetic care would have a modest impact of reducing mean HbA1c by 0.5%.ResultsIn total, 75% (n = 76) of 101 participants presented for follow-up care. Mean and median HbA1c decreased from 8.71 (SD 2.0) and 8.5% to 8.36 (SD 2.1) and 7.7%, respectively (P = 0.07). The percentage of individuals with HbA1c ≤7.5 increased by 10.4% at follow-up. The mean HbA1c decrease was 1.1%.ConclusionsThough limited by sample size, our results suggest that medical STMM’s may have a clinically meaningful impact in chronic disease management when utilizing a systematic combination of education, medical therapy, clearly documented medication instructions and regular trip intervals.

Delta Wing-Fuselage Interactions - Experimental Study

2011 ◽  
Vol 274 ◽  
pp. 43-52
Author(s):  
I. Boumrar ◽  
A. Ouibrahim
Keyword(s):  
Experimental Study ◽  
Subsonic Flow ◽  
Delta Wing ◽  
Aerodynamic Characteristics ◽  
Apex Angle ◽  
Delta Wings ◽  
Mean Velocity ◽  
Cylindrical Form ◽  
The Mean ◽  
The Impact

Experiments were conducted on thin delta wings to investigate, for subsonic flow, the effect of both privileged apex angle values and the wing-fuselage interactions on the aerodynamic characteristics, i.e. the distribution of the defect pressure on the extrados, the drag and the lift coefficients. For this purpose, several delta wing models of various apex angle (β = 75, 80 and 85°) were realized and tested without and with fuselages of cylindrical form, with diameters of 20 and 30 mm, downstream the apex and appropriately disposed on the extrados. The impact of the apex angle as well as the interaction on the defect pressure were specially considered along the apex vortices where the pressure defect is usually maximum. The above mentioned effects were investigated via the variations of the mean velocity in the wind tunnel and the incidence (attack) angle.

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