Analysis on Influencing Factors of Recurrence after Indirect Inguinal Hernia Laparoscopic Surgery

This paper aims to analyze the recurrence of indirect inguinal hernia in children after laparoscopic surgery and investigate the influencing factors that may lead to recurrence so as to guide the prevention and treatment of postoperative recurrence of this kind of disease in the future. The data of 260 children with indirect inguinal hernia treated by laparoscopic surgery and followed up in our hospital from July 2019 to July 2021 were selected. A self-designed questionnaire was used to collect the basic data. The recurrence was analyzed, and the influencing factors of recurrence were analyzed by univariate analysis and multivariate analysis. Among 400 children after indirect inguinal hernia laparoscopic surgery, an occurrence was observed in 15 children, and the recurrence rate was 5.77%. Univariate analysis showed that the age and course of disease were not correlated with recurrence after indirect inguinal hernia laparoscopic surgery ( P > 0.05 ). Being male, bilateral lesions, exact high ligation, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, circumferential wiring, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery ( P < 0.05 ). Logistic multivariate regression analysis showed that being male, bilateral lesions, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05 ). Exact high ligation and circumferential wiring were protective factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05 ). After indirect inguinal hernia laparoscopic surgery, recurrences were affected by many factors, such as gender, site of pathological changes, and loose hernia back wall peritoneum. For these children with risk factors, reasonable intervention should be taken to reduce recurrence; exact high ligation and circumferential wiring are the protective factors. If permitted, the children meeting related indications can be treated by high ligation or circumferential wiring to reduce the risk of recurrence after indirect inguinal hernia laparoscopic surgery.

Smartphone-based DIY home microsurgical training with 3D printed microvascular clamps and Japanese noodles

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least 3.5-5x magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approx. 0.83 mm) without an overly thick and unrealistic “vessel” wall. The current set-up however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels) and video recordings were submitted for internal validation by senior surgeons. A “wet” operative field where the knojac noodle lumen can be distended or collapsed, unlike other non-living models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course, and potentially, be extended to low-middle income countries (LMICs) without routine access to microsurgical training for capacity development. That it can be utilised remotely also bodes well with the current limitations on face to-face training due to COVID restrictions and lockdowns.

Giant Inguinoscrotal Hernia

The following article devoted to the case of surgical treatment of giant inguinoscrotal hernia of a patient which signed the informed consent to the processing of personal data with dimensions of hernial sac 400x330x306 mm, size of hernial gates 9x8x7cm, loops of the small intestine, mesentery, a large number of heterogeneous liquid up to 14.7 L were determined in the hernial sac. Left herniotomy was performed. Back wall plastic of the inguinal canal was performed according to Liechtenstein. Mesh implant was used for the plastic.

Isothermal Air Flow Investigation in Industrial Baking Oven of Different Impeller Locations using Computational Fluid Dynamics (CFD) Approach

Computational fluid dynamics (CFD) modelling was performed on a forced convection oven to investigate the isothermal airflow. Three oven design configurations based on their impeller location (back, side, and top wall) were compared with respect to their Turbulence Kinetic Energy (TKE) profile to determine the optimal configuration design for quick uniform baking. The air velocity was estimated from both experimental and modelling approaches at specific points in an oven with the back walled impeller. The CFD model was validated resulting in a calculation error of 30.34% of actual velocity which was mainly due to limitation in grid density and the turbulence modelling. The other two oven configurations were simulated and their average TKE data were extracted and compared. The third configuration (impeller at the top wall) was found to have the highest average TKE of 3.55 m2/s2 followed by the first configuration (impeller at the back wall) with 3.30 m2/s2 which provides a relatively uniform TKE distribution across the cavity. The findings show the significance of impeller placement in oven performance.

Kraft recovery boiler operation with splash plate and/or beer can nozzles — a case study

In this work, we study a boiler experiencing upper furnace plugging and availability issues. To improve the situation and increase boiler availability, the liquor spray system was tuned/modified by testing different combinations of splash plate and beer can nozzles. While beer cans are typically used in smaller furnaces, in this work, we considered a furnace with a large floor area for the study. The tested cases included: 1) all splash plate nozzles (original operation), 2) all beer can nozzles, and 3) splash plate nozzles on front and back wall and beer cans nozzles on side walls. We found that operating according to Case 3 resulted in improved overall boiler operation as compared to the original condition of using splash plates only. Additionally, we carried out computational fluid dynamics (CFD) modeling of the three liquor spray cases to better understand the furnace behavior in detail for the tested cases. Model predictions show details of furnace combustion characteristics such as temperature, turbulence, gas flow pattern, carryover, and char bed behavior. Simulation using only the beer can nozzles resulted in a clear reduction of carryover. However, at the same time, the predicted lower furnace temperatures close to the char bed were in some locations very low, indicating unstable bed burning. Compared to the first two cases, the model predictions using a mixed setup of splash plate and beer can nozzles showed lower carryover, but without the excessive lowering of gas temperatures close to the char bed.

Cleisostoma luopingense, a new species of Orchidaceae from Yunnan, China

Cleisostoma luopingense, a new species of Orchidaceae, is described and illustrated from Yunnan Province, China. It is morphologically similar to C. williamsonii, but can be easily distinguished from the latter in having unbranched inflorescence and laxly placed 6–10 flowers; elliptic petals (size: 3.0–3.2 × 1.8–2.0 mm); back wall callus of spur yellow, T-shaped and mid-lobule deeply bilobed at base, column without stelidia.

Kesehatan Tenggorok pada Siswa di Sekolah Dasar Negeri 11 Manado

Health problems such as throat disease can be caused by various factors either external or internal. This study was aimed to obtain a description of throat health status of students at Sekolah Dasar Negeri 11 (Public Elementary School) Manado. This was a descriptive and observational study with a cross sectional design. There were a total of 25 male and female students. The results showed that 25 students (100%) had normal tonsil color; 24 students (96%) had normal tonsil surface and one student (4%) had pathological tonsil surface; 22 students (88%) had normal tonsil size and three students (12%) had pathological tonsil size. There were 25 students (100%) who had normal results on examination of pharynx both mucosa and the back wall of pharynx. In conclusion, most students of SDN 11 Manado had normal throat health status.Keywords: throat health status; elementary students Abstrak: Masalah kesehatan seperti penyakit tenggorok dapat disebabkan oleh berbagai faktor baik eksternal maupun internal. Penelitian ini bertujuan untuk mendapatkan gambaran kesehatan tenggorok siswa Sekolah Dasar Negeri 11 Manado. Jenis penelitian ialah deskriptif observasional dengan desain potong lintang. Jumlah total keseluruhan subyek penelitian ialah 25 siswa. Hasil penelitian mendapatkan sebanyak 25 siswa (100%) dengan warna tonsil normal; 24 siswa (96%) dengan permukaan tonsil normal dan satu siswa (4%) dengan permukaan tonsil patologik; 22 siswa (88%) dengan ukuran tonsil normal dan 3 siswa (12%) lainnya dengan ukuran tonsil patologik. Sebanyak 25 siswa (100%) dengan hasil normal pada pemeriksaan faring baik mukosa maupun dinding belakang faring. Simpulan penelitian ini ialah sebagian besar siswa SDN 11 Manado memiliki gambaran kesehatan tenggorokan yang normal.Kata kunci: kesehatan tenggorok; siswa Sekolah Dasar

Supermicrosurgical Suture-Stent Technique for A Lymphaticovenular Bypass

Background: Lymphaticovenular anastomosis (LVA) is a challenging procedure and requires a sophisticated supermicrosurgical technique. The aim of this study was to evaluate and establish a discrete supermicrosurgical anastomosis method using the “suture-stent technique”. Methods: Forty-eight LVA sites of twenty patients with lower extremity lymphedema who had undergone LVA between July 2020 and January 2021 were included in this study. LVA was performed with the conventional technique or with the suture-stent technique. The patency of the anastomoses was evaluated using an infrared camera system intraoperatively. The success rate on the first try and the final success rate for each group were compared. Results: After full application of the exclusion criteria, 35 LVAs of 16 patients including 20 limbs were included in the analysis. The ratio of good patency findings after anastomosis in the suture-stent technique group was 100%. The incidences of leakage or occlusion on the first try were statistically greater in the conventional technique group (29.4%) than in the suture-stent technique group (0%) (p = 0.0191). All anastomoses achieved good patency in the final results. Conclusion: With its minimal risk of catching the back wall during the anastomosis, the suture-stent technique can be considered an optimal anastomosis option for LVA.