Safety and Ease of Sheath Insertion During Endovascular Treatment Via the Common Femoral Artery After Endarterectomy With Autologous Repair: A Retrospective Cohort Study

Background Endovascular treatment (EVT) using the common femoral artery (CFA) for access after endarterectomy (EA) may result in sheath insertion difficulties because of subcutaneous scar tissue, as well as difficulties with hemostasis. We evaluated the safety of CFA access and the ease of sheath insertion over time after EA. Method We included 19 patients (21 limbs, 40 cases) in whom the CFA was used after EA with autologous repair as an access route in EVT for peripheral arterial disease in our institution from January 2013 to December 2020. Nine limbs underwent simple closure repair and 12 underwent autologous patch repair. Difficult sheath insertions were defined as those in which additional devices (stiff guidewire or a smaller diameter sheath for dilation) were used for scheduled sheath insertion. The inability to insert a sheath with the scheduled diameter was defined as a failed sheath insertion. We evaluated the EVT timing after EA for difficult sheath insertions, and whether the CFA was repaired with simple closure or autologous patch repair during EA surgery. Results There were 10 (25%) difficult sheath insertions, with one (2.5%) failure. The rate of difficult sheath insertions peaked from 6 months to 1 year after EA and gradually decreased (47% from 6 months to 3 years, 14% thereafter). There were more statistically significant difficult sheath insertions with simple closure repair (50%) than with autologous patch repair (12%) (P = 0.018). Hemostasis devices were used in 90% of EVT cases. The median maximum sheath diameter was 6 Fr (mean = 5.8 Fr). None of the cases required surgical procedures to achieve hemostasis after EVT. Conclusion EVT may be performed safely using the CFA after EA. The difficulty of sheath insertion may differ depending on the EVT timing after EA; it was more difficult with simple closure than with autologous patch repair, possibly related to scar formation.

Competence-based fuzzy skill functions

Fuzzy skill functions connect knowledge states at the performance level with latent cognitive abilities at the competence level. Given that there may exist precedence relations among skills, the main idea of this study is trying to develop fuzzy competence structures restricted on the possible fuzzy sets of skills that can occur. The knowledge structures delineated by fuzzy skill functions are related to the fuzzy competence structures. Knowledge spaces can be delineated by disjunctive fuzzy skill functions when the fuzzy competence structures are $\sqcup$-closed. Simple closure spaces can be delineated by conjunctive fuzzy skill functions when the fuzzy competence structures are $\sqcap$-closed. Delineating knowledge structures via competence-based fuzzy skill functions just depends on the effective competence states. We design algorithms for delineating knowledge structures via competence-based fuzzy skill functions without listing all fuzzy competence states of fuzzy competence structures.

Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report

Background Bochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited. Case presentation A 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient’s postoperative course was uneventful with no recurrences within the first year post-surgery. Conclusion Combined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.

A COMPARATIVE STUDY OF SUBCUTANEOUS SINGLE CLOSED SUCTION DRAIN VERSUS SIMPLE CLOSURE IN EMERGENCY MIDLINE LAPAROTOMY WOUNDS

Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs).. Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane. This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases.

Decreased risk of liver and intrahepatic cancer in non-H. pylori-infected perforated peptic ulcer patients with truncal vagotomy: a nationwide study

The vagal nervous system is central to the physiological responses and systemic diseases of the liver. We evaluated the subsequent risk of liver and intrahepatic cancer (HCC/ICC) in non-H. pylori (HP)-infected perforated peptic ulcer (PPU) patients with and without vagotomy. Hospitalized PPU patients who underwent simple closure or truncal vagotomy/pyloroplasty (TVP) in the National Health Insurance Research Database from 2000 to 2008 were enrolled. The exclusion criteria included: (1) Multiple surgeries for PPU were received at the same admission; (2) Any cancer history; (3) Previous peptic ulcer-associated surgery; (4) HP infection history; (5) Viral hepatitis infection history; (6) Follow-up duration < 1 year; and (7) Age < 18 years. The risks of developing HCC/ICC in PPU patients with and without vagotomy were assessed at the end of 2013. To balance the baseline condition between groups, we used the propensity score matched method to select study subjects. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence interval (CI) of HCC/ICC. Before propensity score matching, 675 simple suture patients and 54 TVP patients had HCC/ICC, which corresponded to incidences of 2.11 and 0.88 per 1000 person-years, respectively. After propensity score matching, 145 simple suture patients and 54 TVP patients experienced HCC/ICC, which corresponded to incidences of 1.45 and 0.88 per 1000 person-years, respectively. The TVP patients had a 0.71 (95% CI 0.54–0.95)- and 0.69 (95% CI 0.49–0.97)-fold risk of developing HCC/ICC compared to simple suture patients before and after propensity score matching. Our findings reported that, in the Asian population, TVP decreases the risk of HCC/ICC in non-HP-infected PPU patients compared to simple closure patients. However, further studies are warranted.

Fistula after hypospadias: preliminary treatment results

Fistula is the commonest complication after hypospadias surgery ranged 10-30%. The results of surgery depending on the severity of hypospadias, surgical technique, and experience of the operating surgeon. This is a prospective study analysis the operational procedures in post-hypospadias urethral fistula repair. Through July 2015 to January 2017, 21 patients with 21 fistulas where classified their treatment into: 6 fistula with simple closure, 7 fistula simple closure with fascial layer, and 7 fistula dorsal slit with fascial layer. According to my experience I have successfully treated all urethral fistulas using my method, with success rate. We concluded that the midline urethral incision with the dartos flip flap is the main point for treatment of difficult urethral fistula after hypospadias operation.

Computational analysis of transport in three-dimensional heterogeneous materials

Porous and heterogeneous materials are found in many applications from composites, membranes, chemical reactors, and other engineered materials to biological matter and natural subsurface structures. In this work we propose an integrated approach to generate, study and upscale transport equations in random and periodic porous structures. The geometry generation is based on random algorithms or ballistic deposition. In particular, a new algorithm is proposed to generate random packings of ellipsoids with random orientation and tunable porosity and connectivity. The porous structure is then meshed using locally refined Cartesian-based or unstructured strategies. Transport equations are thus solved in a finite-volume formulation with quasi-periodic boundary conditions to simplify the upscaling problem by solving simple closure problems consistent with the classical theory of homogenisation for linear advection–diffusion–reaction operators. Existing simulation codes are extended with novel developments and integrated to produce a fully open-source simulation pipeline. A showcase of a few interesting three-dimensional applications of these computational approaches is then presented. Firstly, convergence properties and the transport and dispersion properties of a periodic arrangement of spheres are studied. Then, heat transfer problems are considered in a pipe with layers of deposited particles of different heights, and in heterogeneous anisotropic materials.