A Modified Hybrid Operation:The Retroperitoneoscopic Nephroureterectomy Without Intraoperative Patient Repositioning

Purpose: To describe the oncological safety and validity of the modified hybrid operation without intraoperative patient repositioning for upper urinary tract urothelial carcinoma (UTUC) patients. Materials and Methods: We collected and retrospectively analyzed the clinical data of 63 consecutive patients underwent the modified hybrid operation for localized UTUC at The Second Hospital of Tianjin Medical University between July 2018 and July 2019. Details of the modified operating technique were summarized and described. Results: All procedures were successful and no reposition or re-sterilization occurred during these operations. The operative time was 135 mins (IQR:125-145) and estimated blood loss was 35 ml (IQR:30-45.5), the time of distal ureter and bladder cuff resection was only 40 mins (IQR:35-47.5). No positive margins were found by pathological investigation. No complication related to the modified position was detected. Follow-up period after surgery was 24 months (IQR:19.5-27) and 12 cases (19.05%) had recurrence.Conclusion: The modified hybrid technique eliminated the need for patients repositioning during the extravesical bladder cuff excision and permitted the continuity of the operation. It minimizes the operative time and eliminates the distortion of the surgeon's lower back. This technique can be safely reproduced with surgical outcomes comparable to other established techniques.

A Huge Aneurism of Ascending Thoracic Aorta

Giant Ascending Aorta Aneurysm (AAA) is a rare condition, because of early diagnosis incidence appears to be increasing as a result of routine screening, increased clinical awareness, and improved imaging modalities. The etiology of aneurysms involving the aortic root and ascending aorta can be genetically triggered, degenerative or atherosclerotic, inflammatory, or can result from infectious diseases. According to many studies for ascending aortic aneurysms larger than 6 cm the risk of rupture, dissection, or deaths was 15.6, making it a large life-threatening aneurysm. We present the case of a Giant AAA of about 8,7 cm diameter in a 68 years old man who was successfully operated on for ascending aorta and aortic root replacement under modified Bentall technique using composite mechanical conduit with coronary reimplantation. Conclusion; Ascending giant aortic aneurysm is a rare finding, varying from asymptomatic clinical presentation. Surgical treatment remains the standard treatment with very good results. The selection of the operating technique is very individual, depending on the case and the experience of the surgeon.

Unicompartmental Knee Arthroplasty: Short-Term Results

Background. Among the methods of surgical treatment of early stages medial knee osteoarthritis in the partial knee replacement (PKR) becomes more and more relevant. The relevance and increasing number of PKR are confirmed by data from various national registers.The aim of the study was to research the early functional results of PKR and to analyze the complications at various stages of the postoperative period.Material and Methods. Study design: a single-center prospective study. The results of 90 operations of PKR in the period from March 2018 to April 2020 are presented. Assessment of knee function and quality of life of patients was performed according to three scalesquestionnaires: KOOS, WOMAC, SF-36, which were filled in preoperatively and then at 3, 6, 9, 12, 18 months. after surgery. Patients within the reporting period provided X-rays and filled in the scales at the face-to-face examination and at remote contact.Results. The most significant improvement of quality of life and median values of the functional results observed after 3 months, and after 18 months. After replacement the best median functional outcome scales KOOS, WOMAC, SF-36 — 79,4 (73,6–84,3); 27,1 (24,8–30,6); 89,1 (85,3–92,6) compared with the functional results obtained before surgery 32,3 (22,8–38,4); 73,6 (63,6–78,8); 35,2 (31,3–42,1); p = 0,027; p = 0.023; p = 0,028, respectively. A negative correlation was obtained between BMI and functional outcome (p = 0.027, R = -0.7).Conclusion. PKR allowed us to achieve an improvement in the quality of life and functional results already in the early postoperative period (from 3 to 18 months after the operation). The improvement of the operating technique, the analysis of errors and the regularity of the performed PKR will improve the results of PKR and minimize the number of complications.

Endoscopic treatment of Achilles tendon enthesopathies: An anatomical and clinical feasibility study

Background: One possible treatment for Achilles tendon enthesopathy is open reconstruction of the Achilles tendon insertion by resection of calcified enthesis and the calcaneal tuberosity followed by reinsertion of the tendon with anchors. Subcutaneous dissection of the tendon in open procedure is at risk of wound complications. We hypothesized that this procedure could be performed under endoscopy. Methods: An innovative operating technique was described. It consisted in removal and reinsertion of the Achilles tendon under endoscopy using five portals with resection of the calcaneal tuberosity and calcified enthesis. A feasibility study was first conducted on five cadaveric feet followed by an in vivo study on five patients. Results: In all cases, the Achilles tendon could be reinserted with the same technique than in open surgery. None of the ten surgical procedures technically failed. It was possible to correctly resect calcifications and the calcaneal tuberosity. Resection was performed under endoscopic and fluoroscopic control for the ten cases. Proper reinsertion was verified under endoscopy, by placement of the ankle in physiological equinus for clinical series and by dissection for cadaveric cases. There were no complications in the clinical series 3 months postoperatively. Conclusion: Achilles enthesopathies can be treated by detachment/reinsertion of the Achilles tendon under endoscopy with resection of calcified enthesis and the calcaneal tuberosity. This endoscopic technique should now be validated by analyzing longer-term clinical and anatomical results and comparing them with the results of open surgery.

Evolution of a hyper-complex intromittent organ in rove beetles – the endophallus of Xantholinini (Staphylinidae: Coleoptera)

Studies on the functional morphology and evolution of genitalia have been crucial to understanding sexual traits in speciation, reproductive isolation and sexual selection in Coleoptera and insects in general. However, the focus of investigation of the intromittent organ of beetles was largely confined to the sclerotized elements of the aedeagus, whereas the membranous structures of the endophallus (=internal sac) have often not been adequately considered. Using a micro-operating technique, we observed living male rove beetles and found five different types of endophallus eversion and related morphological modifications. Analysing genital data of a larger sample of Xantholinini, we could demonstrate that endophallus complexity and modifications tend to vary inversely with the median lobe (penis: intromittent organ). Our comparative morphological study, combined with a molecular phylogenetic analysis, suggests that endophallus spiralling occurring after endophallus eversion is an innovation in beetle evolution.

Advanced Operating Technique for Centralized and Decentralized Reservoirs Based on Flood Forecasting to Increase System Resilience in Urban Watersheds

The frequency of inundation in urban watersheds has increased, and structural measures have been conducted to prevent flood damage. The current non-structural measures for complementing structural measures are mostly independent non-structural measures. Unlike the current non-structural measures, the new operating technique based on flood forecasting is a real-time mixed measure, which means the combination of different non-structural measures. Artificial rainfall events based on the Huff distribution were used to generate preliminary and dangerous thresholds of flood forecasting. The new operation for centralized and decentralized reservoirs was conducted by two thresholds. The new operation showed good performance in terms of flooding and resilience based on historical rainfall events in 2010 and 2011. The flooding volume in the new operation decreased from 6617 to 3368 m3 compared to the current operation in 2010, and the flooding volume in 2011 decreased from 664 to 490 m3. In the 2010 event, the results of resilience were 0.831835 and 0.866566 in current and new operations, respectively. The result of resilience increased from 0.988823 to 0.993029 in the 2011 event. This suggestion can be applied to operating facilities in urban drainage systems and might provide a standard for the design process of urban drainage facilities.

Optimisation of loading capacity of smoking kiln on drying characteristics of Catfish (Clarias gariepinus)

Fish smoking is widely used in the fish processing industry, especially in the post-harvest catfish product due to its simple operating technique. The objective of this study was to optimise the tray loading capacity of a smoking kiln for catfish. A mixture design was employed to investigate the effects of varied fish size (0.25, 0.30 and 0.35 kg) component tray loading on the loading capacity, drying rate and moisture ratio during smoking process. The results showed that the loading capacity of the kiln was between 190 and 198 pieces of fish at minimum and maximum 50 and 52 kg. High moisture ratio was observed at equal size combination at low drying rate. The catfish weight mixtures of 0.25, 0.30 and 0.35 kg used to evaluate the kiln load capacity optimization were significant (P < 0.05). The smoking kiln worked optimally at catfish size (50, 50 and 0 %) with maximum desirability of 0.63 resulted in weight of fish loaded of 51.30 kg, moisture ratio of 0.21 and drying rate of 0.5 kg−1 h. This study brings new knowledge about the loading capacity and confirms that the smoking kiln is an acceptable technology for processing fish.