Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

Facilitation of adhesion and spreading of endothelial cells on silicone oxide-coated dacron material by microwave-excited low-pressure plasma

Objectives Autologous transplants are still the means of choice for bypass surgery. In addition to good tolerability, there is a reduced thrombogenicity and fewer neointima hyperplasia compared to artificial materials. However, since viable transplants are limited, attempts are being made to improve existing artificial vascular prosthesis material. Next to the reduction of thrombogenicity, a rapid endothelialization of the vascular graft should reduce intimal hyperplasia and thus prevent stenoses. The effect of newly developed silicon oxide coatings on the growth of endothelial cells was therefore the goal of this work in a cell culture study. Methods A woven, uncoated polyethylene terephthalate (PET) vessel prosthesis was used. The coating process was carried out in a low-pressure plasma reactor in a multi-step process. After preparation of the vacuum chamber hexamethyldisiloxane (HDMSO) with oxygen was evaporated using argon plasma. By this an approx. 1 nm thin adhesion promoter layer was separated from plasma and HMDSO. The silicone oxide barrier layer was applied to the PET vessel samples. The carbon content of the layer could be selectively altered by changing the HMDSO oxygen flow ratio, resulting in coatings of 100 nm, 500 nm, and 1,000 nm. In addition, two different oxygen-to-HMDSO ratios were used. To achieve a carbon coating as low as possible, the ratio was set to 200:1. A carbon-rich layer was obtained with the 1:1 setting. The various coatings were then examined for their surface texture by scanning electron microscopy (SEM) as well as by cell culture experiments for cell viability and growth using EA.hy 926 cells. Results SEM showed no changes in the surface morphology; however a layer thickness of 1,000 nm showed peeled off coating areas. Alamar blue assays showed a significantly higher metabolic activity (p=0.026) for the coating 500 nm, ratio 200:1 compared to untreated control samples and a significantly lower metabolic activity (p=0.037) of the coating 500 nm, ratio 1:1 compared to the coating 500 nm, ratio 200:1. This underlines the apparent tendency of the 1:1 coating to inhibit the metabolic activity of the cells, while the 200:1 coating increases the activity. Fluorescence microscopy after calcein acetoxymethyl ester (AM) staining showed no significant difference between the different coatings and the uncoated PET material. However, a tendency of the increased surface growth on the coating 500 nm, ratio 200:1, is shown. The coatings with the ratio 1:1 tend to be less densely covered. Conclusions The results of this work indicate a great potential in the silicon coating of vascular prosthesis material. The plasma coating can be carried out easy and gently. Cell culture experiments demonstrated a tendency towards better growth of the cells on the 200:1 ratio coating and a poorer growth on the carbon-rich coating 1:1 compared to the uncoated material. The coating with silicon oxide with a thickness of 500 nm and an oxygen-HMDSO ratio of 200:1, a particularly low-carbon layer, appears to be a coating, which should therefore be further investigated for its effects on thrombogenicity and intimal hyperplasia.

Impact of In Situ NH3 pre-treatment of LPCVD SiN passivation on GaN HEMT performance

The impact on the performance of GaN HEMTs of in situ ammonia (NH3) pre-treatment prior to the deposition of silicon nitride (SiN) passivation with low-pressure chemical vapor deposition is investigated. Three different NH3 pre-treatment durations (0, 3, and 10 minutes) were compared in terms of interface properties and device performance. A reduction of oxygen at the interface between SiN and epi-structure is detected by Scanning Transmission Electron Microscopy-Electron Energy Loss Spectroscopy measurements in the sample subjected to 10 minutes of pre-treatment. The samples subjected to NH3 pre-treatment show a reduced surface-related current dispersion of 9 % (compared to 16% for the untreated sample), which is attributed to the reduction of oxygen at the SiN/epi interface. Furthermore, NH3 pre-treatment for 10 minutes significantly improves the current dispersion uniformity from 14.5 % to 1.9 %. The reduced trapping effects result in a high output power of 3.4 W/mm at 3 GHz (compared to 2.6 W/mm for the untreated sample). These results demonstrate that the in situ NH3 pre-treatment before low-pressure chemical vapor deposition of SiN passivation is critical and can effectively improves the large-signal microwave performance of GaN HEMTs.

Summer monsoon low pressure systems over the Indian region and their relationship with the sub-divisional rainfall

In the present paper performance of the monthly sub-divisional summer monsoon rainfall is studied in association with the position of the Low Pressure System (LPS) over the Indian region. Existence of the LPS over a particular location increases the rainfall activities in certain parts of the country while decreases in some other parts. For this study, the Indian region (5°-35° N and 60° -100° E) is divided into 5° Lat. ´ 5° Long. grids. The duration of LPS is taken in terms of LPS days with respect to the location of LPS in a particular grid. Monthly total number of LPS days in each of the grids are computed during the summer monsoon season, June to September for the period 1891 – 1990. Maximum number of LPS days (more than half of the total) are observed in the latitude belt between 20°-25°N. The percentages of total LPS days in this area are higher in July and August which are peak monsoon months as compared to June and September. When there is a LPS are in the area 20°-25° N and 80°-90° E, there is significant increase in the rainfall activities in the sub-divisions along mean monsoon trough while northeast India and southeast peninsular India experience significant decrease in rainfall in the months of July and August. Owing to the movement of LPS from east to west through central India, most parts of the country, excluding northeast India and south peninsular India get good rainfall activity. Correlation coefficients between monthly LPS days over the different grids and monthly sub-divisional rainfall are computed to study the relationships. The performance of sub-divisional rainfall mostly related with the occurrence of LPS in certain grid- locations. The correlation field maps may give some useful information about rainfall performance due to LPS in a particular grid locations.