Postoperative Drainage for 6, 12, or 24 Hours After Burr-Hole Evacuation of Chronic Subdural Hematoma in Symptomatic Patients (DRAIN-TIME 2): Study Protocol for a Nationwide Randomized Controlled Trial

Background: Chronic subdural hematoma (CSDH) is a common acute or subacute neurosurgical condition, typically treated by burr-hole evacuation and drainage. Recurrent CSDH occurs in 5-20 % of cases and requires reoperation in symptomatic patients, sometimes repeatedly. Postoperative subdural drainage of maximal 48 hours is effective in reducing recurrent hematomas. However, the shortest possible drainage time without increasing the recurrence rate is unknown.Methods: DRAIN-TIME 2 is a Danish multi-center, randomized controlled trial of postoperative drainage time including all four neurosurgical departments in Denmark. Both incapacitated and mentally competent patients are enrolled. Patients older than 18 years, free of other intracranial pathologies or history of previous brain surgery, are recruited at time of admission or no later than 6 hours after surgery. Each patient is randomized to either 6, 12, or 24 hours of passive subdural drainage following single burr-hole evacuation of a CSDH. Mentally competent patients are asked to complete the SF-36 questionnaire. The primary endpoint is CSDH recurrence rate at 90 days. Secondary outcome measures include SF-36 at 90 days, length of hospital stay, drain-related complications, and complications related to immobilization and mortality.Discussion: This multi-center trial will provide evidence regarding shortest possible drainage time without increasing the recurrence rate. The potential impact of this study is significant as we believe that a shorter drainage period may be associated with fewer drain-related complications, faster mobilization, fewer complications related to immobilization, and shorter hospital stays—thus reducing the overall health service burden from this condition. The expected benefits for patients’ lives and health costs will increase as the CSDH patient population grows.Trial registration: ISRCTN15186366. https://doi.org/10.1186/ISRCTN15186366. Registered in December 2020 and updated in October 2021.This protocol was developed in accordance with the SPIRIT checklist and by use of the structured study protocol template provided by BMC Trials.

Assessing Mechanical Catheter Dysfunction in Peritoneal Dialysis Patients: A Case Control, Proof-of-Concept Study

New guidelines on evaluation of peritoneal membrane function recommend ruling out catheter dysfunction when evaluating patients with low ultrafiltration capacity. We introduce the use of a combination of parameters obtained from daily measurements of the cycler software for predicting catheter dysfunction in automated peritoneal dialysis patients. Out of 117 patients treated between 2015 and 2021, all patients with verified catheter dysfunction (n=14) were identified and compared to controls (n=19). We retrieved cycler data for seven days each and tested parameters predictive capability of catheter dysfunction. Total number of alarms/week >7 as single predictive parameter of catheter dislocation identified 85.7% (sensitivity) of patients with dislocated catheter and 31.6% (1-specificity) of control patients. A combination of parameters (number of alarms/week >7, drain time >22 min, ultrafiltration of last fill <150 mL) where at least two of three parameters appeared identified the same proportion of patients with catheter dislocation, but was more accurate in identifying controls (21% false positive). An easily applicable combination of daily cycler readout parameters, also available in remote monitoring platforms can be used as predictor of inadequate catheter function during routine follow-up with potential for earlier diagnosis of this frequent complication in the future.

Latissimus Dorsi Muscle Flap Transfer Through Endoscopic Approach Combined With the Implant After Tissue Expansion for Breast Reconstruction of Mastectomy Patients

Background: The increasing demand for breast reconstruction and good outcomes lead plastic surgeons to look for a new method to obtain more natural and aesthetically pleasing appearance of the reconstructed breasts.Methods: A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the symmetry of bilateral breasts.Results: The mean endoscopic LDMF harvest time was 90.4 minutes (70.0~120.0 min). The average drain time after the final reconstruction was 10.1 days (6~19 days). In the mean follow-up of 11.2 months (6~28 months), there were no postoperative complications noted. The average post–reconstruction breasts asymmetry was 4.8%±2.4%, the reconstructed side achieved good volume symmetry to the contralateral side (P=0.256).Conclusions: The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, shorten the LDMF harvest time and reduce the incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

Efficiency the Utilization of Folow up Palm Plants foor Increasing Production Beef Cattle in District Pasaman Barat

The main problem in the development of cattle business people in palm plantation, one exeption availibility of forage animal feed whether in quantity n quality. Other side the existence of palm leaves the midrib has been waste of a disturbing and not been utilized by farmers. To the touch technological innovations feed in te form of silage then palm leaves the midrib has been animal feed worthy of in eating of cattle. The purpose of this research is identify the effects the provisio of feed based silage palm leaves midrib increased body weight on cattle beef and analyzing efficiency the cost of animal feed. Research in farmer group Tanjung Keramat in district Kinali, Pasaman Barat in february until april 2017. Respondent are set down in purposive sampling. This research used 18 tail local bulls created the average 2 until 2, 5 years. Treatment provides was P1 control grass field is 10% from body weght (25 Kg) + bran is 10% from body weght (2,5 Kg) , P2 granting of silage then palm leaves (10 kg) + bran (1,5 Kg) + gliserida ( 2 Kg). In an analysis using t tableindependent sample t-testα=5%. Result of research shows P1 increase body weight cattle 0,68 kg/tail/day and P2 0,81 kg/ tail/ day . Provision of feed based silage then palm leaves significant compared feed control t test (-6,9) > t tabel (2,4). With efficiency cost feed during 90 days P1 (Rp. 967.500,-/cattle) and P2 (Rp. 675.500,-/cattle). So, with provision palm leaves besides increasing body weight cattle, can also reducing the grass that drain time dan energy can reduce the cost daily cattle feed.

Integration of Solar dryer with a Hybrid system of Gasifier- Solid Oxide Fuel Cell/Gas Turbine: Performance Analysis

A novel approach is presented to reduce the moisture content of biomass by employing a solar dryer. The impact of decreasing moisture contents on the key parameters of the system is investigated. Also, the effect of air mass flux on drying rate of biomass is evaluated and discussed considering three alternative air mass flux rates as well as two different time periods for drying and discharging biomass, namely 15 and 30 minutes. Results demonstrate that by reducing the moisture of biomass, power output and efficiency of the hybrid system have been improved from 265 kW and 30% efficiency up to 295 kW and 57.6% respectively. The best efficiency performance of system is achieved by the 15 minutes drain time and air mass flux of 0.011 kgm^(-2) s^(-1), while the best power generation of the system will be obtained by the 30 minutes drain time and air mass flux of 0.011 kgm^(-2) s^(-1).

BBR-ACD: BBR with Advanced Congestion Detection

With the aim of improved throughput with reduced delay, Google proposed the bottleneck bandwidth and round-trip time (BBR) congestion control algorithm in 2016. Contrasting with the traditional loss-based congestion control algorithms, it operates without bottleneck queue formation and packet losses. However, we find unexpected behaviour in BBR during testbed experiments and network simulator 3 (NS-3) simulations. We observe huge packet losses, retransmissions, and large queue formation in the bottleneck in a congested network scenario. We believe this is because of BBR’s nature of sending extra data during the bandwidth probing without considering the network conditions, and the lack of a proper recovery mechanism. In a congested network, the sent extra data creates a large queue in the bottleneck, which is sustained due to insufficient drain time. BBR lacks a proper mechanism to detect such large bottleneck queues, cannot comply with the critical congestion situation properly, and results in excessive retransmission problems. Based on these observations, we propose a derivative of BBR, called “BBR with advanced congestion detection (BBR-ACD)”, that reduces the excessive retransmissions without losing the merits. We propose a novel method to determine an actual congestion situation by considering the packet loss and delay-gradient of round-trip time, and implement a proper recovery mechanism to handle such a congestion situation. Through extensive test and NS-3 simulations, we confirmed that the proposed BBR-ACD could reduce the retransmissions by about 50% while improving the total goodput of the network.

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.

Avaliação do tempo de dreno de sucção em pacientes submetidos à artrodese lombar: estudo prospectivo randomizado

Evaluation of the suction drain time in patients undergoing lumbar arthrodesis: prospective randomized study

Effect of Initial Height on Drain Time of Water Drainage Through Cylindrical Tank

Draining of liquids through cylindrical tanks is very common phenomena. An interesting but undesirable Aircore is generated during draining process. Therefore understanding of air core formation and its growth is of quite interest in literature. In present study, water draining through cylindrical tanks is studied by experimental techniques. Rotational Froude number is varied based on different initial heights of water in the cylinder. Spatial and temporal variation of critical height and critical time against experiments performed is reported in paper. From comparison of critical height ratio against Froude numbers under consideration, it is found that air core generates slower for lower Froude numbers. Therefore, for higher initial heights of liquid column in the tank, the Aircore generates later as compared to lower initial liquid height case, and this seems to be the reason for the same drain time for all the initial water heights being used in the study. In order to validate the concept, further experiments are performed without initial swirl of tank. Thus causing no Aircore to generate during draining. It is found that with decreasing height the drain time decreases. This validate the concept that early Aircore generation was the major reason behind same drain times with different volumes of water in the cylinder.