Search results for: cardiac surgery

Authors: F. DelGaudio, H. Gill

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Resuscitation during cardiopulmonary (CPA) arrest is dynamic, high stress, high acuity situation, which can easily lead to communication breakdown, and errors. The care of these high acuity patients has also been shown to increase physiologic stress and task saturation of providers, which can negatively impact the care being provided. These difficulties are further complicated during a global pandemic and pose a significant safety risk to bedside providers. Nurse-led codes are a relatively new concept that may be a potential solution for alleviating some of these difficulties. An experienced nurse who has completed advanced cardiac life support (ACLS), and additional training, assumed the responsibility of directing the mechanics of the appropriate ACLS algorithm. This was done in conjunction with a physician who also acted as a physician leader. The additional nurse-led code training included a multi-disciplinary in situ simulation of a CPA on a suspected COVID-19 patient. During the CPA, the nurse leader’s responsibilities include: ensuring adequate compression depth and rate, minimizing interruptions in chest compressions, the timing of rhythm/pulse checks, and appropriate medication administration. In addition, the nurse leader also functions as a last line safety check for appropriate personal protective equipment and limiting exposure of staff. The use of nurse-led codes for CPA has shown to decrease the cognitive overload and task saturation for the physician, as well as limiting the number of staff being exposed to a potentially infectious patient. The real-world application has allowed physicians to perform and oversee high-risk procedures such as intubation, line placement, and point of care ultrasound, without sacrificing the integrity of the resuscitation. Nurse-led codes have also given the physician the bandwidth to review pertinent medical history, advanced directives, determine reversible causes, and have the end of life conversations with family. While there is a paucity of research on the effectiveness of nurse-led codes, there are many potentially significant benefits. In addition to its value during a pandemic, it may also be beneficial during complex circumstances such as extracorporeal cardiopulmonary resuscitation.

Keywords: cardiopulmonary arrest, COVID-19, nurse-led code, task saturation

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Authors: Sabine Danzinger, Nora Hielscher, Miriam Izso, Johanna Metzler, Carmen Trinkl, Christian Pfeifer, Kristina Tendl-Schulz, Christian F. Singer

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The objective of this study is to analyze the characteristics of invasive lobular carcinoma (ILC) compared with invasive ductal carcinoma (IDC) and to investigate the impact of histology on axillary lymph node (ALN) involvement in luminal A subtype tumors. Methods: We retrospectively analyzed patients diagnosed with ILC or IDC from 2012 to 2016 who underwent surgery. Patients constituted 493 primary early breast cancer cases (82 ILC; 411 IDC). Results: Compared with IDC, ILC tumors were significantly more likely to be grade 2, estrogen receptor- (ER) positive (þ), have a lower proliferation rate (Ki67 <14%), and a higher patholog- ical T stage (pT2–4). The luminal A subtype was significantly more common in ILC compared with IDC. In a multivariate regression model, grade 2, ERþ, progesterone receptor-positive, pT2, and pT3 were significantly associated with ILC. Additionally, with the luminal A subtype, ALN involvement (pathological node stage (pN)1–3) was significantly more frequent with ILC versus IDC. Conclusions: Our data suggests that grade 2, positive hormone receptor status, and higher pathological T stage are associated with ILC. With the luminal A subtype, ALN involvement was more frequent with ILC versus IDC.

Keywords: breast cancer, lobular histology, tumor biology, hormone receptor, ki67

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Authors: Anita Khadka, Gregory Epiphaniou, Carsten Maple

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There is a dramatic surge in the adoption of machine learning (ML) techniques in many areas, including the nuclear industry (such as fault diagnosis and fuel management in nuclear power plants), autonomous systems (including self-driving vehicles), space systems (space debris recovery, for example), medical surgery, network intrusion detection, malware detection, to name a few. With the application of learning methods in such diverse domains, artificial intelligence (AI) has become a part of everyday modern human life. To date, the predominant focus has been on developing underpinning ML algorithms that can improve accuracy, while factors such as resiliency and robustness of algorithms have been largely overlooked. If an adversarial attack is able to compromise the learning method or data, the consequences can be fatal, especially but not exclusively in safety-critical applications. In this paper, we present an in-depth analysis of five adversarial attacks and three defence methods on a crack detection ML model. Our analysis shows that it can be dangerous to adopt machine learning techniques in security-critical areas such as the nuclear industry without rigorous testing since they may be vulnerable to adversarial attacks. While common defence methods can effectively defend against different attacks, none of the three considered can provide protection against all five adversarial attacks analysed.

Keywords: adversarial machine learning, attacks, defences, nuclear industry, crack detection

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Authors: Kave Moloudi, Heidi Abrahamse, Blassan P. George

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Radiotherapy (RT) and photodynamic therapy (PDT) are both forms of cancer treatment that aim to kill cancer cells while minimizing damage to healthy tissue. The similarity between RT and PDT lies in their mechanism of action. Both treatments use energy to damage cancer cells. RT uses high-energy radiation to damage the DNA of cancer cells, while PDT uses light energy to activate a photosensitizing agent, which produces reactive oxygen species (ROS) that damage the cancer cells. Both treatments require careful planning and monitoring to ensure the correct dose is delivered to the tumor while minimizing damage to surrounding healthy tissue. They are also often used in combination with other treatments, such as surgery or chemotherapy, to improve overall outcomes. However, there are also significant differences between RT and PDT. For example, RT is a non-invasive treatment that can be delivered externally or internally, while PDT requires the injection of a photosensitizing agent and the use of a specialized light source to activate it. Additionally, the side effects and risks associated with each treatment can vary. In this review, we focus on generalizing the 6Rs of radiobiology in PDT, which can open a window for the clinical application of Radio-photodynamic therapy with minimum side effects. Furthermore, this review can open new insight to work on and design new radio-photosensitizer agents in Radio-photodynamic therapy.

Keywords: radiobiology, photodynamic therapy, radiotherapy, 6Rs in radiobiology, ROS, DNA damages, cellular and molecular mechanism, clinical application.

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Authors: Shantanu Vyas, Neerja Meena

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Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Keywords: cosmetic correction and facial assemetry, aesthetic results, facial infiltration, surgery

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Authors: Ndje Ndje Mireille

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The improvement in the physical aspects of hysterectomy has tended to make us forget the psychological burden of this operation for many women. African women closely associate fertility and femininity, and they fear that their desire will diminish, that they will be less desirable after having undergone a hysterectomy. Medicine may be tempted to trivialize this surgical intervention by relying on the evolution of current surgery that leaves little or no marks. It is possible to think that the uterus is useless for a nun who has decided to freely disregard her motherhood. We used the clinical research method for this study. Through a semi-directive interview guide, we collected the verbatims of an hysterectomized catholic nun. The verbatims were transcribed and analyzed with the thematic content analysis. This analysis shows that the medical reality does not always correspond to the subjective experience of women, for whom hysterectomy can imply strong symbolic damage. The uterus is not essential to life, but it is essential to give life, and this lack can reactivate a desire for motherhood. The experience of hysterectomy is unique for each woman in relation to her history. This operation will eliminate all hope of pregnancy; it will be felt as intimate mutilation and an attack on femininity, it will bring up concerns about sexuality. Even if a woman has past the age of having children, has gone through menopause, or has freely decided not to have children, she still find it difficult to accept this procedure. The lack of uterus make a woman feel useless.

Keywords: hysterectomy, symbolic damage, desire for motherhood, feminity, nun

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Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

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Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Yung-Gi Chen, Pei-Leun Kang, Yu-Hsin Lin, Shwu-Jen Chang

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Myocardial tissue has limited self-repair ability due to its loss of differentiation characteristic for most mature cardiomyocytes. Therefore, the effective use of stem cell technology in regenerative medicine is an important development to alleviate the current difficulties in cardiac disease treatment. The main purpose of this project was to develop a 3-D hydrogel electrical stimulating system for promoting the differentiation of stem cells into myocardial cells, and the patch will be used to repair damaged myocardial tissue. This project was focused on the preparation of the electrical stimulation system with carbon/CaCl₂ electrodes covered with carbon nanotube-hydrogel. In this study, we utilized screen imprinting techniques and used Poly(lactic-co-glycolic acid)(PLGA) membranes as printing substrates to fabricate a carbon/CaCl₂ interdigitated electrode that covered with alginate/carbon nanotube hydrogels. The single-walled carbon nanotube was added in the hydrogel to enhance the mechanical strength and conductivity of hydrogel. In this study, we used PLGA (85:15) as electrode preparing substrate. The CaCl₂/ EtOH solution (80% w/v) was mixed into carbon paste to prepare various concentration calcium-containing carbon paste (2.5%, 5%, 7.5%, 10% v/v). Different concentrations of alginate (1%, 1.5%, 2% v/v) and SWCNT(Diameter < 2nm, length between 5-15μm) (1, 1.5, 3 mg/ml) are gently immobilized on the electrode by cross-linking with calcium chloride. The three-dimensional hydrogel electrode was tested for its redox efficiency by cyclic voltammetry to determine the optimal parameters for the hydrogel electrode preparation. From the result of the final electrodes, it indicated that the electrode was not easy to maintain the pattern of the interdigitated electrode when the concentration of calcium of chloride was more than 10%. According to the gel rate test and cyclic voltammetry experiment results showed the SWCNT could increase the electron conduction of hydrogel electrodes significantly. So far the 3D electrode system has been completed, 2% alginate mixed with 3mg SWCNT is the optimal condition to construct the most complete structure for the hydrogel preparation.

Keywords: myocardial tissue engineering, screen printing technology, poly (lactic-co-glycolic acid), alginate, single walled carbon nanotube

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Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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Authors: Kamila Dus-Szachniewicz, Artur Bednarkiewicz, Katarzyna Gdesz-Birula, Slawomir Drobczynski

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In modern oncology hyperthermia (HT) is defined as a controlled tumor heating. HT treatment temperatures range between 40–48 °C and can selectively damage heat-sensitive cancer cells or limit their further growth, usually with minimal injury to healthy tissues. Despite many advantages, conventional whole-body and regional hyperthermia have clinically relevant side effects, including cardiac and vascular disorders. Additionally, the lack of accessibility of deep-seated tumor sites and impaired targeting micrometastases renders HT less effective. It is believed that above disadvantages can significantly overcome by the application of biofunctionalized microparticles, which can specifically target tumor sites and become activated by an external stimulus to provide a sufficient cellular response. In our research, the unique optical tweezers system have enabled capturing the silica microparticles, primary cells and tumor spheroids in highly controllable and reproducible environment to study the impact of localized heat stimulation on normal and pathological cell and within multicellular tumor spheroid. High throughput spheroid model was introduced to better mimic the response to HT treatment on tumors in vivo. Additionally, application of local heating of tumor spheroids was performed in strictly controlled conditions resembling tumor microenvironment (temperature, pH, hypoxia, etc.), in response to localized and nonhomogeneous hyperthermia in the extracellular matrix, which promotes tumor progression and metastatic spread. The lack of precise control over these well- defined parameters in basic research leads to discrepancies in the response of tumor cells to the new treatment strategy in preclinical animal testing. The developed approach enables also sorting out subclasses of cells, which exhibit partial or total resistance to therapy, in order to understand fundamental aspects of the resistance shown by given tumor cells in response to given therapy mode and conditions. This work was funded by the National Science Centre (NCN, Poland) under grant no. UMO-2017/27/B/ST7/01255.

Keywords: cancer spheroids, hyperthermia, microparticles, optical tweezers

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Authors: I. V. Palamarchuk, N. V. Zaichko

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Background and Aims: Galectin-3 is a marker of subclinical cardiac injury and is elevated in individuals with type 2 diabetes mellitus; while hydrogen sulfide (H₂S), metabolite of sulfur-containing amino acids, is considered having antifibrogenic effects. This study was designed to investigate whether metformin and its combination with NaHS can influence plasma galectin-3 and cystathionine-γ-lyase/hydrogen sulfide (CSE/H₂S) system in diabetic rat’s heart. Methods: 32 healthy male rats (180-250 g) were divided into 4 groups. To induct diabetes, rats (group 2-4) were injected with streptozotocin (STZ, 40 mg/kg/i.p., 0.1 M citrate buffer (pH 4.5). Rats from 3d (STZ+Metf) and 4th (STZ+Metf+NaHS) groups were given metformin (500 mg/kg/day) orally, and rats from 4th (STZ+Metf+NaHS) group were injected sodium hydrosulfide (NaHS, 3 mg/kg/i.p.) once per day starting from 3 to 28 day after streptozotocin injection. Rats of first group (control) were administered the equivalent volumes of 0.9% NaCl. Plasma galectin-3 was measured by ELISA. Rats’ hearts were sampled for determination of H2S by reaction with N,N-Dimethyl-p-phenylenediamine. Determination of CSE gene expression was performed in real time using PCR in the presence of SYBR Green I, using DT-Light detecting amplifier ('DNA-technology', Russia). Results: Induction of streptozotocin diabetes (STZ-diabetes, group 2) was followed by low myocardial H2S concentration and CSE expression (by 35%, p < 0.05 and 60.5%, p < 0.001 respectively, than that in controls), while plasma galectin-3 in this group was significantly higher than in controls (by 3.8 times, p < 0.05). Administration of metformin (group 3) resulted in significantly higher H₂S concentration (by 28.5%, p < 0.05), whereas CSE expression was only by 6% more than that in STZ-diabetes, as well as plasma galectin-3 was only by 14.8% lower in comparison with untreated diabetic rats. The inhibition of H₂S generation and CSE activity by diabetes was greatly attenuated in STZ+Metf+NaHS group. The combination of metformin with NaHS significantly stimulated H₂S production (by 48%, p < 0.05 and 15%, p < 0.05 more than STZ-diabetes and STZ+Metf respectively) and CSE gene expression (by 64.8%, p < 0.05 compared to STZ-diabetes and by 55.4%,p < 0.05 compared to STZ+Metf). Besides, plasma galectin-3 in rats receiving metformin and NaHS was significantly lower by 42%, p < 0.05 and 32.5%, p < 0.05 compared to STZ-diabetes and STZ+Metf groups respectively. Conclusions: To summarize, dysfunction of CSE/H2S system and galectin-3 stimulation was found in streptozotocin-induced diabetic rats. Metformin and its combination with exogenous H2S effectively prevented the development of metabolic changes induced by diabetes. These findings suggest that CSE/H₂S system can be integrated into pathogenesis of diabetic complications through modulation of pro-inflammatory and pro-fibrogenic mediator galectin-3.

Keywords: cystathionine-γ-lyase, diabetic heart, galectin-3, hydrogen sulfide, metformin, sodium hydrosulfide

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Authors: Amlan Kumar Das, Avinash Marwal, Vikram Pareek

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Liposome plays an important role in medical and pharmaceutical science as e.g. nano scale drug carriers. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment. Magnet-driven liposome used for the targeted delivery of drugs to organs and tissues1. These liposome preparations contain encapsulated drug components and finely dispersed magnetic particles. Liposomes are vesicles of varying size consisting of a spherical lipid bilayer and an aqueous inner compartment that are generated in vitro. These are useful in terms of biocompatibility, biodegradability, and low toxicity, and can control biodistribution by changing the size, lipid composition, and physical characteristics2. Furthermore, liposomes can entrap both hydrophobic and hydrophilic drugs and are able to continuously release the entrapped substrate, thus being useful drug carriers. Magnetic liposomes (MLs) are phospholipid vesicles that encapsulate magneticor paramagnetic nanoparticles. They are applied as contrast agents for magnetic resonance imaging (MRI)3. The biological synthesis of nanoparticles using plant extracts plays an important role in the field of nanotechnology4. Green-synthesized magnetite nanoparticles-protein hybrid has been produced by treating Iron (III)/Iron(II) chloride with the leaf extract of Dhatura Inoxia. The phytochemicals present in the leaf extracts act as a reducing as well stabilizing agents preventing agglomeration, which include flavonoids, phenolic compounds, cardiac glycosides, proteins and sugars. The magnetite nanoparticles-protein hybrid has been trapped inside the aqueous core of the liposome prepared by reversed phase evaporation (REV) method using oleic and linoleic acid which has been shown to be driven under magnetic field confirming the formation magnetic liposome (ML). Chemical characterization of stealth magnetic liposome has been performed by breaking the liposome and release of magnetic nanoparticles. The presence iron has been confirmed by colour complex formation with KSCN and UV-Vis study using spectrophotometer Cary 60, Agilent. This magnet driven liposome using nanoparticles-protein hybrid can be a smart vesicles for the targeted drug delivery.

Keywords: nanoparticles-protein hybrid, magnetic liposome, medical, pharmaceutical science

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Authors: Kelechi Emmanuel, Kyaw Thein Aung, William Burch

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Introduction: Although rewarding in more ways than one, rural medicine can be challenging. The factors that lead to the challenges experienced in rural medicine include but are not limited to scarcity of resources, poor patient education inadequately trained professionals. This is the first single center study done on the challenges of and ways to improve diagnosis in rural medicine. Materials and Methods: Questionnaires were given to providers in a single hospital in rural Tennessee USA. In which providers were asked the question ‘In the past six months, what measures have you taken to improve your diagnostic accuracy given limited resources. Results: The questionnaire was passed to ten physicians working in a two hundred and twentyfive hospital bed. Physicians who participated included physicians in hospital medicine, emergency medicine, surgery, cardiology and gastroenterology. The study found that improved physical examination skills, access to specialist especially via telemedicine and affiliation to centers with more experienced professionals improved diagnosis and overall patient outcome in rural medicine. Conclusion: From this single center study, there is evidence to show that in addition to honing physical examination skills and having access to immediate results of testing done; hospital collaborations and access to highly trained specialist via telemedicine does improve diagnosis in rural medicine.

Keywords: rural medicine, diagnostic accuracy, diagnosis, telemedicine

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Authors: Khalil Ibrahim, Ahmed Ramadan, Mohamed Fanni, Yo Kobayashi, Ahmed Abo-Ismail, Masakatus G. Fujie

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This paper deals with the design process and the dynamic control simulation of a new type of 4-DOFs parallel mechanism that can be used as an endoscopic surgical manipulator. The proposed mechanism, 2-PUU_2-PUS, is designed based on the screw theory and the parallel virtual chain type synthesis method. Based on the structure analysis of the 4-DOF parallel mechanism, the inverse position equation is studied using the inverse analysis theory of kinematics. The design and the stress analysis of the mechanism are investigated using SolidWorks software. The virtual prototype of the parallel mechanism is constructed, and the dynamic simulation is performed using ADAMS TM software. The system model utilizing PID and PI controllers has been built using MATLAB software. A more realistic simulation in accordance with a given bending angle and point to point control is implemented by the use of both ADAMS/MATLAB software. The simulation results showed that this control method has solved the coordinate control for the 4-DOF parallel manipulator so that each output is feedback to the four driving rods. From the results, the tracking performance is achieved. Other control techniques, such as intelligent ones, are recommended to improve the tracking performance and reduce the numerical truncation error.

Keywords: parallel mechanisms, medical robotics, tracjectory control, virtual chain type synthesis method

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Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

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The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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Authors: Danny Fraser, James Zhang

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Aim of the study: Our study aims to identify any statistically significant evidence as it relates to PROMs for mastectomy and implant-based reconstruction to guide future surgical management. Method: The demographic, pre and post-operative treatment and implant characteristics were collected of all patients at Basildon hospital who underwent breast reconstruction from 2017-2023. We used the Breast-Q psychosocial well-being, physical well-being, and satisfaction with breasts scales. An Independent t-test was conducted for each group, and linear regression of age and implant size. Results: 69 patients were contacted, and 39 PROMs returned. The mean age of patients was 57.6. 40% had smoked before, and 40.8% had BMI>30. 29 had pre-pectoral placement, and 40 had subpectoral placement. 17 had smooth implants, and 52 textured. Sub pectoral placement was associated with higher (75.7 vs. 61.9 p=0.046) psychosocial scores than pre pectoral, and textured implants were associated with a lower physical score than the smooth surface (34.7 VS 50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusion: We present a large cohort of patients who underwent breast reconstruction. Understanding the PROMs of these procedures can guide clinicians, patients and policy makers to be more informed of the course of rehabilitation of these operations. Significance: We have found that from a patient perspective subpectoral implant placement was associated with a statistically significant improvement in psychosocial scores.

Keywords: breast surgery, mastectomy, breast implants, oncology

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Authors: Tran Thi Anh Dao, M. Arnold, L. Schacher, D. C. Adolphe, G. Reys

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During tooth extraction or implant surgery, dentists are in contact with numerous infectious germs from patients' saliva and blood. For that reason, dentist's clothes have to play their role of protection from contamination. In addition, dentist's apparels should be not only protective but also comfortable and breathable because dentists have to perform many operations and treatments on patients throughout the day with high concentration and intensity. However, this type of protective garments has not been studied scientifically, whereas dentists are facing new risks and eager for looking for a comfortable personal protective equipment. For that reason, we have proposed some new designs of dentist's gown. They were expected to diminish heat accumulation that are considered as an important factor in reducing the level of comfort experienced by users. Experiments using infra-red technology were carried out in order to compare the breathable properties between a traditional gown and a new design with open zones. Another experiment using pressure sensors was also carried out to study ergonomic aspects trough the flexibility of movements of sleeves. The sleeves-design which is considered comfortable and flexible will be chosen for the further step. The results from the two experiments provide valuable information for the development of a new design of dentists' gowns in order to achieve maximum levels of cooling and comfort for the human body.

Keywords: garment, dentists, comfort, design, protection, thermal

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Authors: Kitti Szoke, Laszlo Szoke, Attila Czompa, Arpad Tosaki, Istvan Lekli

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Autophagy plays an important role in cardiac hypertrophy, which is one of the most common causes of heart failure in the world. This self-degradative catabolic process, responsible for protein quality control, balancing sources of energy at critical times, and elimination of damaged organelles. The autophagic activity can be triggered by starvation, oxidative stress, or pharmacological agents, like rapamycin. This induced autophagy can promote cell survival during starvation or pathological stress. In this study, it is investigated the effect of the induced autophagic process on angiotensin induced hypertrophic H9c2 cells. In our study, it is used H9c2 cells as an in vitro model. To induce hypertrophy, cells were treated with 10000 nM angiotensin-II, and to activate autophagy, 100 nM rapamycin treatment was used. The following groups were formed: 1: control, 2: 10000 nM AT-II, 3: 100 nM rapamycin, 4: 100 nM rapamycin pretreatment then 10000 nM AT-II. The cell viability was examined via MTT (cell proliferation assay) assay. The cells were stained with rhodamine-conjugated phalloidin and DAPI to visualize F-actin filaments and cell nuclei then the cell size alteration was examined in a fluorescence microscope. Furthermore, the expression levels of autophagic and apoptotic proteins such as Beclin-1, p62, LC3B-II, Cleaved Caspase-3 were evaluated by Western blot. MTT assay result suggests that the used pharmaceutical agents in the tested concentrations did not have a toxic effect; however, at group 3, a slight decrement was detected in cell viability. In response to AT-II treatment, a significant increase was detected in the cell size; cells became hypertrophic. However, rapamycin pretreatment slightly reduced the cell size compared to group 2. Western blot results showed that AT-II treatment-induced autophagy, because the increased expression of Beclin-1, p62, LC3B-II were observed. However, due to the incomplete autophagy, the apoptotic Cleaved Caspase-3 expression also increased. Rapamycin pretreatment up-regulated Beclin-1 and LC3B-II, down-regulated p62 and Cleaved Caspase-3, indicating that rapamycin-induced autophagy can restore the normal autophagic flux. Taken together, our results suggest that rapamycin activated autophagy reduces angiotensin-II induced hypertrophy.

Keywords: angiotensin-II, autophagy, H9c2 cell line, hypertrophy, rapamycin

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Authors: M. Błoch, P. Karpiński, P. Gasperowicz, R. Płoski, A. Lebioda, P. Skiba, A. Rozensztrauch, D. Patkowski, R. Śmigiel

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Introduction: The cause of the isolated form of esophageal atresia has been yet unknown. Objectives: The primary objective of this study was to indicate epigenetic factors which may play an important role in the etiopathogenesis of esophageal atresia. Methods: We recruited a group of 6 pairs of twins, among whom one of the twins developed EA. The selection of such a group for testing allows for excluding external factors (e.g., infections, drugs, toxins) as the cause of the birth defect. The analyzes were performed with the use of genetic material isolated from the whole blood and esophagus tissue of a patient with EA. The reduced representation bisulphite sequencing (RRBS) technique was used to study the change in the genomic imprinting -a change in the expression of genes, which may be the epigenetic cause of EA. Results: In the course of the analyzes, significant hypomethylation and hypermethylation regions were identified. 65 genes with probably increased expression and 65 with decreased expression were selected. These genes have not been marked in literature as possibly pathogenic in esophageal atresia. However, their participation in the pathogenesis of esophageal atresia cannot be clearly excluded. Conclusion: We suggest a role of hypomethylation or hypermethylation of selected genes as one of the possible epigenetic factors in EA pathogenesis. The use of the RRBS technique in the search for the cause of EA is pioneer research; therefore, it seems necessary to extend the research group to new patients with EA. Acknowledgment: The work was supported by the National Science Centre, Poland, under research project 2016/21/N/NZ5/01927.

Keywords: esophageal atresia, epigenetics, embryonic development, surgery, genes expression, twins

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Authors: L. Siva Rama Krishna, Sriram Venkatesh, M. Sastish Kumar, M. Uma Maheswara Chary

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Rapid Prototyping (RP) is a technology that produces models and prototype parts from 3D CAD model data, CT/MRI scan data, and model data created from 3D object digitizing systems. There are several RP process like Stereolithography (SLA), Solid Ground Curing (SGC), Selective Laser Sintering (SLS), Fused Deposition Modelling (FDM), 3D Printing (3DP) among them SLS and FDM RP processes are used to fabricate pattern of custom cranial implant. RP technology is useful in engineering and biomedical application. This is helpful in engineering for product design, tooling and manufacture etc. RP biomedical applications are design and development of medical devices, instruments, prosthetics and implantation; it is also helpful in planning complex surgical operation. The traditional approach limits the full appreciation of various bony structure movements and therefore the custom implants produced are difficult to measure the anatomy of parts and analyse the changes in facial appearances accurately. Cranioplasty surgery is a surgical correction of a defect in cranial bone by implanting a metal or plastic replacement to restore the missing part. This paper aims to do a comparative study on the dimensional error of CAD and SLS RP Models for reconstruction of cranial defect by comparing the virtual CAD with the physical RP model of a cranial defect.

Keywords: rapid prototyping, selective laser sintering, cranial defect, dimensional error

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Authors: S. alireza Mirghasemi, Shervin Rashidinia, Mohammadsaleh Sadeghi, Mohsen Talebizadeh, Narges Rahimi Gabaran, S. Shahin Eftekhari, Sara Shahmoradi

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Purpose: There are various pin-in-plaster methods for treating distal radius fractures. This study is meant to introduce a modified technique of pin-in-plaster. Materials and methods: Fifty-four patients with distal radius fractures were followed up for one year. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than 7 days after injury. Range of motion and functional results were evaluated. Radiographic parameters including radial inclination, tilt, and height, were measured preoperatively and postoperatively. Results: The average radial tilt was 10.6° and radial height was 10.2 mm at the sixth month postoperatively. Three cases of pin tract infection were recorded, who were treated totally with oral antibiotics. There was no case of pin loosening. Of total 73 patients underwent surgery, three cases of radial nerve irritation were recorded at the time of cast removal. All of them resolved at the 6th month follow up. No median nerve compression and carpal tunnel syndrome have found. We also had no case of tendon injury. Conclusion: Our modified technique is effective to restore anatomic congruity and maintain reduction.

Keywords: distal radius fracture, percutaneous pinning, pin-in-plaster, modified method of pin-in-plaster, operative treatment

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Authors: Madhukar Kasarla, Sumit Fogla, Kiran Panuganti, Gaurav Jain, Abhijit Ramanujam, Astha Jain, Shashank Kraleti, Sharat Musham, Arun Chaudhury

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Patients have often chosen to travel for care — making pilgrimages to academic meccas and state-of-the-art hospitals for sophisticated surgery. This culture is still persistent in the landscape of US healthcare, with hundred thousand of visitors coming to the shores of United States to seek the high quality of medical care. One of the major challenges in this form of medical tourism has been the language barrier. Thus, an Iraqi patient, with immediate needs of communicating the healthcare needs to the treating team in the hospital, may face huge barrier in effective patient-doctor communication, delaying care and even at times reducing the quality. To circumvent these challenges, we are proposing the use of a state-of-the-art tool, Talk2All, which can translate nearly one hundred international languages (and even sign language) in real time. The tool is an easy to download app and highly user friendly. It builds on machine learning principles to decode different languages in real time. We suggest that the use of Talk2All will tremendously enhance communication in the hospital setting, effectively breaking the language barrier. We propose that vigorous incorporation of Talk2All shall overcome practical challenges in international medical and surgical tourism.

Keywords: language translation, communication, machine learning, medical tourism

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Authors: C. Soh, S. Muktar, C. M. Malata, J. R. Benson

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Introduction Reasons for requesting CPM include prevention of recurrence, peace of mind and moving on after breast cancer. Some women seek CPM as a delayed procedure but factors influencing this are poorly understood. Methods A retrospective analysis examined patients undergoing CPM as either an immediate or delayed procedure with or without breast reconstruction (BR) between January 2009 and December 2019. A cross-sectional survey based on validated questionnaires (5 point Likert scale) explored patients’ decision-making process in terms of timing of CPM and any BR. Results A total of 123 patients with unilateral breast cancer underwent CPM with 39 (32.5%) delayed procedures with or without BR. The response rate amongst patients receiving questionnaires (n=33) was 22/33 (66%). Within this delayed CPM cohort were three reconstructive scenarios 1) unilateral immediate BR with CPM (n=12); 2) delayed CPM with concomitant bilateral BR (n=22); 3) delayed bilateral BR after delayed CPM (n=3). Two patients had delayed CPM without BR. The most common reason for delayed CPM was to complete all cancer treatments (including radiotherapy) before surgery on the unaffected breast (score 2.91). The second reason was unavailability of genetic test results at the time of therapeutic mastectomy (score 2.64) whilst the third most cited reason was a subsequent change in family cancer history. Conclusion Factors for delayed CPM are patient-driven with few women spontaneously changing their mind having initially decided against immediate CPM for reasons also including surgical duration. CPM should be offered as a potentially delayed option with informed discussion of risks and benefits.

Keywords: Breast Cancer, CPM, Prophylactic, Rationale

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Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar

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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.

Keywords: acute pancreatitis, ERCP, morbidity, treatment

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Authors: J. Milton, C. Uzoigwe, O. Ayeko, B. Offorha, K. Anderson, R. G. Middleton

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Background: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 units in order to determine if the unit volume was associated with performance for each particular outcome. Method: We analysed 175 institutions treating a total of 67,673 patients over the course of a year. Results: The number of hip fractures seen per unit ranged between 86 and 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. Patients treated at large institutions had shorter lengths of stay. With regard to most other outcomes, there was no association between unit case volume and performance, notably compliance with the Best Practice Tariff, time to surgery, proportion of eligible patients undergoing total hip arthroplasty, length of stay, delirium risk, and pressure sore risk assessments. Conclusion: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Keywords: institution volume, mortality, neck of femur fractures, osteoporosis

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Authors: Shekoufeh Behdad, Sahar Yadegari, Alireza Ghehrazad, Amirhossein Yadegari

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Background: In this study, we compared the effect of intravenous dexamethasone with placebo on hemodynamic variables and hypotension in patients undergoing cesarean section under spinal anesthesia. Materials and methods: This double-blind, randomized clinical trial was conducted with the approval of the university ethics committee. Written informed consent was obtained from all participating patients. Before spinal anesthesia, patients were randomly assigned to receive either dexamethasone (8 mg IV) or placebo (normal saline). Hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were measured before drug administration and every 3 minutes until the birth of the neonate and then every 5 minutes until the end of surgery. Side effects such as hypotension, bradycardia, nausea, and vomiting were assessed and recorded for all the patients. Results: There were no significant differences in mean systolic, diastolic, and mean arterial blood pressures before and after administration of the studied drugs in both groups (P.Value>0.05), but heart rate and the incidence of hypotension in the dexamethasone group were less than placebo significantly. Conclusions: Intravenous administration of 8 mg dexamethasone before spinal anesthesia in females undergoing cesarean section can reduce the incidence of post-spinal hypotension without causing serious side effects.

Keywords: cesarean section, hypotension, spinal anesthesia, dexamethasone

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Authors: Yori Gidron, Maartje Mol, Norbert Foudraine, Frits Van Osch, Joop Van Den Bergh, Moshe Farchi, Maud Straus

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Background: The worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-COV2), which began in 2019, also known as Covid-19, has infected over 136 million people and tragically took the lives of over 2.9 million people worldwide. Many of the complications and deaths are predicted by the inflammatory “cytokine storm.” One way to progress in the prevention of death is by finding a predictive and protective factor that inhibits inflammation, on the one hand, and which also increases anti-viral immunity on the other hand. The vagal nerve does precisely both actions. This study examined whether vagal nerve activity, indexed by heart-rate variability (HRV), predicts survival in patients with Covid-19. Method: We performed a pseudo-prospective study, where we retroactively obtained ECGs of 271 Covid-19 patients arriving at a large regional hospital in The Netherlands. HRV was indexed by the standard deviation of the intervals between normal heartbeats (SDNN). We examined patients’ survival at 3 weeks and took into account multiple confounders and known prognostic factors (e.g., age, heart disease, diabetes, hypertension). Results: Patients’ mean age was 68 (range: 25-95) and nearly 22% of the patients had died by 3 weeks. Their mean SDNN (17.47msec) was far below the norm (50msec). Importantly, relatively higher HRV significantly predicted a higher chance of survival, after statistically controlling for patients’ age, cardiac diseases, hypertension and diabetes (relative risk, H.R, and 95% confidence interval (95%CI): H.R = 0.49, 95%CI: 0.26 – 0.95, p < 0.05). However, since HRV declines rapidly with age and since age is a profound predictor in Covid-19, we split the sample by median age (40). Subsequently, we found that higher HRV significantly predicted greater survival in patients older than 70 (H.R = 0.35, 95%CI: 0.16 – 0.78, p = 0.01), but HRV did not predict survival in patients below age 70 years (H.R = 1.11, 95%CI: 0.37 – 3.28, p > 0.05). Conclusions: To the best of our knowledge, this is the first study showing that higher vagal nerve activity, as indexed by HRV, is an independent predictor of higher chances for survival in Covid-19. The results are in line with the protective role of the vagal nerve in diseases and extend this to a severe infectious illness. Studies should replicate these findings and then test in controlled trials whether activating the vagus nerve may prevent mortality in Covid-19.

Keywords: Covid-19, heart-rate Variability, prognosis, survival, vagal nerve

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Authors: Gurfateh Singh, Mu Khan, Razia Khanam, Govind Mohan

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Objective: The present study has been designed to investigate the beneficial role of Fenofibrate & Clofibrate in attenuated the cardioprotective effect of ischemic preconditioning (IPC) in hyperlipidemic rat hearts. Materials & Methods: Experimental hyperlipidemia was produced by feeding high fat diet to rats for a period of 28 days. Isolated langendorff’s perfused normal and hyperlipidemic rat hearts were subjected to global ischemia for 30 min followed by reperfusion for 120 min. The myocardial infarct size was assessed macroscopically using triphenyltetrazolium chloride staining. Coronary effluent was analyzed for lactate dehydrogenase (LDH) and creatine kinase-MB release to assess the extent of cardiac injury. Moreover, the oxidative stress in heart was assessed by measuring thiobarbituric acid reactive substance, superoxide anion generation and reduced form of glutathione. Results: The ischemia-reperfusion (I/R) has been noted to induce oxidative stress by increasing TBARS, superoxide anion generation and decreasing reduced form of glutathione in normal and hyperlipidemic rat hearts. Moreover, I/R produced myocardial injury, which was assessed in terms of increase in myocardial infarct size, LDH and CK-MB release in coronary effluent and decrease in coronary flow rate in normal and hyperlipidemic rat hearts. In addition, the hyperlipidemic rat hearts showed enhanced I/R-induced myocardial injury with high degree of oxidative stress as compared with normal rat hearts subjected to I/R. Four episodes of IPC (5 min each) afforded cardioprotection against I/R-induced myocardial injury in normal rat hearts as assessed in terms of improvement in coronary flow rate and reduction in myocardial infarct size, LDH, CK-MB and oxidative stress. On the other hand, IPC mediated myocardial protection against I/R-injury was abolished in hyperlipidemic rat hearts. However, Treatment with Fenofibrate (100 mg/kg/day, i.p.), Clofibrate (300mg/kg/day, i.p.) as a agonists of PPAR-α have not affected the cardioprotective effect of IPC in normal rat hearts, but its treatment markedly restored the cardioprotective potentials of IPC in hyperlipidemic rat hearts. Conclusion: It is noted that the high degree of oxidative stress produced in hyperlipidemic rat heart during reperfusion and consequent down regulation of PPAR-α may be responsible to abolish the cardioprotective potentials of IPC.

Keywords: Hyperlipidemia, ischemia-reperfusion injury, ischemic preconditioning, PPAR-α

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Authors: Deok Hyun Han

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Objective: To explore outcomes of UventaTM metallic ureteral stent between malignant and benign ureteral obstruction. Methods: We reviewed the medical records of 90 consecutive patients who underwent Uventa stent placement for benign or malignant ureteral obstruction from December 2009 to June 2013. We evaluated the clinical outcomes, complications, and reasons and results for unexpected stent removals. Results: The median follow-up was 10.7 (0.9 – 41) months. From a total of 125 ureter units, there were 24 units with benign obstructions and 101 units with malignant obstructions. Initial technical successes were achieved in all patients. The overall success rate was 70.8% with benign obstructions and 84.2% with malignant obstructions. The major reasons for treatment failure were stent migration (12.5%) in benign and tumor progression (11.9%) in malignant obstructions. The overall complication rate was similar between benign and malignant obstructions (58.3% and 42.6%), but severe complications, which are Clavien grade 3 or more, occurred in 41.7% of benign and 6.9% of malignant obstructions. The most common complications were stent migration (25.0%) in benign obstructions and persistent pain (14.9%) in malignant obstructions. The stent removal was done in 16 units; nine units that were removed by endoscopy and seven units were by open surgery. Conclusions: In malignant ureteral obstructions, the Uventa stent showed favorable outcomes with high success rate and acceptable complication rate. However, in benign ureteral obstructions, overall success rate and complication rate were less favorable. Malignant ureteral obstruction seems to be appropriate indication of Uventa stent placement. However, in chronic diffuse benign ureteral obstructions the decision of placement of Uventa stent has to be careful.

Keywords: cause, complication, ureteral obstruction, metal stent

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Authors: Animesh Gupta

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Objective: The purpose of this study is to evaluate the versatility and outcome of lateral supra malleolar flap (LSMF) in soft tissue reconstruction of the regions including the distal leg, ankle, dorsal foot and heel. Methods: From March 2021 to April 2023, 18 patients with soft tissue defects in the regions, including the distal leg, ankle, dorsal foot and heel, who underwent LSMF repair for lower limb wound reconstruction were analyzed. The location, size of the defects, etiology, outcome, complications, and other alternative options were studied and presented. Results: The follow-up period of the cases was 3-6 months after surgery. All flaps were successful; however, one flap was complicated by venous congestion and was managed by loosening a few sutures and the patient was required to elevate the affected limb to resolve the issue. Conclusion: The LSMF has numerous advantages in repairing soft tissue defects in areas involving the ankle, distal leg, heel and dorsum of the foot. In comparison to reverse sural flaps for repairing defects in the heel and lower leg, LSMF offers shorter operation time, shorter hospitalization, lower cost, and fewer postoperative complications.

Keywords: lateral supra malleolar flap, LSMF, soft tissue reconstruction, lower leg defect

Procedia PDF Downloads 75