Case of colonic intussusception secondary to mobile cecum syndrome repaired by laparoscopic cecopexy using a barbed wound suture device

A 27-year-old man with recurrent right lower quadrant pain was admitted to our hospital. Ultrasonography and computed tomography examination of the abdomen revealed a target sign in the ascending colon, which was compatible with the diagnosis of cecal intussusception. The intussusception was spontaneously resolved at that time, but it relapsed 6 mo later. The patient underwent a successful colonoscopic disinvagination; there was no evidence of neoplastic or inflammatory lesions in the colon and terminal ileum. The patient underwent laparoscopic surgery for recurring cecal intussusception. During laparoscopy, we observed an unfixed cecum on the posterior peritoneum(i.e. a mobile cecum). Thus, we performed laparoscopic appendectomy and cecopexy with a lateral peritoneal flap using a barbed wound suture device. The patient's post-operative course was uneventful, and he continued to do well without recurrence at 10 mo after surgery. Laparoscopic cecopexy using a barbed wound suture device is a simple and reliable procedure that can be the treatment of choice for recurrent cecal intussusception associated with a mobile cecum.

Fabrication and Tissue Anchoring Performance of Nylon and Polypropylene Barbed Surgical Sutures

Barbed surgical sutures have attracted worldwide attention in recent years. The plurality of barbs projecting out and penetrating into surrounding tissue eliminates the need for tying a knot. In the current study,nylon and polypropylene( PP) barbed sutures with two different barb geometries designed to anchor in porcine skin and tendon tissues were fabricated by a specially designed mechanical cutting machine. The tensile properties were compared between the barbed and unbarbed control sutures. The in vitro tissue anchoring ability was measured by two tissue /suture pullout tests,one for skin and the other for tendon tissue. Regardless of the type of tissue,the PP barbed suture with its higher modulus had a superior anchoring ability. Given the same suture material,improved anchoring performance was shown in tendon tissue.

Efficacy of staple line reinforcement by barbed suture for preventing anastomotic leakage in laparoscopic rectal cancer surgery

BACKGROUND Anastomotic leakage(AL) is a severe complication in rectal cancer surgery.Various methods, including intracorporeal reinforcing suturing, have been used to reduce the incidence of AL. However, little is known about the efficacy of staple-line reinforcement by barbed suture for preventing AL.AIM To evaluate the efficacy of staple-line reinforcement using barbed suture for preventing AL in laparoscopic surgery for rectal cancer.METHODS We retrospectively reviewed the clinical datum of 319 patients undergoing laparoscopic low anterior resection combined with double stapling technique between May 1, 2017 and January 31, 2021. All surgeries were performed by the same surgical team specializing in colorectal surgery. Patients were divided into two groups depending on whether they received reinforcing sutures. Patients’ baseline characteristics did not show any significant difference between the two groups. We analyzed patient-, tumor-, as well as surgery-related variables using univariate and multivariate logistic analyses.RESULTS There were 168 patients in the reinforcing suture group and 151 patients in the non-reinforcing suture group. AL occurred in 25 cases(7.8%). Its incidence was significantly higher in the non-reinforcing suture group than in the reinforcing suture group(4.8% vs 11.3%, P = 0.031). The multivariate analyses demonstrated that the tumor site, tumor size and presence of staple-line reinforcement were independent risk factors for AL. We divided these patients into two risk groups based on the combination of tumor site and tumor size. Patients without any risk factor were assigned to the low-risk group(n = 177), whereas those having one or two risk factors were assigned to the high-risk group(n = 142). In the high-risk group, the AL incidence considerably decreased in the reinforcing suture group compared with that in the non-reinforcing suture group(P = 0.038). Nonetheless, no significant difference was found in the low-risk group between the two groups.CONCLUSION Staple-line reinforcement by barbed suture may decrease the incidence of AL. A large-scale prospective randomized controlled trial is needed for evaluating the efficacy of staple-line reinforcement for preventing AL.

Prospective Interventional Study to Quantify Barbed Suture Exposure at Vaginal Vault and Assess Post-Operative Risk

Background: The use of barbed suture in laparoscopic surgery is increasing ever since 2008. Published reports of use of unidirectional barbed suture for vaginal vault closure following total laparoscopic hysterectomy (TLH), indicates it is safe. Despite of this many reports of adhesions and bowel obstruction are reported. This complication was never assessed in relation to amount of suture exposure at vaginal vault. We thought of quantifying the barbed suture exposure at vaginal vault and assess the risk of post-operative complications. Objective: The objective was to quantify the exposure of barbed suture at vaginal vault by adopting a uniform technique of vault suturing and assessing postoperative risk related to adhesions at vaginal vault. Method: In 30 patients who underwent TLH, a uniform new technique of vaginal vault closure using barbed suture was used and the portion of suture exposed at vaginal vault was quantified. The patients were followed up for a period of 6 months to assess post-operative risk of adhesions at vault and sequalae. Result: Mean length of suture exposed was 2.64 ± 1.65 mm only. Suture exposure at vaginal vault was seen in 23 (76.67%) out of 30 patients. The suture was exposed on average at 1.57 ± 1.20 places at vaginal vault. Conclusion and Recommendations: The study with an accepted relative error of 5% quantifies barbed suture exposure at vaginal vault. We had adopted a uniform new method of vaginal vault suturing to study and to quantify barbed suture exposure. It was observed that very minimal portion of suture was exposed at vaginal vault. It was exposed at only a couple of places at vaginal vault. Thus, decreasing suture exposure at vaginal vault will reduce its exposure related risk.

Tissue Holding Performance of Barbed Sutures

A new technology of knotless barbed surgical sutures has made its mark in cosmetic surgery around the world. Although this technology is still under development, it has been approved by the Federal Drug Administration in USA, and is now used for facelift and eyelid ptosis procedures. The objectives of this study were to review the different types of knotless sutures, assess the tissue holding capacity of barbed sutures and perform image analysis to better understand the mechanism of energy absorption by the barbs under loading by the forces of surrounding tissues. A two dimensional finite element analysis was also performed to identify the areas of stress concentration, which are the main precursors for the peeling of the barbs beyond the maximun tissue holding force for a particular polymer. It was found that barbed sutures exhibit tissue holding capacities comparable to that of knotted sutures. This technology needs to be investigated further so as to optimize the barb geometry for superior holding capacity in a variety of different tissues.

Using a New Glacial History Paradigm and Bald Eagle Through Valley Topographic Map Evidence to Determine Central Pennsylvania’s Geomorphic History, USA

A new glacial history paradigm that describes huge and prolonged southwest-oriented meltwater floods flowing along the rising rim of a deep “hole” (which a large continental icesheet created and occupied) is used to explain previously unexplained or poorly explained central Pennsylvania Bald Eagle through valley region topographic map evidence. Pennsylvania’s Bald Eagle through valley as defined here extends in a northeast direction from near Altoona to near Williamsport along the Allegheny Front escarpment base and forms the boundary between the Appalachian Plateau to the northwest and the Ridge and Valley Province to the southeast. The Lycoming and Towanda Creek valleys follow a probable northeastern Bald Eagle through valley extension and a probable southern extension continues southward along the Allegheny Front base by crossing Juniata River tributary drainage basins to reach the Potomac River drainage basin. Landform features identified on topographic maps, which include through valleys (valleys crossing drainage divides), barbed tributaries, drainage route orientations, drainage route direction changes, water gaps, and gaps located along the Allegheny Front crest, are used to reconstruct how the Pennsylvania Susquehanna and Juniata River drainage systems developed. The resulting geomorphic history describes how massive southwest-oriented floods moving across what was probably a low relief and rising surface (now preserved if preserved at all by the region’s highest elevations) flowed to an actively eroding Potomac River drainage system before being captured and sometimes reversed first by Juniata River valley headward erosion, second by West Branch Susquehanna River valley headward erosion (to create northeast-oriented Bald Eagle Creek and the northeast-oriented West Branch Susquehanna River segment) and third by North Branch Susquehanna River valley headward erosion. This interpretation explains most if not all of the previously poorly explained and unexplained topographic map evidence.

Optimization of the design of a barbed suture for flexor tendon repair using extended finite element analysis

Aim: Use of barbed sutures for fiexor tendon repair is a promising technique. These sutures lie within the substance of the tendon, avoiding the need of external knots and so improving tendon gliding. The load is dispersed equally along the length of the barbed suture, decreasing the possibility of rupture. The purpose of this article is to propose enhanced suture geometry by comparing different cross-sectional configurations, barb cut angles and cut depths using the finite element method. Methods: lnspired by the geometry of fiexor tendons, an elliptical cross-sectional wire was investigated. Mechanical behavior of five different aspect ratios (ρ = 1/3, 1/2, 1, 2, 3), three different cut angles (150°, 154°, 160°) and three cut depths (0.07-mm, 0.12-mm, 0.18-mm) were studied via extended finite element analysis using ABAQUS, for two different loading conditions: one to assess the strength of the suture and the second to evaluate the strength of a single barb. An extended finite element method has been implemented on ABAQUS to predict crack growth in viscoelastic material. Results: Based on these results, an elliptical suture having an aspect ratio of 1/2, 160° of cut angle, and 0.12-mm of cut depth is recommended. Conclusion: Barbed sutures are a good option for tendon repair. Our experiments assessed the mechanical performance of barbed sutures and suggested an optimized suture geometry for a single-stranded repair technique.

Photometric analysis of absorbable barbed suture for periareolar closure in mastopexy

Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective photometric analysis comparing this technique with the same closure using Gortex®suture.This study is designed to compare the degree of areolar widening and safety profile of using absorbable barbed sutures for periareolar closure versus permanent smooth suture.Methods:A retrospective chart review was conducted of all patients whose periareolar closures were performed using an interlocking purse-string technique over a 10-year period.Only patients undergoing circumvertical mastopexy were included.All had photometric evaluation and follow-up performed within 6-24 months.Results:In total,20 patients(40 areolas),which were closed with absorbable barbed suture,were analyzed photometrically.In this suture group,areola size increased a mean of 4.9%from baseline,and no complications(0%)were observed.This compared favorably with previously reported complication rates using permanent sutures and with a series of cases presented herein in which permanent smooth suture was used for purse string closure.The degree to which absorbable barbed suture controls areolar spread was shown to be significantly better than those where permanent smooth purse string techniques were employed.Conclusion:Circumvertical mastopexy closures using absorbable barbed suture was shown to be safe and effective and compared favorably to older techniques using permanent smooth suture for similar closures.This paper lends support to the safety of using absorbable barbed suture in circumareolar closures to limit areolar spread.

Optimization of tissue anchoring performance and mechanical properties of barbed sutures for flexor tendons repair

Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.

Use of Stream and Dismembered Stream Valleys Now Crossing Wyoming’s Northern Laramie Mountains to Test a Recently Proposed Regional Geomorphology Paradigm, USA

Detailed topographic maps show multiple stream valleys and what are probably dismembered stream valleys that extend completely across Wyoming’s northern Laramie Mountains. Several of the most obvious valleys are described with valley origins first explained (or attempted to be explained) from the commonly accepted regional geomorphology paradigm (accepted paradigm) perspective and second from a recently proposed regional geomorphology paradigm (new paradigm) perspective in an effort to determine which of the two paradigms provides the simplest explanations. Accepted paradigm explanations require at least some of the valley erosion to have occurred prior to deposition of Oligocene and Miocene sediments that once covered the northern Laramie Mountains (with some of the exhumed valleys now containing sediment cover remnants). In contrast the fundamentally different new paradigm requires immense south-oriented continental ice sheet melt water floods to have crossed the region as ice sheet related crustal warping raised the region and the Laramie Mountains (and implies sediments now partially filling some of the valleys are probably flood deposited materials). The new paradigm provides simpler explanations for the origins of the valleys now extending completely across the northern Laramie Mountains and also for their related barbed tributaries, truncated side valleys, and drainage route U-turns than the accepted paradigm, although the new paradigm also leads to a fundamentally different middle and late Cenozoic regional geologic history than is currently recognized. One paradigm cannot be used to judge a different paradigm, but the paradigms can be compared based on their ability to explain evidence and Occam’s Razor can determine which of the two paradigms provides the simplest explanations. New paradigm explanations for northern Laramie Mountains valley origins investigated here require fewer assumptions than the accepted paradigm explanations suggesting the new paradigm merits serious future consideration.

Hybrid natural orifice transluminal endoscopic surgery for ileocecal resection

Although laparoscopic colectomy is commonly performed around the world,an operative wound formed during the surgery is large but not sufficient enough to convert for the majority of open surgery.Thus,a certain sized skin incision is required to remove the resected colon.Here we report the case of a pure laparoscopic ileocecal resection which involves transanal specimen extraction.We present a case characterized by a laterally spreading type of tumor of the cecum.We performed a pure laparoscopic ileocecal resection and the resected specimen was removed transanally using colonoscopy.Intracorporeal functional anastomosis was then performed using a flexible linear stapling device under supporting barbed suture traction.The patient was discharged without complications on postoperative day 4.Laparoscopic colectomy performed with minimal incision could essentially increase the usage of this surgical technique.Although our method is restricted to flat or small lesions,we think it is a feasible and realistic solution for minimization of operative invasion because it involves specimen extraction through a natural orifice.

The Outlook of the Development of Innovative Products from Biocompatible Natural Spider Silk in the Beauty Thread-Lifting Industry

Embedding thread lift rhytidectomy,also known as“thread lifting”in China,with the natures of simple operation,less trauma and quick recovery,is progressively used in clinical practice as a new technology of face lifting.Herewith,a brief introduction of the previous advances of thread lifting techniques and materials in the facial beauty industry,combined with the discussion on various types of sutures,common complications,and the site of actions were provided.The main limitations of present thread lifting material include:(1)the use of non-absorbable sutures is liable to cause allergies and a series of complications;(2)the absorbable sutures are easily degradation,and people need to reshape in a relatively short period.Therefore,the high biocompatible spider silk was proposed as a novel material of thread lifting suture and related devices,the advantages and preliminary achievements on spider silk were also addressed.

Yampa River-Colorado River Drainage Divide Origin Determined from Topographic Map Evidence, Southern Routt County, Colorado, USA

Detailed topographic map evidence and a new Cenozoic geologic and glacial history paradigm are used to determine the previously unexplained Yampa River-Colorado River drainage divide origin. The Yampa River now flows in a north direction away from the Colorado River (between the Park Range to the east and the Flat Tops region to the west) before turning in a west direction to reach the Unita Mountains where it joins the south-oriented Green River, which eventually joins the southwest-oriented Colorado River. Topographic maps show the Yampa-Colorado River drainage divide is asymmetric with steeper slopes leading to the Colorado River, barbed (south-oriented) tributaries leading to north-oriented Yampa River headwaters (especially near the Yampa River turn to the west), and evidence of a large north-to-south oriented diverging and converging channel complex that preceded present-day drainage routes. Map evidence is interpreted to mean massive south-oriented floods flowed through what are now north-oriented Yampa River headwaters valleys and that headward erosion of a deep west-oriented valley beheaded and reversed those south-oriented flood flow channels to create the north-oriented Yampa River headwaters and the Egeria Park area Yampa-Colorado River drainage divide seen today. Large south-oriented floods leading to the Colorado River (while regional uplift was occurring) are inconsistent with accepted Cenozoic geologic and glacial history paradigm predictions, but are predicted by a newly proposed Cenozoic geologic and glacial history paradigm in which a thick continental ice sheet created a deep “hole” by eroding underlying bedrock and also by causing crustal warping that raised the present-day northern Colorado east-west continental divide as immense south-oriented meltwater floods flowed across it.

Research on the ultraweak photon emission from anti-cancer plants

UPE (Ultraweak photon emission) is one kind of a common phenomenon in biological organisms. It contains a wealth of information of biological functions. In this paper, single photon counting system is used to measure UPE of some anti- cancer herbal plants. For the plants, the changes of UPE under different water condition are stud-ied and the varying laws of ultraweak photon number with time are analysed. The results are higher fit double exponential decay law.

Sperm of rosy barb (Puntius conchonius) as an in vitro assay system of nonylphenol cytotoxicity

Nonylphenol （NP） is the final degradation product of alkylphenol polyethoxylates （APEs）, which are widely present in plastics, papers, pulp, detergents, pesticides, herbicides, paints and cosmetics. It is estimated that annual global production of APEs is about 500000 t, 60% of which eventually ends up in aquatic ecosystems primarily via wastewater （So16 et cd., 2000）. NP is resistant to biodegradation and persistent in the environment （Arukwe et al., 2000）.

Particle Agglomeration in Bipolar Barb Agglomerator Under AC Electric Field

The development of an efficient technology for removing fine particles in flue gas is essential as the haze is becoming more and more serious.To improve agglomeration effectiveness of fine particles,a dual zone electric agglomeration device consisting of a charging chamber and an agglomeration chamber with bipolar barb electrodes was developed.The bipolar barb electric agglomerator with a polar distance of 200 mm demonstrates good agglomeration effectiveness for particles with a size less than 8.0μm under applied AC electric field.An optimal condition for achieving better agglomeration effectiveness was found to be as follows：flue gas flow velocity of3.00 m/s,particle concentration of 2.00 g/m^3,output voltage of 35 kV and length of the barb of16 ram.In addition,4.0-6.0μm particles haste the best effectiveness with the variation of particle volume occupancy of-3.2.

Microsatellite DNA markers to assess population structure of red tailed barb Gonoproktopterus curmuca

本文检测了三种鲤科鱼的 1 6对微卫星引物在红尾中的适用性 ,其中 6对引物可以成功扩增 ,且 5个位点具有多态性。对采自两条不同河流的标本 ,通过检测这些多态微卫星位点的遗传变异情况 ,评估了它们在红尾种群结构分析的适合性。结果显示这 5个多态位点在上述两个样本中的平均表观杂合度分别是 0 2 93和0 4 71。

Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor

Background Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture （SRS） in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy （LPN） for a single renal mass of moderate or high complexity by assessing peri-operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass （RENAL score 〉7） in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture （Quill PDO SRS group; n=34） and absorbable vicryl （non-SRS group; n=30）, respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group. Results Mean warm ischemia time （WIT） in SRS group was less than non-SRS group （18.0 vs. 24.8 minutes, P=-0.021）. Renorrhaphy suture cost in SRS group was lower than non-SRS group （$269.6 vs. $335.8, P=0,001）. There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.

Towards a Theory of Bisimulation for the Higher-Order Process Calculi

In this paper, a labelled transition semantics for higher-order processcalculi is studied. The labelled transition semantics is relatively clean and simple, andcorresponding bisimulation equivalence can be easily formulated based on it. And the congruenceproperties of the bisimulation equivalence can be proved easily. To show the correspondence betweenthe proposed semantics and the well-established ones, the bisimulation is characterized as a versionof barbed equivalence and a version of context bisimulation.