Background: Ultrasonic energy devices are utilized for transection, incision, and hemostasis in traditional open and laparoscopic procedures. The Harmonic HD 1000i Shears, designed to deliver a precise amount of therm...Background: Ultrasonic energy devices are utilized for transection, incision, and hemostasis in traditional open and laparoscopic procedures. The Harmonic HD 1000i Shears, designed to deliver a precise amount of thermal energy during tissue transection and vessel sealing, has been utilized in many specialties. This study aimed to confirm real-world safety and performance of the Harmonic device in two thoracoscopic procedures: lobectomy and segmentectomy. Methods: The primary endpoint of this retrospective, observational, single-arm study was rate of post-operative blood transfusions related to study device or procedure. Secondary endpoints included occurrence of intra- and post-operative adverse events (AEs) or complications device- or procedure-related, and rate of required additional hemostatic measures. Adults included those who underwent thoracoscopic lobectomy or segmentectomy where HD 1000i shears were used while excluding those where additional advanced energy devices were used. The study was conducted at Severance Hospital, Yonsei University Health System, South Korea from May 1, 2018, to November 30, 2020. Results: Subjects included n = 766 lobectomies (mean age 63.79, 52% male) and n = 215 segmentectomies (mean age 63.19, 54% male). Estimated blood loss was 50 mL (0 min, 3200 max) and 20 mL (0 min, 800 max), intraoperative transfusion rate 0.001% and 0%, intraoperative complication/AE rate 1% and 2%, and post-operative complication/AE rate 9% and 4% in the lobectomy and segmentectomy groups, respectively. Median operative times were 108 min. (35 min, 395 max) for lobectomies and 105 min. (32 min, 574 max) for segmentectomies. Conclusion: Given the low rate of blood loss and intra- and post-operative complication/AE rates, HD 1000i can be used confidently for thoracoscopic pulmonary resection in adults.展开更多
Historical fecal indicator bacteria measurements （n = 125,000; 10 years） in Orange County coastal zone, an interface with urban watershed that is one of the most developed areas in the United States and source of hi...Historical fecal indicator bacteria measurements （n = 125,000; 10 years） in Orange County coastal zone, an interface with urban watershed that is one of the most developed areas in the United States and source of highly polluted runoff discharges, have been compiled and analyzed. During the period from 2000 to 2010, fecal indicator bacteria concentrations in Orange County Beaches progressively increased （poor water quality） in the first half of the decade and progressively decreased （improved water quality） during the last half of the decade. Among all physical, chemical and environmental factors, 59%-74% of the variability in the fecal indicator bacteria concentrations in the coastal zone records can be attributed to seasonal and interannual variability in local rainfall, implying that stormwater runoff from the surrounding urban watershed is a primary source of fecal pollution in Orange County Beaches. These results suggest that efforts to improve water quality in Orange County Beaches and protect beach-goers from pollution will likely have greater efficacy during wet weather periods than the rest of the year. In addition, this study identified the effect of alongshore surf zone current on fecal pollution caused by coastal waves. The data and analysis presented in this paper provide a framework for evaluating the longer period water quality trend in the coastal area, and elucidate Best-Management-Practices that can improve public health protection by managing coastal water quality compliance with standards.展开更多
文摘Background: Ultrasonic energy devices are utilized for transection, incision, and hemostasis in traditional open and laparoscopic procedures. The Harmonic HD 1000i Shears, designed to deliver a precise amount of thermal energy during tissue transection and vessel sealing, has been utilized in many specialties. This study aimed to confirm real-world safety and performance of the Harmonic device in two thoracoscopic procedures: lobectomy and segmentectomy. Methods: The primary endpoint of this retrospective, observational, single-arm study was rate of post-operative blood transfusions related to study device or procedure. Secondary endpoints included occurrence of intra- and post-operative adverse events (AEs) or complications device- or procedure-related, and rate of required additional hemostatic measures. Adults included those who underwent thoracoscopic lobectomy or segmentectomy where HD 1000i shears were used while excluding those where additional advanced energy devices were used. The study was conducted at Severance Hospital, Yonsei University Health System, South Korea from May 1, 2018, to November 30, 2020. Results: Subjects included n = 766 lobectomies (mean age 63.79, 52% male) and n = 215 segmentectomies (mean age 63.19, 54% male). Estimated blood loss was 50 mL (0 min, 3200 max) and 20 mL (0 min, 800 max), intraoperative transfusion rate 0.001% and 0%, intraoperative complication/AE rate 1% and 2%, and post-operative complication/AE rate 9% and 4% in the lobectomy and segmentectomy groups, respectively. Median operative times were 108 min. (35 min, 395 max) for lobectomies and 105 min. (32 min, 574 max) for segmentectomies. Conclusion: Given the low rate of blood loss and intra- and post-operative complication/AE rates, HD 1000i can be used confidently for thoracoscopic pulmonary resection in adults.
文摘Historical fecal indicator bacteria measurements （n = 125,000; 10 years） in Orange County coastal zone, an interface with urban watershed that is one of the most developed areas in the United States and source of highly polluted runoff discharges, have been compiled and analyzed. During the period from 2000 to 2010, fecal indicator bacteria concentrations in Orange County Beaches progressively increased （poor water quality） in the first half of the decade and progressively decreased （improved water quality） during the last half of the decade. Among all physical, chemical and environmental factors, 59%-74% of the variability in the fecal indicator bacteria concentrations in the coastal zone records can be attributed to seasonal and interannual variability in local rainfall, implying that stormwater runoff from the surrounding urban watershed is a primary source of fecal pollution in Orange County Beaches. These results suggest that efforts to improve water quality in Orange County Beaches and protect beach-goers from pollution will likely have greater efficacy during wet weather periods than the rest of the year. In addition, this study identified the effect of alongshore surf zone current on fecal pollution caused by coastal waves. The data and analysis presented in this paper provide a framework for evaluating the longer period water quality trend in the coastal area, and elucidate Best-Management-Practices that can improve public health protection by managing coastal water quality compliance with standards.
