BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of ...BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.展开更多
Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating r...Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.展开更多
Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the id...Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.展开更多
Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation o...Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.展开更多
Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit...Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.展开更多
The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,e...The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,endodontic surgery,and dental restoration.However,the improper use of this microscope continues to be common in clinical settings,primarily due to operators’insufficient understanding and proficiency in both the features and established operating procedures of this equipment.In October 2019,Professor Jingping Liang,Vice Chairman of the Society of Cariology and Endodontology,Chinese Stomatological Association,organized a consensus meeting with Chinese experts in endodontics and operative dentistry.The objective of this meeting was to establish a standard operation procedure for the dental operative microscope.Subsequently,a consensus was reached and officially issued.Over the span of about four years,the content of this consensus has been further developed and improved through practical experience.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complic...BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complications such as bleeding and perforation,and the operation time is also longer.ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning,early identification,and prevention of complications.METHODS We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021.The baseline data,clinical features,and endoscopic and pathological characteristics of patients were collected.The multivariate linear regression model was used to investigate the influencing factors of ESD operation time.Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.RESULTS The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815%of ESD operation time when other influencing factors remained unchanged.The operation time increased by 3.766%or 10.247%if the lesion was mixed or concave.The operation time increased by 4.417%if combined with an ulcer or scar.The operation time increased by 3.692%if combined with perforation.If infiltrated into the submucosa,it increased by 2.536%.Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion,lesion morphology,and ESD operation time were independent influencing factors for delayed hemorrhage after ESD.Patients with lesion≥3.0 cm(OR=3.785,95%CI:1.165-4.277),lesion morphology-concave(OR=10.985,95%CI:2.133-35.381),and ESD operation time≥60 min(OR=2.958,95%CI:1.117-3.526)were prone to delayed hemorrhage after ESD.CONCLUSION If the maximum diameter of the lesion in patients with early gastric cancer is≥3.0 cm,and the shape of the lesion is concave,or accompanied by an ulcer or scar,combined with perforation,and infiltrates into the submucosa,the ESD operation will take a longer time.When the maximum diameter of the lesion is≥3.0 cm,the shape of the lesion is concave in patients and the operation time of ESD takes longer time,the risk of delayed hemorrhage after ESD is higher.展开更多
Introduction: Perioperative hypothermia in cardiac surgery is associated with adverse outcome. The aim of this investigation was to study whether an underbody forced-air warming blanket during coronary artery bypass g...Introduction: Perioperative hypothermia in cardiac surgery is associated with adverse outcome. The aim of this investigation was to study whether an underbody forced-air warming blanket during coronary artery bypass graft surgery with normothermic cardiopulmonary bypass can prevent postoperative hypothermia. Methods: After Medical Ethics Committee approval, 60 low-risk cardiac surgery patients at random were assigned into a group that received standard thermal care management (control group n = 30) and a group that received the underbody forced-air warming system plus the standard thermal care (intervention group n = 30). Results: The temperature after-drop from the end of cardiopulmonary bypass to arrival in the ICU was less in the intervention group versus control group (0.4°C ± 0.3°C vs 0.6°C ± 0.4°C;P = 0.027). Out of the intervention group, 27 patients arrived in the ICU with a bladder temperature ? 36°C (90%) as compared to 14 patients (46.7%) from the control group (P < 0.001). The peripheral temperature was significantly higher in the intervention group as compared to the control group (P < 0.001). Conclusions: A full underbody forced-air warming blanket prevents postoperative hypothermia in normothermic coronary artery bypass graft surgery patients.展开更多
New fractional operators, the COVID-19 model has been studied in this paper. By using different numericaltechniques and the time fractional parameters, the mechanical characteristics of the fractional order model arei...New fractional operators, the COVID-19 model has been studied in this paper. By using different numericaltechniques and the time fractional parameters, the mechanical characteristics of the fractional order model areidentified. The uniqueness and existence have been established. Themodel’sUlam-Hyers stability analysis has beenfound. In order to justify the theoretical results, numerical simulations are carried out for the presented methodin the range of fractional order to show the implications of fractional and fractal orders.We applied very effectivenumerical techniques to obtain the solutions of themodel and simulations. Also, we present conditions of existencefor a solution to the proposed epidemicmodel and to calculate the reproduction number in certain state conditionsof the analyzed dynamic system. COVID-19 fractional order model for the case of Wuhan, China, is offered foranalysis with simulations in order to determine the possible efficacy of Coronavirus disease transmission in theCommunity. For this reason, we employed the COVID-19 fractal fractional derivative model in the example ofWuhan, China, with the given beginning conditions. In conclusion, again the mathematical models with fractionaloperators can facilitate the improvement of decision-making for measures to be taken in the management of anepidemic situation.展开更多
Objective: To evaluate the effect of operating room nursing on the outcome of patients undergoing robot-assisted tumor surgery. Methods: This research starts from October 2021 to October 2022. The number of patients w...Objective: To evaluate the effect of operating room nursing on the outcome of patients undergoing robot-assisted tumor surgery. Methods: This research starts from October 2021 to October 2022. The number of patients with robot-assisted tumor surgery included in our hospital is 769. The patients are treated in the operating room, and the prognosis of the patients is summarized. Results: The intraoperative blood loss in patients undergoing robot-assisted tumor surgery was (57.51 ± 12.01) ml;the operation time was (3.57 ± 0.66) h;and the hospital stay was (6.04 ± 0.53) d. There were 21 cases of complications after robot-assisted tumor surgery, accounting for 2.73%. After surgery, all robot-assisted tumor surgery patients recovered and were discharged smoothly after being checked by doctors. Conclusion: Robot-assisted tumor surgery nursing has a definite effect on patients’ rehabilitation in the operating room.展开更多
Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure op...Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.展开更多
Objective The aim of this study was to conduct a security assessment of intraoperative intraperitoneal chemotherapy using lobaplatin for advanced colorectal cancer.Methods From February 2015 to February 2016,143 patie...Objective The aim of this study was to conduct a security assessment of intraoperative intraperitoneal chemotherapy using lobaplatin for advanced colorectal cancer.Methods From February 2015 to February 2016,143 patients with colorectal cancer who underwent surgery in our department were selected prospectively.All patients were randomly screened and enrolled into the intraperitoneal chemotherapy(IPC)(74 cases)and control(69 cases)groups,depending on the distribution of cases in the random table.In the trial group,patients were administered 40 mg lobaplatin by intraperitoneal implantation intraoperatively,together with intravenous chemotherapy post-operatively using a typical FOLFOX strategy with oxaliplatin,fluorouracil,and leucovorin.In the control group,only FOLFOX was administered.Bowel function recovery time,adverse reactions and complications,and preand post-chemotherapy laboratory examinations were compared.In addition,a 5-year-long follow-up was performed.Results Recovery times of bowel function were 73.5±9.7 h and 74.8±10.3 h respectively,and the difference was not significant(P>0.05).Wound fat liquefaction was observed in five cases in both groups(6.8%vs.7.2%,P>0.05).The outcomes of nausea and vomiting(57 cases,77.0%vs.50 cases,72.5%),constipation(43 cases,58.1%vs.36 cases,52.2%),and diarrhea(5 cases,6.8%vs.5 cases,7.2%)were not statistically significant(all P>0.05).Indices of white blood cell count,blood platelet count,and hepatorenal function were not significantly different(all P>0.05)neither post-operatively nor post-chemotherapy.The 5-year survival rate was not significantly different between the groups(58.1%vs.56.5%,P>0.05).Conclusion Intraoperative chemotherapy with lobaplatin for advanced colorectal cancer is safe and tolerable.展开更多
Because of the features involved with their varied kernels,differential operators relying on convolution formulations have been acknowledged as effective mathematical resources for modeling real-world issues.In this p...Because of the features involved with their varied kernels,differential operators relying on convolution formulations have been acknowledged as effective mathematical resources for modeling real-world issues.In this paper,we constructed a stochastic fractional framework of measles spreading mechanisms with dual medication immunization considering the exponential decay and Mittag-Leffler kernels.In this approach,the overall population was separated into five cohorts.Furthermore,the descriptive behavior of the system was investigated,including prerequisites for the positivity of solutions,invariant domain of the solution,presence and stability of equilibrium points,and sensitivity analysis.We included a stochastic element in every cohort and employed linear growth and Lipschitz criteria to show the existence and uniqueness of solutions.Several numerical simulations for various fractional orders and randomization intensities are illustrated.展开更多
AIM:To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope,which lacks information on the movement and position of the surgeon’s hands,and to fac...AIM:To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope,which lacks information on the movement and position of the surgeon’s hands,and to facilitate the reproduction of a skilled surgeon’s technique by a surgeon in training.METHODS:A small camera was attached to the operating microscope with a custom adapter.Microscopic surgeon’s view and direct surgeon’s view through this new camera were recorded in the surgical recording system.Both movies were synchronized and analyzed how do surgeons handle the instruments.RESULTS:A small camera attached to the operating microscope allowed the surgeon’s hands motion to be recorded without interfering with the surgeon’s movements.Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device.Even in the simple paracentesis procedure,different surgeons used different methods.Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view.CONCLUSION:Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.展开更多
BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center gu...BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.展开更多
Purpose–To address the problem that the current train operation mode that train selects one of several offline pre-generated control schemes before the departure and operates following the scheme after the departure,...Purpose–To address the problem that the current train operation mode that train selects one of several offline pre-generated control schemes before the departure and operates following the scheme after the departure,energy-saving performance of the whole metro system cannot be guaranteed.Design/methodology/approach–A cooperative train control framework is formulated to regulate a novel train operation mode.The classic train four-phase control strategy is improved for generating specific energy-efficient control schemes for each train.An improved brute force(BF)algorithm with a two-layer searching idea is designed to solve the optimisation model of energy-efficient train control schemes.Findings–Case studies on the actual metro line in Guangzhou,China verify the effectiveness of the proposed train control methods compared with four-phase control strategy under different kinds of train operation scenarios and calculation parameters.The verification on the computation efficiency as well as accuracy of the proposed algorithm indicates that it meets the requirement of online optimisation.Originality/value–Most existing studies optimised energy-efficient train timetable or train control strategies through an offline process,which has a defect in coping with the disturbance or delays effectively and promptly during real-time train operation.This paper studies an online optimisation of cooperative train control based on the rolling optimisation idea,where energy-efficient train operation can be realised once train running time is determined,thus mitigating the impact of unpredictable operation situations on the energy-saving performance of trains.展开更多
Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical s...Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.展开更多
Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and stra...Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.展开更多
Consider a pseudo-differential operator T_(a)f(x)=∫_(R^(n))e^(ix,ζ)a(x,ζ)f(ζ)dζwhere the symbol a is in the rough Hormander class L^(∞)S_(ρ)^(m)with m∈R andρ∈[0,1].In this note,when 1≤p≤2,if n(ρ-1)/p and ...Consider a pseudo-differential operator T_(a)f(x)=∫_(R^(n))e^(ix,ζ)a(x,ζ)f(ζ)dζwhere the symbol a is in the rough Hormander class L^(∞)S_(ρ)^(m)with m∈R andρ∈[0,1].In this note,when 1≤p≤2,if n(ρ-1)/p and a∈L^(∞)S_(ρ)^(m),then for any f∈S(R^(n))and x∈R^(n),we prove that M(T_(a)f)(x)≤C(M(|f|^(p))(x))^(1/p) where M is the Hardy-Littlewood maximal operator.Our theorem improves the known results and the bound on m is sharp,in the sense that n(ρ-1)/p can not be replaced by a larger constant.展开更多
The main objective of this study is to determine the hydrogeochemical specificities of the groundwater of the Angovia mine operating permit, located in the Yaouré mountains in the center-west of Côte d’Ivoi...The main objective of this study is to determine the hydrogeochemical specificities of the groundwater of the Angovia mine operating permit, located in the Yaouré mountains in the center-west of Côte d’Ivoire. To do so, descriptive and multivariate statistical analysis methods with the SOM (Self Organizing Maps) algorithm were applied to the physicochemical parameters of 17 boreholes using the calcite (ISC) and dolomite (ISD) saturation indices. The results obtained have shown that the groundwater in the Angovia mine operating permit area has an average temperature of 27.52°C (long rainy season) and 27.87°C (long dry season) and has an average pH of 7.09 ± 0.35 during the main rainy season and 7.32 ± 0.35 during the main dry season. They are mineralized with an average electrical conductivity of 505.98 ± 302.85 μS/cm during the long rainy season and with 450.33 ± 233.74 μS/cm as average during the long dry season. The main phenomena at the origin of groundwater mineralization are water residence time, oxidation-reduction and surface inflow. The study of the relative age of the water shows that the groundwater in the Angovia mine operating permit area is mainly undersaturated with respect to calcite and dolomite. They are therefore very old in the aquifer with a slow circulation speed during the long rainy season and the long dry season.展开更多
文摘BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.
基金Hebei University Affiliated Hospital Youth Fund Scientific Research Project Project Number:2019Q017。
文摘Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.
文摘Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.
文摘Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.
文摘Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.
文摘The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,endodontic surgery,and dental restoration.However,the improper use of this microscope continues to be common in clinical settings,primarily due to operators’insufficient understanding and proficiency in both the features and established operating procedures of this equipment.In October 2019,Professor Jingping Liang,Vice Chairman of the Society of Cariology and Endodontology,Chinese Stomatological Association,organized a consensus meeting with Chinese experts in endodontics and operative dentistry.The objective of this meeting was to establish a standard operation procedure for the dental operative microscope.Subsequently,a consensus was reached and officially issued.Over the span of about four years,the content of this consensus has been further developed and improved through practical experience.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complications such as bleeding and perforation,and the operation time is also longer.ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning,early identification,and prevention of complications.METHODS We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021.The baseline data,clinical features,and endoscopic and pathological characteristics of patients were collected.The multivariate linear regression model was used to investigate the influencing factors of ESD operation time.Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.RESULTS The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815%of ESD operation time when other influencing factors remained unchanged.The operation time increased by 3.766%or 10.247%if the lesion was mixed or concave.The operation time increased by 4.417%if combined with an ulcer or scar.The operation time increased by 3.692%if combined with perforation.If infiltrated into the submucosa,it increased by 2.536%.Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion,lesion morphology,and ESD operation time were independent influencing factors for delayed hemorrhage after ESD.Patients with lesion≥3.0 cm(OR=3.785,95%CI:1.165-4.277),lesion morphology-concave(OR=10.985,95%CI:2.133-35.381),and ESD operation time≥60 min(OR=2.958,95%CI:1.117-3.526)were prone to delayed hemorrhage after ESD.CONCLUSION If the maximum diameter of the lesion in patients with early gastric cancer is≥3.0 cm,and the shape of the lesion is concave,or accompanied by an ulcer or scar,combined with perforation,and infiltrates into the submucosa,the ESD operation will take a longer time.When the maximum diameter of the lesion is≥3.0 cm,the shape of the lesion is concave in patients and the operation time of ESD takes longer time,the risk of delayed hemorrhage after ESD is higher.
文摘Introduction: Perioperative hypothermia in cardiac surgery is associated with adverse outcome. The aim of this investigation was to study whether an underbody forced-air warming blanket during coronary artery bypass graft surgery with normothermic cardiopulmonary bypass can prevent postoperative hypothermia. Methods: After Medical Ethics Committee approval, 60 low-risk cardiac surgery patients at random were assigned into a group that received standard thermal care management (control group n = 30) and a group that received the underbody forced-air warming system plus the standard thermal care (intervention group n = 30). Results: The temperature after-drop from the end of cardiopulmonary bypass to arrival in the ICU was less in the intervention group versus control group (0.4°C ± 0.3°C vs 0.6°C ± 0.4°C;P = 0.027). Out of the intervention group, 27 patients arrived in the ICU with a bladder temperature ? 36°C (90%) as compared to 14 patients (46.7%) from the control group (P < 0.001). The peripheral temperature was significantly higher in the intervention group as compared to the control group (P < 0.001). Conclusions: A full underbody forced-air warming blanket prevents postoperative hypothermia in normothermic coronary artery bypass graft surgery patients.
基金Lucian Blaga University of Sibiu&Hasso Plattner Foundation Research Grants LBUS-IRG-2020-06.
文摘New fractional operators, the COVID-19 model has been studied in this paper. By using different numericaltechniques and the time fractional parameters, the mechanical characteristics of the fractional order model areidentified. The uniqueness and existence have been established. Themodel’sUlam-Hyers stability analysis has beenfound. In order to justify the theoretical results, numerical simulations are carried out for the presented methodin the range of fractional order to show the implications of fractional and fractal orders.We applied very effectivenumerical techniques to obtain the solutions of themodel and simulations. Also, we present conditions of existencefor a solution to the proposed epidemicmodel and to calculate the reproduction number in certain state conditionsof the analyzed dynamic system. COVID-19 fractional order model for the case of Wuhan, China, is offered foranalysis with simulations in order to determine the possible efficacy of Coronavirus disease transmission in theCommunity. For this reason, we employed the COVID-19 fractal fractional derivative model in the example ofWuhan, China, with the given beginning conditions. In conclusion, again the mathematical models with fractionaloperators can facilitate the improvement of decision-making for measures to be taken in the management of anepidemic situation.
文摘Objective: To evaluate the effect of operating room nursing on the outcome of patients undergoing robot-assisted tumor surgery. Methods: This research starts from October 2021 to October 2022. The number of patients with robot-assisted tumor surgery included in our hospital is 769. The patients are treated in the operating room, and the prognosis of the patients is summarized. Results: The intraoperative blood loss in patients undergoing robot-assisted tumor surgery was (57.51 ± 12.01) ml;the operation time was (3.57 ± 0.66) h;and the hospital stay was (6.04 ± 0.53) d. There were 21 cases of complications after robot-assisted tumor surgery, accounting for 2.73%. After surgery, all robot-assisted tumor surgery patients recovered and were discharged smoothly after being checked by doctors. Conclusion: Robot-assisted tumor surgery nursing has a definite effect on patients’ rehabilitation in the operating room.
文摘Introduction: Death is a major accident which constitutes an element whose evaluation and analysis are necessary in a surgical service. Such a study is especially important in our country where the health structure operates with limited resources and more than half of the population lives below the poverty line. The objective of this study was to determine the frequency of post-operative mortality, to describe the main comorbidity factors responsible for this mortality and to identify the main cause of post-operative death in the urology department of the Ignace Deen National Hospital Material and Method: This was a retrospective descriptive study lasting 5 years from January 1, 2015 to December 31, 2019. It had focussed on all the files of patients operated on at the Urology Department of the Ignace Deen National Hospital, either in an emergency or planned and who died in per or post-operative immediately or 30 days later. Results: We recorded 63 cases of post-operative death, or a frequency of 1.84%. The average age was 61.92 ± 16.91 with the extremes of 12 and 91 years. Bladder (20.63%) and prostate tumours (60.3%) were the main admission diagnoses. High blood pressure was the main comorbidity factor found with 38.09% of cases followed by diabetes with 12.69%. Transurethral resection of the prostate, transurethral resection of the bladder and prostate adenocomectomy were the most performed surgical procedure with respective proportion of 19.04%, 20.63% and 38.09%. Probable cause of death were anemia in 25 cases (39.68%), septic in 20 cases (31.75%), heart failure in 6 cases (9.52%), pulmonary embolism in 5 cases (7.94%), obstructive renal failure 4 cases (6.35%) and stroke in 3 cases (4.76%). Conclusion: The majority of deaths occurred in patients over the age of fifty. Anaemia was the main cause of deaths. Difficulties in procuring blood products as well as the lack of modern therapeutic means are factors that make it difficult for patients to adequately manage.
文摘Objective The aim of this study was to conduct a security assessment of intraoperative intraperitoneal chemotherapy using lobaplatin for advanced colorectal cancer.Methods From February 2015 to February 2016,143 patients with colorectal cancer who underwent surgery in our department were selected prospectively.All patients were randomly screened and enrolled into the intraperitoneal chemotherapy(IPC)(74 cases)and control(69 cases)groups,depending on the distribution of cases in the random table.In the trial group,patients were administered 40 mg lobaplatin by intraperitoneal implantation intraoperatively,together with intravenous chemotherapy post-operatively using a typical FOLFOX strategy with oxaliplatin,fluorouracil,and leucovorin.In the control group,only FOLFOX was administered.Bowel function recovery time,adverse reactions and complications,and preand post-chemotherapy laboratory examinations were compared.In addition,a 5-year-long follow-up was performed.Results Recovery times of bowel function were 73.5±9.7 h and 74.8±10.3 h respectively,and the difference was not significant(P>0.05).Wound fat liquefaction was observed in five cases in both groups(6.8%vs.7.2%,P>0.05).The outcomes of nausea and vomiting(57 cases,77.0%vs.50 cases,72.5%),constipation(43 cases,58.1%vs.36 cases,52.2%),and diarrhea(5 cases,6.8%vs.5 cases,7.2%)were not statistically significant(all P>0.05).Indices of white blood cell count,blood platelet count,and hepatorenal function were not significantly different(all P>0.05)neither post-operatively nor post-chemotherapy.The 5-year survival rate was not significantly different between the groups(58.1%vs.56.5%,P>0.05).Conclusion Intraoperative chemotherapy with lobaplatin for advanced colorectal cancer is safe and tolerable.
文摘Because of the features involved with their varied kernels,differential operators relying on convolution formulations have been acknowledged as effective mathematical resources for modeling real-world issues.In this paper,we constructed a stochastic fractional framework of measles spreading mechanisms with dual medication immunization considering the exponential decay and Mittag-Leffler kernels.In this approach,the overall population was separated into five cohorts.Furthermore,the descriptive behavior of the system was investigated,including prerequisites for the positivity of solutions,invariant domain of the solution,presence and stability of equilibrium points,and sensitivity analysis.We included a stochastic element in every cohort and employed linear growth and Lipschitz criteria to show the existence and uniqueness of solutions.Several numerical simulations for various fractional orders and randomization intensities are illustrated.
文摘AIM:To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope,which lacks information on the movement and position of the surgeon’s hands,and to facilitate the reproduction of a skilled surgeon’s technique by a surgeon in training.METHODS:A small camera was attached to the operating microscope with a custom adapter.Microscopic surgeon’s view and direct surgeon’s view through this new camera were recorded in the surgical recording system.Both movies were synchronized and analyzed how do surgeons handle the instruments.RESULTS:A small camera attached to the operating microscope allowed the surgeon’s hands motion to be recorded without interfering with the surgeon’s movements.Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device.Even in the simple paracentesis procedure,different surgeons used different methods.Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view.CONCLUSION:Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.
文摘BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.
基金This research was supported by the National Natural Science Foundation of China(Grant No.71971016).On behalf of all co-authors,the corresponding author states that there is no conflict of interest.
文摘Purpose–To address the problem that the current train operation mode that train selects one of several offline pre-generated control schemes before the departure and operates following the scheme after the departure,energy-saving performance of the whole metro system cannot be guaranteed.Design/methodology/approach–A cooperative train control framework is formulated to regulate a novel train operation mode.The classic train four-phase control strategy is improved for generating specific energy-efficient control schemes for each train.An improved brute force(BF)algorithm with a two-layer searching idea is designed to solve the optimisation model of energy-efficient train control schemes.Findings–Case studies on the actual metro line in Guangzhou,China verify the effectiveness of the proposed train control methods compared with four-phase control strategy under different kinds of train operation scenarios and calculation parameters.The verification on the computation efficiency as well as accuracy of the proposed algorithm indicates that it meets the requirement of online optimisation.Originality/value–Most existing studies optimised energy-efficient train timetable or train control strategies through an offline process,which has a defect in coping with the disturbance or delays effectively and promptly during real-time train operation.This paper studies an online optimisation of cooperative train control based on the rolling optimisation idea,where energy-efficient train operation can be realised once train running time is determined,thus mitigating the impact of unpredictable operation situations on the energy-saving performance of trains.
文摘Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.
基金funded by King Saud University,Riyadh,Saudi Arabia.
文摘Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.
基金Supported by the National Natural Science Foundation of China(11871436,12071437)。
文摘Consider a pseudo-differential operator T_(a)f(x)=∫_(R^(n))e^(ix,ζ)a(x,ζ)f(ζ)dζwhere the symbol a is in the rough Hormander class L^(∞)S_(ρ)^(m)with m∈R andρ∈[0,1].In this note,when 1≤p≤2,if n(ρ-1)/p and a∈L^(∞)S_(ρ)^(m),then for any f∈S(R^(n))and x∈R^(n),we prove that M(T_(a)f)(x)≤C(M(|f|^(p))(x))^(1/p) where M is the Hardy-Littlewood maximal operator.Our theorem improves the known results and the bound on m is sharp,in the sense that n(ρ-1)/p can not be replaced by a larger constant.
文摘The main objective of this study is to determine the hydrogeochemical specificities of the groundwater of the Angovia mine operating permit, located in the Yaouré mountains in the center-west of Côte d’Ivoire. To do so, descriptive and multivariate statistical analysis methods with the SOM (Self Organizing Maps) algorithm were applied to the physicochemical parameters of 17 boreholes using the calcite (ISC) and dolomite (ISD) saturation indices. The results obtained have shown that the groundwater in the Angovia mine operating permit area has an average temperature of 27.52°C (long rainy season) and 27.87°C (long dry season) and has an average pH of 7.09 ± 0.35 during the main rainy season and 7.32 ± 0.35 during the main dry season. They are mineralized with an average electrical conductivity of 505.98 ± 302.85 μS/cm during the long rainy season and with 450.33 ± 233.74 μS/cm as average during the long dry season. The main phenomena at the origin of groundwater mineralization are water residence time, oxidation-reduction and surface inflow. The study of the relative age of the water shows that the groundwater in the Angovia mine operating permit area is mainly undersaturated with respect to calcite and dolomite. They are therefore very old in the aquifer with a slow circulation speed during the long rainy season and the long dry season.