Case Report: Observation of Postoperative Refractive Status of Glaucoma Combined with Cataract and Irregular Astigmatism

Significance: So far, many scholars have studied the astigmatism caused by glaucoma surgery, but they cannot provide enough useful help for the clinic. When a patient has glaucoma, cataracts and irregular astigmatism at the same time, it is often difficult to achieve satisfactory results. Purpose: This study intends to describe a case of a patient with glaucoma, irregular astigmatism, and cataract who was successfully treated. Additionally, it can serve as a useful source of inspiration for the future care of patients like this. Case Presentation: A 24-year-old male with keratoconus in the past. He had undergone a corneal crosslinking operation in the right eye and a penetrating keratoplasty in the left eye due to his long history of keratoconus in both eyes. Right now, the keratoconus in that eye is stable. Unfortunately, he has now been diagnosed with open-angle glaucoma and complicated cataracts in both eyes, and he was admitted to our hospital for surgery. The right eye had significant irregular astigmatism, which was discovered during the preoperative assessment, and the implantation of a Toric intraocular lens was unable to produce good results. Finally, we chose to perform EXPRESS glaucoma drainage device implantation + phacoemulsification + intraocular lense (ZEISS CT ASPHINA 409MP) implantation. The patient had stable postoperative astigmatism with rule thanks to the traction effect of the scleral flap suture. Astigmatism was typically stable six months after surgery, and the corrected visual acuity with glasses had improved to 20/25. Conclusion: This patient suffers from cataracts, keratoconus, glaucoma, and irregular astigmatism. Due to the interconnectedness of these four disorders, simultaneous success is challenging. We realized that surgically induced astigmatism, frequently affects vision early after filtering surgery for glaucoma patients. In the instance of this patient, we tightly sutured the scleral flap and using tractive action, established regular astigmatism. After the patient’s astigmatism stabilized, optometry was given to correct the vision. This technique should result in much better visual acuity. Finally, it came to pass.

Influence of preoperative astigmatism on corneal biomechanics and accurate intraocular pressure measurement after micro-incision phacoemulsification

AIM: To define the corneal hysteresis(CH), corneal resistance factor(CRF), Goldmann-correlated intraocular pressure(IOPg) and corneal compensated intraocular pressure(IOPcc) prior to and following coaxial micro-incision phacoemulsification in patients with corneal astigmatism. METHODS: Of 97 patients with cataracts were enrolled in the study. Group 1 included patients with corneal astigmatism(K1-K2) values of K1-K2<+1.0 D, and group 2 with values of K1-K2 ≥+1.0 D and ≤+2.25 D. Coaxial micro-incision phacoemulsification of a corneal incision of 2.0 mm with intraocular lens(IOL) implantation was performed. CH, CRF, IOPg, IOPcc, waveform score(WS) were measured preoperatively and one week, one month postoperatively using an Ocular Response Analyzer. Axial length(AXL) was calculated by Tomey Optical Biometer OA 2000.RESULTS: Group 1 consisted of 51 patients with mean corneal astigmatism value of +0.49±0.25 D. Group 2 included 46 patients with astigmatism of +1.43±0.43 D. In group 1, CRF(t=2.68, P<0.05), CH(t=2.64, P<0.05) and WS(t=3.51, P<0.05) were significantly lower one week postoperatively, when compared to the preoperative values. CRF significantly decreased(t=3.61, P<0.05) when measured one month following the surgery. In group 2 CH(t=5.92, P<0.05), and WS(t=3.96, P<0.05) were significantly lowered one week after cataract surgery. Moreover, we observed a significant decrease in IOPg(t=2.24, P<0.05), CRF(t=5.05, P<0.05) and CH(t=2.31, P<0.05) one month after phacoemulsification. There was no statistically significant(t=-0.83, P=0.41) difference in AXL between study groups.CONCLUSION: CRF, CH and IOPg are reduced in patients with preoperative corneal astigmatism equal or higher than +1.0 D and lower than +2.25 D. Hence, bias of IOPg measurement in these patients may cause underestimation of the real IOP both before and after cataract surgery. The measurement of IOPcc allows the precise assessment of IOP pre-and postoperatively, independently on corneal astigmatism, CH and CRF values.

Incision Site in Manual Small Incision Cataract Surgery in Case of Preoperative Direct Astigmatism

We compared surgically induced astigmatism (SIA) by a superior incision with a temporal incision in manual small incision cataract surgery (MSICS), in patients with bilateral direct (regular) preoperative corneal astigmatisms. Patients and method: We carried out a prospective study from July 1st 2018 to September 30th 2019 in the department of ophthalmology at the University Hospital of Brazzaville. Keratometric readings were recorded before surgery to assess preoperative corneal astigmatisms. Keratometric evaluation was done 45 days post-operatively. Patients were followed 90 days after surgery in order to assess the healing of the surgical site. The surgically induced astigmatism (SIA) is the difference in the magnitude vectors between the preoperative and postoperative astigmatism. The result was positive if the postoperative astigmatism was greater than the preoperative astigmatism and negative if the postoperative astigmatism was less than the preoperative astigmatism. Results: Our study sample included 48 eyes from 24 patients, including 24 operated on temporal incision and 24 in superior incision. The average SIA for superior incisions was 0.33 ± 1.55 diopters (D), versus 0.33 ± 1.44 for temporal incisions. For superior incisions the SIA was 0.81 for astigmatisms lower than 2D, against 0.16D for the temporal incisions. On the other hand, for preoperative astigmatisms greater than 2D, the surgically induced astigmatism was &plusmn;0.62D, marking a decrease in preoperative astigmatism for the superior incisions against an increase of 0.5D for the temporal incisions. The healing was delayed for the temporal incisions responsible for discomfort persisting beyond 45 days. Conclusion: The temporal incision had better results than the superior incision for astigmatisms lower than 2D, and less good for astigmatisms higher than 2D. The temporal incision healed less well.

Effect of low-degree astigmatism on the objective visual quality

AIM:To evaluate the effect of low-degree astigmatism on objective visual quality through the Optical Quality Analysis System(OQAS).METHODS:This study enrolled 46 participants(aged 23 to 30y,90 eyes)with normal or corrected-to-normal vision.The cylindrical lenses(0,0.5,0.75,1.0,and 1.25 D)were placed at the axial direction(180°,45°,90°,and 135°)in front of the eyes with the best correction to form 16 types of regular low-degree astigmatism.OQAS was used to detect the objective visual quality,recorded as the objective scattering index(OSI),OQAS values at contrasts of 100%,20%,and 9%predictive visual acuity(OV100%,OV20%,and OV9%),modulation transfer function cut-off(MTFcut-off)and Strehl ratio(SR).The mixed effect linear model was used to compare objective visual quality differences between groups and examine associations between astigmatic magnitude and objective visual quality parameters.RESULTS:Apparent negative relationships between the magnitude of low astigmatism and objective visual quality were observed.The increase of OSI per degree of astigmatism at 180°,45°,90°,and 135°axis were 0.38(95%CI:0.35,0.42),0.50(95%CI:0.46,0.53),0.49(95%CI:0.45,0.54)and 0.37(95%CI:0.34,0.41),respectively.The decrease of MTFcut-off per degree of astigmatism at 180°,45°,90°,and 135°axis were-10.30(95%CI:-11.43,-9.16),-12.73(95%CI:-13.62,-11.86),-12.75(95%CI:-13.79,-11.70),and-9.97(95%CI:-10.92,-9.03),respectively.At the same astigmatism degree,OSI at 45°and 90°axis were higher than that at 0°and 135°axis,while MTFcut-off were lower.CONCLUSION:Low astigmatism of only 0.50 D can significantly reduce the objective visual quality.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review

Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.

Correlation of Hamstring Tendon Size in Pre-Operative MRI Measurement with Intra-Operative Graft Size in Primary Anterior Cruciate Ligament (ACL) Reconstruction

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.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

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.

Symmetrical femtosecond laser arc incision in correcting corneal astigmatism in cataract patients

AIM:To evaluate the effect of symmetrical arc incision correcting corneal astigmatism in femtosecond laserassisted phacoemulsification(FLACS).METHODS:This study enrolled patients with cataract combined with regular corneal astigmatism of>0.75 D,who underwent FLACS.Symmetrical arc incision was set at 8 mm diameter and 85%depth.The follow-up time was 3-24mo(4.92±3.49mo).Pentacam recorded the corneal astigmatism and higher-order aberration at pre-operation and post-operation.The changes in corneal astigmatism were analyzed by Alpins method.The correlation of astigmatism type,age,corneal horizontal diameter,corneal thickness,arc incision length,and correction index(CI)was analyzed,and the residual corneal astigmatism was compared with the residual whole eye astigmatism.RESULTS:Totally 79 patients(102 eyes)were enrolled,10 patients had corneal epithelial injury,1 patient occurred corneal epithelial hyperplasia.The corneal astigmatism was 1.23±0.38 D pre-operation,and decreased to 0.76±0.39 D post-operation(t=10.146,P=0.000).Corneal high-order aberration was 0.17±0.08μm pre-operation and 0.24±0.11μm post-operation(t=-5.186,P=0.000).The residual corneal astigmatism and residual whole eye astigmatism were no significant difference(t=-0.347,P=0.729).Using Alpin’s method,the following were determined:target-induced astigmatism(TIA)=1.23±0.38 D,surgeryinduced astigmatism(SIA)=0.77±0.45 D,difference vector(DV)=0.77±0.39 D,and CI=0.54±0.28.Age,astigmatism size,corneal horizontal diameter,corneal thickness,and arc incision length were not correlated with CI.The CI for against the rule astigmatism(ATR)was better than that for with the rule astigmatism(WTR;P=0.001).CONCLUSION:Femtosecond laser-assisted astigmatic keratotomy has better CI of ATR,but increase higher-order corneal aberration.CI is not ideal,it’s not a perfect choice if we pursue ideal correction effect.

Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry

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.

Effectiveness of toric soft contact lenses for vision correction in patients with different degrees of astigmatism: a real-world study

AIM:To assess the visual correction of patients with different degrees of astigmatism with toric soft contact lenses(TSC).METHODS:It was a real-world study with prospective and single-arm design.A total of 384 patients with astigmatism who came for TSC fitting and alignment from November 2022 to January 2023 were included.According to the difference in astigmatism,patients were divided into groups A(cylinder degree:-0.75 to-0.50 D),B(cylinder degree:-1.75 to-1.00 D)and C(cylinder degree≤-2.00 D),and followed up on the day of wear,1wk,1 and 3mo,mainly to observe visual acuity,refraction,lens fit,visual quality and comfort at 1wk after wear.The visual acuity success rate and the overall success rate of the fitting were evaluation indicators(taking into account the four dimensions of visual acuity,fitting,quality of vision and comfort).The visual acuity success rate was calculated by taking“corrected visual acuity with contact lenses is no less than 1 line or better than best spectacle-corrected visual acuity”(i.e.corrected visual acuity with contact lenses is 1 line below,equal to,one line above or more than best spectaclecorrected visual acuity)as the criterion for visual success,and the the overall success rate of the fitting was calculated by using the comprehensive indicators(visual acuity,fit,visual quality,comfort)to meet certain conditions as the judgment criteria for successful fitting.RESULTS:After 1wk of wearing TSC,the visual acuity success rates of patients were 100%(207/207),98.58%(139/141)and 97.22%(35/36)in the three groups,respectively,with residual cylinder closed to 0.The acceptability of the lens fitting was over 95%;the incidence of adverse visual symptoms was within 10%and the comfort acceptability was over 97%.The overall success rate of fitting for patients with high,medium and low astigmatism was 93.72%(194/207),90.78%(128/141)and 88.89%(32/36),respectively.CONCLUSION:TSC(model:G&G POP·CT)are effective in correcting astigmatism in patients with different degrees of astigmatism.

Exploring ideal operative time for best outcomes in gastric cancer surgery:A multi-institutional study based on KLASS-07 database

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.

Investigating the impact of preoperative corneal astigmatism orientation on the postoperative spherical equivalent refraction following intraocular lens implantation

Background:To investigate the impact of the orientation of preoperative corneal astigmatism on achieving the postoperative target refraction following monofocal intraocular lens(IOL)implantation.Methods:This study enrolled 339 eyes who had uneventful cataract surgery or refractive lens exchange(RLE)with subsequent monofocal IOL implantation.Eyes were initially categorized dependent upon axial length and then on the orientation of preoperative anterior corneal astigmatism.Group 1 had against-the-rule(ATR)anterior corneal astigmatism,group 2 had with-the-rule(WTR)anterior corneal astigmatism,and group 3 had oblique(OB)anterior corneal astigmatism.The preoperative corneal astigmatism was determined by the IOLMaster(Carl Zeiss Meditec AG).Postoperative refraction was completed for all eyes,and the results were calculated and compared for the separate groups.Results:In eyes with axial lengths greater than 22.0 mm and less than 25.0 mm there was a significant difference between the magnitude of preoperative corneal astigmatism between groups 2 and 3 with 0.827±0.376 D in group 2,and 0.677±0.387 D in group 3.The mean postoperative spherical equivalent(SE)prediction error was−0.132±0.475 D in group 1,0.026±0.497 D in group 2,and−0.130±0.477 D in group 3.There was a significant difference between groups 1 and 2.There was no significant difference in the magnitude of preoperative corneal astigmatism and postoperative SE prediction error between the anterior corneal astigmatism orientation groups in eyes with axial lengths of less than or equal to 22.0 mm and greater than or equal to 25.0 mm.Conclusions:The orientation of preoperative anterior corneal astigmatism significantly affected the postoperative biometry prediction error in eyes with astigmatism of 1.75 D or less in eyes with the axial length between 22.0 mm and 25.0 mm.However,the results were not clinically significant.

Post-Operative Mortality Analysis in the Urology Department of Conakry University Hospital

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.

Preliminary security investigation and short-time follow-up of intraoperative intraperitoneal chemotherapy with lobaplatin for advanced colorectal cancer

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.

Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

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.

Research on the cooperative train control method in the metro system for energy saving

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.

Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer

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.

Operative timing and indications for patients with severe acute pancreatitis: report of 172 cases

Objective: To investigate the operative timing and indi-cations for severe acute pancreatitis(SAP).Methods: Data collected from 172 patients with SAPtreated in our hospital since 1980 were analyzed retro-spectively.Results: In the 94 patients who had undergone early op-eration before June 1992, 57 (62.8%) healed, 35 (37.2%)died, and 16 (17.0%) had no postoperative compli-cations. In the 78 patients who had been treated after July1992 according to the principle of individualization, 66(84.6%) healed, 12 (15.4%) died, and 37 (47.4%)had no postoperative complications. In the 78 patients32 received non-operative treatment but 30 (93.8%)cured, 12 early operation but 7(58.3%)cured, 18 lateoperation but 13 (72.2%) cured, and 16 selected timeoperation but all cured.Conclusions: It is concluded that individualized thera-py is effective and reasonable for treating SAP. Theindications for early, late and selected time operationshould be emphasized.

Postoperative Analgesia for Abdominal Laparoscopic Surgery: Tap Block vs Peri-Orificial Infiltrations

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.

Operative link on gastritis assessment stage is an appropriate predictor of early gastric cancer

AIM: To assess the predictive value of Operative Link on Gastritis Assessment(OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment(OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer(EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy(EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori(H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively(P = 0.005), the proportions of OLGA stages Ⅲ-Ⅳ cases were 52.1% and 22.4%, respectively(P < 0.001), and the proportions of OLGIM stages Ⅲ-Ⅳ cases were42.3% and 19.9%, respectively(P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA(OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages Ⅲ-Ⅳ(OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages Ⅲ-Ⅳ(P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA(75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages Ⅲ-Ⅳ(OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.