Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

Оценка сближения проводов распределительных устройств электростанций по допустимому импульсу электродинамических усилий

The paper contains description of the method how to estimate switch-gear wife closeness. This method is based on the usage of electrodynamic force impulse. An approximate formula is deduced for determination of allowable value in respect of phase closeness of electrodynamic force impulse. The paper has made it possible to obtain an additional condition for estimation of non-allowable phase closeness of flexible buses in terms of design and allowable values of electrodynamic force impulse. Certainty of calculations has been estimated with the help of BUSEF computer program.Излагается метод оценки сближения проводов распределительных устройств, основанный на использовании импульса ЭДУ. Выводится приближенная формула для определения допустимого в отношении сближения фаз импульса ЭДУ. Получено дополнительное условие оценки недопустимых сближений фаз гибких шин по величинам расчетного и допустимого импульсов ЭДУ. С использованием компьютерной программы BUSEF выполнена оценка достоверности расчетов

Упрощенный метод расчета сближения проводов с учетом конструктивных элементов распределительных устройств при двухфазном коротком замыкании

The paper proposes a simplified and modified method of calculation of wire closing-in under two-phase short-circuit. The method takes into account main characteristics of short-circuit with the help of electrodynamic force impulse. An explicit formula have been developed to calculate maximum wire deflection with due account of constructive elements of switch gears and correction factor. The value of correction factor is calculated with the help of computer program in view of changes in wire configuration and their deformation in case of short-circuit.Излагается упрощенный модифицированный метод расчета сближения проводов при двухфазном коротком замыкании. Метод учитывает основные характеристики КЗ с помощью импульса ЭДУ. Получена явная формула расчета максимальных отклонений проводов с учетом конструктивных элементов распределительных устройств и поправочного коэффициента, величина которого рассчитана по компьютерной программе с учетом изменения формы проводов и их деформации при КЗ

Current practice in Australia and New Zealand for defunctioning ileostomy after rectal cancer surgery with anastomosis: Analysis of the Bi-National Colorectal Cancer Audit (BCCA)

AIM: This study aimed to investigate the use of defunctioning stomas after rectal cancer surgery in Australia and New Zealand (ANZ), as current practice is unknown. METHODS: From the Bi-National Colorectal Cancer Audit (BCCA) database, rectal cancer patients who underwent a resection between 2007 and 2019 with the formation of an anastomosis were extracted and analysed. Primary outcome was the rate of defunctioning stoma formation. Secondary outcomes were: anastomotic leakage (AL) rates and other postoperative complications, length of hospital stay (LOS), readmissions and 30-day mortality rates between stoma and no stoma groups. Propensity score-matching was performed to correct for differences in baseline characteristics between stoma and no-stoma groups. RESULTS: In total, 2,581 (89%) received a defunctioning stoma and 319 (11%) did not. There were more male patients in the stoma group (65.5 vs. 57.7% for the no-stoma group; p=0.006). The median age was 64 years in both groups. The stoma group underwent more ultra-low anterior resections (79.9 vs. 30.1%; p<0.0001), included more AJCC stage III patients (53.7 vs. 29.2%; p<0.0001) and received more neoadjuvant therapy (66.9 vs. 16.3%; p<0.0001). The AL rate was similar in both groups (5.1 vs. 6.0%; p=0.52). LOS was longer in the stoma group (8 vs. 6 days; p<0.0001) with higher 30-day readmission rates (14.9 vs. 8.3%; p=0.003). After propensity score-matching (n=208 in both groups), AL rates remained similar (2.9% for stoma vs. 5.8% for no stoma group; p=0.15), but stoma patients required less reoperations (0% vs. 8%; p=0.016). The stoma group had higher postoperative ileus rates and an increased LOS. CONCLUSION: In ANZ, most patients who underwent rectal cancer resections with the formation of an anastomosis received a defunctioning stoma. A defunctioning stoma does not prevent anastomotic leakage from occurring but is mostly associated with a lower reoperation rate. Patients with a defunctioning stoma experienced a higher postoperative ileus rate and had an increased length of hospital stay.Vera E. M. Grupa, Hidde M. Kroon, Izel Ozmen, Sergei Bedrikovetski, Nagendra N. Dudi-Venkata, Ronald A. Hunter, Tarik Sammou

Design of a multi-level inverter for solar power systems with a variable number of levels technique

Overall harmonic distortion and losses will grow during an energy conversion process, while power stability will be reduced. Multilevel inverter technologies have recently become very popular as low-cost alternatives for a variety of industrial purposes. The design's minimal benefits include reduced component losses, decreased switching and conduction losses, along with enhanced output voltage and current waveforms. Also, a reduction of the harmonic components of the current and output voltage of the inverter are the most important requirements in multilevel inverters. A seven-level inverter design is presented in this paper that is simulated using MATLAB/Simulink. The inverter converts the DC voltage from three photovoltaic (PV) systems into AC voltage at seven levels. During an outage of one of the PV systems, the inverter will make a switching reduction and supply the AC voltage as a five-level inverter. The inverter’s total harmonic distortion (THD) when it performs as a five-level or seven-level inverter is 4.19% or 1.13% respectively. The modulation technique used is phase disposition via six carriers and a single reference signal at the fundamental frequency. © 2023, Institute of Advanced Engineering and Science. All rights reserved.Ministry of Education and Science of the Russian Federation, Minobrnauka: FEUZ-2022-0031Funding from the Ministry of Science and Higher Education of the Russian Federation (Ural Federal University Program of Development within the Priority-2030 Program) is gratefully acknowledged: Grant Number FEUZ-2022-0031

Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.Laura Bravo ... COVIDSurg Collaborative : (Royal Adelaide Hospital, N. N. Dudi-Venkata, H. M. Kroon, T. Sammour) ... et al.

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Changing outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer

Background Pelvic exenteration for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is technically challenging but increasingly performed in specialist centres. The aim of this study was to compare outcomes of exenteration over time. Methods This was a multicentre retrospective study of patients who underwent exenteration for LARC and LRRC between 2004 and 2015. Surgical outcomes, including rate of bone resection, flap reconstruction, margin status and transfusion rates, were examined. Outcomes between higher- and lower-volume centres were also evaluated. Results Some 2472 patients underwent pelvic exenteration for LARC and LRRC across 26 institutions. For LARC, rates of bone resection or flap reconstruction increased from 2004 to 2015, from 3.5 to 12.8 per cent, and from 12.0 to 29.4 per cent respectively. Fewer units of intraoperative blood were transfused over this interval (median 4 to 2 units; P = 0.040). Subgroup analysis showed that bone resection and flap reconstruction rates increased in lower- and higher-volume centres. R0 resection rates significantly increased in low-volume centres but not in high-volume centres over time (low-volume: from 62.5 to 80.0 per cent, P = 0.001; high-volume: from 83.5 to 88.4 per cent, P = 0.660). For LRRC, no significant trends over time were observed for bone resection or flap reconstruction rates. The median number of units of intraoperative blood transfused decreased from 5 to 2.5 units (P < 0.001). R0 resection rates did not increase in either low-volume (from 51.7 to 60.4 per cent; P = 0.610) or higher-volume (from 48.6 to 65.5 per cent; P = 0.100) centres. No significant differences in length of hospital stay, 30-day complication, reintervention or mortality rates were observed over time. Conclusion Radical resection, bone resection and flap reconstruction rates were performed more frequently over time, while transfusion requirements decreased

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks