State of art in hernia surgery - results of our recent experience

Introduction. Minimally invasive surgery (MIS) has gained popularity in all surgical fields, and hernia surgery is one of the most recent. Inguinal, umbilical, and incisional hernias benefit from laparoscopic procedures. Short hospitalization, reduced return-to-work time, and fast recovery after surgery recommend MIS as the new standard for hernia surgery. Methods. In this review, we analyzed our experience in the period 2019-2023, including patients with hernia defects who underwent MIS. The procedures performed were as follows: intraperitoneal onlay mesh (IPOM) and extended total extraperitoneal (eTEP) for umbilical hernias; total extraperitoneal (TEP) and trans-abdominal preperitoneal (TAPP) for inguinal hernias; and eTEP, IPOM, and trans-abdominal retromuscular (TARM) for incisional hernias. Surgeries were performed laparoscopically under general anesthesia. The study included 236 procedures:49 for incisional hernias (20.76%), 52 for umbilical hernias (22.03%), and 135 for inguinal hernias. (57.21%). eTEP was predominant in incisional hernias (61.22%), followed by IPOM (20.42%), and TARM (18.36%). Inguinal hernias were treated using TEP (88.89%) and TAPP (11.12%). Umbilical hernias were operated on using IPOM (23.08%) and eTEP (76.92%). Emergent surgery was performed in 38 cases (16.11%):7 cases of umbilical hernias, 26 cases of inguinal hernias, and 5 cases of incisional hernias. Results: The conversion rate was 5.08% (12 cases), which was related to difficulties in dissection (eTEP) and peritoneal tear (TEP). The complication rate was 11.86% and included 12 hematomas, 10 bleeding events, 3 intestinal fistulas, and 2 bowel obstructions. Of these, 75% required a reoperation. One patient died of postoperative pulmonary thromboembolism. Seromas were observed in 7.2% of patients. Four recurrences (1.7%) have been reported to date. Conclusion: Our results show reduced complication rates, reduced recurrences, and wound-related occurrences and support MIS as a valuable tool in hernia surgery

Wireless Power Transfer Systems Optimization Using Multiple Magnetic Couplings

Multiple magnetic couplings used to increase the link distance in wireless power transfer systems (WPTSs) are not new. An efficient power transfer in conditions of an extended link distance requires a series connection of the intermediate coils. However, all four connections of the emitter and receiver coils are equally possible. This present paper conducts an extensive analysis of WPTSs utilizing three magnetic couplings. The type of connection of the emitter and receiver coils represented the criterion utilized for the WPTS optimization assessment. The first step requires the determination of the schematic of the sinusoidal equivalent circuit. Then, one synthesizes the functions describing the system performances (e.g., the amount of delivered active power or efficiency) by applying the entirely symbolic and or the hybrid symbolic-numerical formalism. The output of such functions consists of appropriate representation in the frequency domain, based upon Laplace state variable equations (SVE) or complex or Laplace modified nodal equations (MNE). The dependency of the WPTS performance on the number of magnetic couplings and their parameters included a study on resistive loss minimization. The minimization applies to the intermediate coils, whereas the outcomes are the active delivered power and the power transfer efficiency—the first study case aimed at a comparison between two distinct WPTSs: three magnetic couplings versus two. The second case of the study compared the WPTSs having a series connection of three magnetic couplings with those built with the emitter-receiver resonators in parallel. One determined the normalized sensitivities as frequency functions, which depend on circuit resistances, load resistance and the coupling factor between the second and the third coil. The optimization algorithms are suitable for computing optimal parameters of the given circuit to ensure maximum and minimum values of the performance value. Good simulation examples followed the proposed optimization techniques

Considerations Regarding the Agronomical Variables Associated to the Performances of SWAT Model Simulations in the Romanian eco-climatic Conditions☆

Abstract The main objective of the study is to optimize the agronomical variables for prediction of water quality at river basin scale for various time intervals using the numerical modeling of the cumulative impact of agricultural operations due to the use of chemical inputs and specific tillage. SWAT (Soil & Water Assessment Tool) model was developed to determine with reasonable accuracy the effect of potential management decisions regarding the water use, sediment transport, and chemical transformations of substances discharged into surface waters in rural ungauged basins. The information flow must start with the adaptation of the inputs required by the SWAT model for the accurate definition of Hydrological Response Units that include unique combinations between slope, soil type, and land use/land cover. All thematic layers must be related to the same coordinate system using the 1970 stereographic projection and Dealul Piscului 1970 geographic coordinate system that are in force in Romania. The meteorological inputs used in SWAT include rainfall, maximum and minimum temperature, solar radiation, relative humidity and wind speed. The prediction of SWAT model considering the diffuse sources of pollution (land areas with intensive agriculture) were analyzed considering the cropping technologies used in various Romanian hydrographical basins, i.e. Ialomita River, Calmatui River, Teleajen River, and Mostistea River. The main constraints observed in the use of SWAT model for efficient predictions in various control sections can be adjusted by the careful selection/adaptation of inputs, the optimal calibration/sensitivity analysis of the model, and the updating of information regarding the land use/land cover in a specific river basin

Analysis of coupled oscillators through a two-port passive network

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Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection