Small trocar site hernia after laparoscopy

AbstractThis review article is attempted to review the cases of 5-mm trocar site hernias (TSHs) after laparoscopic surgery and identify the risks associated with incarceration. We searched the English literature on the PubMed website using the key words “trocar site hernia” and “5 mm”. We evaluated a total of 24 cases of 5-mm TSHs and analyzed and results showed that 17 (71%) and 7 (29%) resulted from gynecologic and gastrointestinal surgeries, respectively. The majority were found at the lateral abdomen (87.5%) and recognized within 2 weeks (87.5%). The most frequently herniated organ (n = 14) was the small bowel. Up to 62.5% of cases (n = 15) were repaired by exploratory laparotomy, and 25% (n = 6) required resection of herniated organs secondary to incarceration. The cases with incarceration were detected at 4.3 ± 2.2 days post-operation and those without incarceration at 47.4 days post-operation. No risk factors could be identified to show a correlation between 5-mm TSHs and incarceration. We concluded that immediate 1--2-week postoperative care is of most importance, since the majority of 5-mm trocar site hernias with or without incarceration occurred within this period

Time series modeling for syndromic surveillance

BACKGROUND: Emergency department (ED) based syndromic surveillance systems identify abnormally high visit rates that may be an early signal of a bioterrorist attack. For example, an anthrax outbreak might first be detectable as an unusual increase in the number of patients reporting to the ED with respiratory symptoms. Reliably identifying these abnormal visit patterns requires a good understanding of the normal patterns of healthcare usage. Unfortunately, systematic methods for determining the expected number of (ED) visits on a particular day have not yet been well established. We present here a generalized methodology for developing models of expected ED visit rates. METHODS: Using time-series methods, we developed robust models of ED utilization for the purpose of defining expected visit rates. The models were based on nearly a decade of historical data at a major metropolitan academic, tertiary care pediatric emergency department. The historical data were fit using trimmed-mean seasonal models, and additional models were fit with autoregressive integrated moving average (ARIMA) residuals to account for recent trends in the data. The detection capabilities of the model were tested with simulated outbreaks. RESULTS: Models were built both for overall visits and for respiratory-related visits, classified according to the chief complaint recorded at the beginning of each visit. The mean absolute percentage error of the ARIMA models was 9.37% for overall visits and 27.54% for respiratory visits. A simple detection system based on the ARIMA model of overall visits was able to detect 7-day-long simulated outbreaks of 30 visits per day with 100% sensitivity and 97% specificity. Sensitivity decreased with outbreak size, dropping to 94% for outbreaks of 20 visits per day, and 57% for 10 visits per day, all while maintaining a 97% benchmark specificity. CONCLUSIONS: Time series methods applied to historical ED utilization data are an important tool for syndromic surveillance. Accurate forecasting of emergency department total utilization as well as the rates of particular syndromes is possible. The multiple models in the system account for both long-term and recent trends, and an integrated alarms strategy combining these two perspectives may provide a more complete picture to public health authorities. The systematic methodology described here can be generalized to other healthcare settings to develop automated surveillance systems capable of detecting anomalies in disease patterns and healthcare utilization

Influence of highway 3D coordination on drivers' perception of horizontal curvature and available sight distance

"This paper is a preprint of a paper submitted to [journal] and is subject to Institution of Engineering and Technology Copyright. If accepted, the copy of record will be available at IET Digital Library"Drivers' road perception is an important human factor of comfort and safety on driving. Available sight distance of crest vertical curves superimposed on horizontal curves can be geometrically optimised by applying 3D coordination criteria. However, drivers might not perceive available sight distance improvements. Two approaches were used to investigate the effect of geometrical optimised design on perceived sharpness and visibility of isolated crest vertical curves overlapped with horizontal curves. A survey-based approach was used to evaluate subjective perception of 100 drivers. Three-dimensional renderings were displayed to subjects; who were asked to rank the curves by sharpness and sight distance. Moreover, 50 of those drivers previously participated on a driving simulation experiment involving the same curves, so objective driving data were collected too. Drivers' survey results indicate that driver's curve perception depends on the algebraic difference of grades while coordination of vertical and horizontal curves does not appear to affect this perception. On the other hand, the operating speeds on different curves were not statistically different from each other. Surprisingly, the operating speeds on a flat curve tended to be lower than on the vertical crest curves superimposed on the same horizontal curve. Likely causes are discussed in the paper.Moreno Chou, AT.; García García, A.; Camacho Torregrosa, FJ.; Llorca Garcia, C. (2013). Influence of highway 3D coordination on drivers' perception of horizontal curvature and available sight distance. IET Intelligent Transport Systems. 7(2):244-250. doi:10.1049/iet-its.2012.0146S24425072Hassan, Y., & Easa, S. M. (2000). Modeling of Required Preview Sight Distance. Journal of Transportation Engineering, 126(1), 13-20. doi:10.1061/(asce)0733-947x(2000)126:1(13)García, A. (2004). Discussion of «Optimal Vertical Alignment Analysis for Highway Design» by T. F. Fwa, W. T. Chan, and Y. P. Sim. Journal of Transportation Engineering, 130(1), 138-138. doi:10.1061/(asce)0733-947x(2004)130:1(138)Bidulka, S., Sayed, T., & Hassan, Y. (2002). Influence of Vertical Alignment on Horizontal Curve Perception: Phase I: Examining the Hypothesis. Transportation Research Record: Journal of the Transportation Research Board, 1796(1), 12-23. doi:10.3141/1796-02Hassan, Y., Sayed, T., & Bidulka, S. (2002). Influence of Vertical Alignment on Horizontal Curve Perception: Phase II: Modeling Perceived Radius. Transportation Research Record: Journal of the Transportation Research Board, 1796(1), 24-34. doi:10.3141/1796-03Hasan, M., Sayed, T., & Hassan, Y. (2005). Influence of vertical alignment on horizontal curve perception: effect of spirals and position of vertical curve. Canadian Journal of Civil Engineering, 32(1), 204-212. doi:10.1139/l04-090Wang, F., & Easa, S. M. (2009). Validation of Perspective-View Concept for Estimating Road Horizontal Curvature. Journal of Transportation Engineering, 135(2), 74-80. doi:10.1061/(asce)0733-947x(2009)135:2(74)Bella, F. (2007). Parameters for Evaluation of Speed Differential. Transportation Research Record: Journal of the Transportation Research Board, 2023(1), 37-43. doi:10.3141/2023-05Ben-Bassat, T., & Shinar, D. (2011). Effect of shoulder width, guardrail and roadway geometry on driver perception and behavior. Accident Analysis & Prevention, 43(6), 2142-2152. doi:10.1016/j.aap.2011.06.004Jia, L., Wang, J., & Lu, M. (2011). Using real-world data to calibrate a driving simulator measuring lateral driving behaviour. IET Intelligent Transport Systems, 5(1), 21-31. doi:10.1049/iet-its.2009.0094Antonson, H., Mårdh, S., Wiklund, M., & Blomqvist, G. (2009). Effect of surrounding landscape on driving behaviour: A driving simulator study. Journal of Environmental Psychology, 29(4), 493-502. doi:10.1016/j.jenvp.2009.03.005Land, M. F., & Lee, D. N. (1994). Where we look when we steer. Nature, 369(6483), 742-744. doi:10.1038/369742a0Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-02Kweon, B.-S., Ellis, C. D., Lee, S.-W., & Rogers, G. O. (2006). Large-Scale Environmental Knowledge. Environment and Behavior, 38(1), 72-91. doi:10.1177/001391650528009

Propofol-Induced Changes in Neurotrophic Signaling in the Developing Nervous System In Vivo

Several studies have revealed a role for neurotrophins in anesthesia-induced neurotoxicity in the developing brain. In this study we monitored the spatial and temporal expression of neurotrophic signaling molecules in the brain of 14-day-old (PND14) Wistar rats after the application of a single propofol dose (25 mg/kg i.p). The structures of interest were the cortex and thalamus as the primary areas of anesthetic actions. Changes of the protein levels of the brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), their activated receptors tropomyosin-related kinase (TrkA and TrkB) and downstream kinases Akt and the extracellular signal regulated kinase (ERK) were assessed by Western immunoblot analysis at different time points during the first 24 h after the treatment, as well as the expression of cleaved caspase-3 fragment. Fluoro-Jade B staining was used to follow the appearance of degenerating neurons. The obtained results show that the treatment caused marked alterations in levels of the examined neurotrophins, their receptors and downstream effector kinases. However, these changes were not associated with increased neurodegeneration in either the cortex or the thalamus. These results indicate that in the brain of PND14 rats, the interaction between Akt/ERK signaling might be one of important part of endogenous defense mechanisms, which the developing brain utilizes to protect itself from potential anesthesia-induced damage. Elucidation of the underlying molecular mechanisms will improve our understanding of the age-dependent component of anesthesia-induced neurotoxicity

Guidance on the management of left ventricular assist device (LVAD) supported patients for the non-LVAD specialist healthcare provider: executive summary

The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD supported patients. Device-related, and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of LVAD implanting centres. The probability of an LVAD supported patient presenting with medical emergency to a local ambulance team, emergency department medical team and internal or surgical wards in a non-LVAD implanting centre is increasing. The purpose of this paper is to supply the immediate tools needed by the non-LVAD specialized physician - ambulance clinicians, emergency ward physicians, general cardiologists, and internists - to comply with the medical needs of this fast-growing population of LVAD supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department, and from the emergency department to the internal or surgical wards and eventually back to the general practitioner.Cardiolog

HFA of the ESC position paper on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider Part 3: at the hospital and discharge.

The growing population of left ventricular assist device (LVAD)-supported patients increases the probability of an LVAD- supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient-device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD-supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non-cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end-of-life approaches are described

Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device-supported patients for the non-left ventricular assist device specialist healthcare provider: Part 2: at the emergency department.

The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD-supported patients and the probability of those patients to present to the emergency department with expected and non-expected device-related and patient-device interaction complications. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co-morbidities common in the older population. In this second part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the LVAD-supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD-supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail