Berntsenknowles7459

Enhanced recovery protocols (ERPs) have shown to improve outcomes in multiple specialties and were recently applied to hepatic resections. The objective of this study was to determine the safety and efficacy of ERP in hepatic resection. Between 2013-2017, 208 patients underwent hepatectomy. The ERP included early ambulation, early oral intake, and multimodal analgesia. Primary study end points were hospital length of stay (LOS) and overall morbidity; secondary end points were return of bowel function (ROBF), 30-day readmission, and 90-day mortality. Major hepatectomies were selected for separate analysis. Overall, pre-ERP (N = 99) and ERP (N = 109) were similar in demographics. ERP patients had earlier oral intake and ROBF with similar overall morbidity. Although median LOS was 5 days, 43% of ERP patients had LOS ≤4 days vs. 27% in the pre-ERP cohort (P = .02). selleck compound 30-day readmission was similar (12%), and 90-day mortality was 2.8% vs. 3.0% (pre-ERP vs. ERP, P = .90). In major hepatectomies, pre-ERP (N = 41) and ERP (N = 33) demographics and operative characteristics were similar. ERP patients had earlier oral intake and ROBF with similar morbidity and mortality. There was no significant difference in median LOS; however, 36% of the major hepatectomy ERP patients had LOS ≤4 days vs. 17% of pre-ERP patients, P = .06. In conclusion, ERP can be safely implemented in hepatectomy, with earlier oral intake and ROBF, shorter LOS in some patients, and no increase in morbidity or mortality.

Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports.

The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries.

Meta-analysis and systematic review.

A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or faanalysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

To develop and validate a CT-based nomogram to predict the occurrence of loculated pneumothorax due to hook wire placement.

Patients (

= 177) were divided into pneumothorax (

= 72) and non-pneumothorax (

= 105) groups. Multivariable logistic regression analysis was applied to build a clinical prediction model using significant predictors identified by univariate analysis of imaging features and clinical factors. Receiver operating characteristic (ROC) was applied to evaluate the discrimination of the nomogram, which was calibrated using calibration curve.

Based on the results of multivariable regression analysis, transfissure approach [odds ratio (OR) 757.94; 95% confidence interval CI (21.20-27099.30)

< 0.0001], transemphysema [OR 116.73; 95% CI (12.34-1104.04)

< 0.0001], localization of multiple nodules [OR 8.04; 95% CI (2.09-30.89)

= 0.002], and depth of nodule [OR 0.77; 95% CI (0.71-0.85)

< 0.0001] were independent risk factors for pneumothorax and were included in the predictive model (

< 0.05). The area under the ROC curve value for the nomogram was 0.95 [95% CI (0.92-0.98)] and the calibration curve indicated good consistency between risk predicted using the model and actual risk.

A CT-based nomogram combining imaging features and clinical factors can predict the probability of pneumothorax before localization of ground-glass nodules. The nomogram is a decision-making tool to prevent pneumothorax and determine whether to proceed with further treatment.

A nomogram composed of transfissure, transemphysema, multiple nodule localization, and depth of nodule has been developed to predict the probability of pneumothorax before localization of GGNs.

A nomogram composed of transfissure, transemphysema, multiple nodule localization, and depth of nodule has been developed to predict the probability of pneumothorax before localization of GGNs.

The Latarjet procedure is indicated for patients with recurrent anterior shoulder instability, previous failed soft tissue stabilization, glenoid bone loss, or high-risk factors for recurrence, although there is still a concern with the surgical complication rates associated with the Latarjet procedure.

To evaluate the 90-day complication rate after the open Latarjet procedure in a high-volume center.

Case series; Level of evidence, 4.

A retrospective review was performed of patients who underwent an open Latarjet procedure at our institution over a 5-year period between January 2015 and December 2019. The complications, readmissions, and reoperations within 90 days were evaluated.

A total of 441 patients with a mean age of 23.0 ± 5.7 years was included; 97.5% of the patients were male. There were 2 intraoperative complications (0.5%) 1 coracoid fracture and 1 anaphylactic reaction to vancomycin. Overall, there were 19 postoperative complications (4.3%) in 18 patients, with 4 (0.9%) readmissions forcomplication rate with a low revision rate. Hematomas were the most common complication experienced by patients who underwent the Latarjet procedure, while there was no recurrent instability or neurological or hardware complications reported among the 441 patients included in this study.Work relative value units (wRVUs) serve as a proxy of surgeon's effort, technical skill, and time to determine reimbursement. The aim of this study is to determine how accurately wRVUs reflect the work effort of surgeons performing laparoscopic inguinal hernia repair (LIHR) as compared to open repair (OIHR). Within the National Surgical Quality Improvement Program database, 40 099 patients who underwent LIHR and 99 176 patients who underwent OIHR between 2012 and 2017 were identified. link2 Mean wRVUs, wRVUs per minute, and operative times were compared between 8 groups based on clinical factors (unilateral vs. bilateral; obstructed vs. non-obstructed; primary vs. recurrent; 2 × 2 × 2 = 8). In both aggregate and matched cohorts, wRVUs for LIHR were significantly lower than OIHR in all 8 categories (P less then .001). On regression analysis, the mean difference in assigned vs. calculated relative value units (RVUs) was most divergent among unilateral, recurrent, obstructed IHR (3.12 mean RVUs, P less then .001). Despite the rising utilization of LIHR, current wRVUs significantly undervalue this technique across all categories and consequently the work of surgeons who perform laparoscopic procedures. This RVU discrepancy in an increasing minimally invasive, value-driven surgical environment calls for more objective criteria to assign RVUs, whereby the value is measured by operative complexity-patient clinical factors and severity of the hernia itself-not solely operative technique.Active learning promotes the capacity of problem solving and decision making among learners. Teachers who apply instructional processes toward active participation of learners help their students develop higher order thinking skills. Due to the recent paradigm shift toward adopting competency-based curricula in the education of healthcare professionals in India, there is an emergent need for physiology instructors to be trained in active-learning methodologies and to acquire abilities to promote these curriculum changes. To address these issues, a series of International Union of Physiological Sciences (IUPS) workshops on physiology education techniques in four apex centers in India was organized in November 2018 and November 2019. The "hands-on" workshops presented the methodologies of case-based learning, problem-based learning, and flipped classroom; the participants were teachers of basic sciences and human and veterinary medicine. The workshop series facilitated capacity building and creation of a national network of physiology instructors interested in promoting active-learning techniques. The workshops were followed by a brainstorming meeting held to assess the outcomes. The aim of this report is to provide a model for implementing a coordinated series of workshops to support national curriculum change and to identify the organizational elements essential for conducting an effective Physiology Education workshop. The essential elements include a highly motivated core organizing team, constant dialogue between core organizing and local organizing committees, a sufficient time frame for planning and execution of the event, and opportunities to engage students at host institutions in workshop activities.Two-dimensional (2D) organic-inorganic hybrid perovskites have been intensively explored in recent years due to their tunable band gaps and exciton binding energies and increased stability with respect to three-dimensional (3D) hybrid perovskites. link3 Experimental observations suggest the existence of localized edge states in 2D hybrid perovskites which facilitate extremely efficient electron-hole dissociation and long carrier lifetimes, while multiple origins for their formation have been proposed. Using first-principles calculations, we demonstrate that layer edge states are stabilized by internal electric fields created by polarized molecular alignment of organic cations in 2D hybrid perovskites when they are two layers or thicker. Our study gives a simple physical explanation of the edge state formation, and facilitating the design and manipulation of layer edge states for optoelectronic applications.By conducting a systematic study of model lipid membranes using the atomic force microscopy (AFM) indentation, we demonstrate the importance of an experimental protocol on the determination of their mechanical parameters. We refine the experimental approach by analyzing the influence of the contact mechanics models used to process the data, substrate preparation, and indenter geometry. We show that both bending rigidity and area compressibility can be determined from a single AFM indentation measurement.The extent of intersystem crossing in the O(3P) + C6H6 reaction, a prototypical system for spin-forbidden reactions in oxygenated aromatic molecules, is theoretically evaluated for the first time. Calculations are performed using nonadiabatic transition-state theory coupled with stochastic master equation simulations and Landau-Zener theory. It is found that the dominant intersystem crossing pathways connect the T2 and S0 potential energy surfaces through at least two distinct minimum-energy crossing points. The calculated channel-specific rate constants and intersystem crossing branching fractions differ from previous literature estimates and provide valuable kinetic data for the investigation of benzene and polycyclic aromatic hydrocarbons oxidation in interstellar, atmospheric, and combustion conditions. The theoretical results are supported by crossed molecular beam experiments with electron ionization mass-spectrometric detection and time-of-flight analysis at 8.2 kcal/mol collision energy. This system is a suitable benchmark for theoretical and experimental studies of intersystem crossing in aromatic species.