Self-rescue technique and Yamane’s technique in situ: Management of intraoperative haptic slippage

Haptic slippage is a frequently encountered and technically demanding complication in Yamane’s surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and self-rescue technique, Yamane’s technique in situ is applicable when the haptic of dislocated intraocular lens suits for flange-making.

Observation on the effect of power PICC with two different external lengths in catheterization of patients with hematologic diseases / 中国实用护理杂志

Objective:To investigate the effect of power PICC with two different external lengths in patients with hematologic diseases.Methods:From August 2020 to August 2021, a retrospective analysis was conducted on 233 cases of hematologic diseases who received power PICC catheterization in Department of Hematology, the Nanfang Hospital of Southern Medical University, the patients were divided into 0-1 cm group (132 cases) and 2-4 cm group (101 cases) according to the external lengths after catheter insertion. The incidence of related complications and patient comfort at 24 hours, 72 hours, 7 days and 14 days after catheterization were compared between the two groups.Results:At 24 hours and 72 hours after catheterization, the incidence of bleeding at puncture point in 0-1 cm group was 14.39%(19/132) and 9.85%(13/132), in 2-4 cm group was 30.69%(31/101) and 32.67%(33/101), the difference was statistically significant ( χ2=9.02, 14.16, both P<0.05). The rate of redness and swelling of punture point at 7 days after catheterization was 9.09%(12/132) and 40.59%(41/101) in the two groups, with statistical significance ( χ2=32.32, P<0.05). The rates of slightly prolapse at 7 and 14 days after catheterization were 18.18% (24/132) and 18.94%(25/132) in 0-1 cm group, 59.41% (60/101) and 67.33%(68/101) in 2-4 cm group, the difference between the two groups was statistically significant ( χ2=42.18, 55.86, both P<0.05). In the observation of comfort at 14 days after catheterization, the comfort score of patients in the 0-1 cm group was significantly higher than that in the 2-4 cm group, and the difference between the two groups was statistically significant ( χ2=7.34, P<0.05). Conclusions:Patients with hematologic diseases can reduce the risk of bleeding and slightly prolapse, and improve the comfort of patients when the external lengths is 0-1 cm of power PICC, which is worthy of clinical application and promotion. The catheterizer should adopt accurate in appropriate measurement method to determine the best lengths of the catheters.

Eukaryotic Multi-subunit DNA dependent RNA Polymerases: An Insight into Their Active Sites and Catalytic Mechanism

Aim:To analyze the most complex multi-subunit (MSU) DNA dependent RNA polymerases (RNAPs) of eukaryotic organisms and find out conserved motifs, metal binding sites and catalytic regions and propose a plausible mechanism of action for these complex eukaryoticMSU RNAPs, using yeast (Saccharomyces cerevisiae) RNAP II, as a model enzyme.Study Design: Bioinformatics, Biochemical, Site-directed mutagenesis and X-ray crystallographic data were analyzed.Place and Duration of Study: School of Biotechnology, MaduraiKamaraj University, Madurai, India, between 2007-2013. Methodology:Bioinformatics, Biochemical, Site-directed mutagenesis (SDM) and X-ray crystallographic data of the enzyme were analyzed. The advanced version of Clustal Omega was used for protein sequence analysis of the MSU DNA dependent RNAPs from various eukaryotic sources. Along with the conserved motifs identified by the bioinformatics analysis, the data already available by biochemical and SDM experiments and X-ray crystallographic analysis of these enzymes were used to confirm the possible amino acids involved in the active sites and catalysis. Results:Multiple sequence alignment (MSA) of RNAPs from different eukaryotic organisms showed a large number of highly conserved motifs among them. Possible catalytic regions in the catalytic subunits of the yeast Rpb2 (= β in eubacteria) and Rpb1 (= β’ in eubacteria) consist of an absolutely conserved amino acid R, in contrast to a K that was reported for DNA polymerases and single subunit (SSU) RNAPs. However, the invariant ‘gatekeeper/DNA template binding’ YG pair that was reported in all SSU RNAPs, prokaryotic MSU RNAPs and DNA polymerases is also highly conserved in eukaryotic Rpb2 initiation subunits, but unusually a KG pair is found in higher eukaryotes including the human RNAPs. Like the eubacterial initiation subunits of MSU RNAPs, the eukaryotic initiation subunits, viz. Rpb2, exhibit very similar active site and catalytic regions but slightly different distance conservations between the templatebinding YG/KG pair and the catalytic R. In the eukaryotic initiation subunits, the proposed catalytic R is placed at the -9thposition from the YG/KG pair and an invariant R is placed at -5 which are implicated to play a role in nucleoside triphosphate (NTP) selection as reported for SSU RNAPs (viral family) and DNA polymerases. Similarly, the eukaryotic elongation subunits (Rpb1) are also found to be very much homologous to the elongation subunits (β’) of prokaryotes. Interestingly, the catalytic regionsare highly conserved, and the metal binding sites are absolutely conserved as in prokaryotic MSU RNAPs. In eukaryotes, the template binding YG pair is replaced with an FG pair. Another interesting observation is, similar to the prokaryotic β’ subunits, inthe eukaryotic Rpb1 elongation subunits also, the proposed catalytic R is placed double the distance, i.e., -18 amino acids downstream from the FG pair unlike in the SSU RNAPs and DNA polymerases where the distance is only -8 amino acids downstream from the YG pair. Thus, the completely conserved FG pair, catalytic R with an invariant R, at -6thposition are proposed to play a crucial role in template binding, NTP selection and polymerization reactions in the elongation subunits of eukaryotic MSU RNAPs. Moreover, the Zn binding motif with the three completely conserved Cs is also highly conserved in the eukaryotic elongation subunits. Another important difference is that the catalytic region is placed very close to the N-terminal region in eukaryotes.Conclusions: Unlike reported for the DNA polymerases and SSU RNA polymerases, the of eukaryotic MSU RNAPs use an R as the catalytic amino acid and exhibit a different distance conservation in the initiation and elongation subunits. An invariant Zn2+binding motif found in the Rpb1 elongation subunits is proposed to participate in proof-reading function. Differences in the active sites of bacterial and human RNA polymerases may pave the way for the design of new and effective drugs for many bacterial infections, including the multidrug resistant strains which are a global crisis at present

Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center

PURPOSE: Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation. MATERIALS AND METHODS: This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities. RESULTS: Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal. CONCLUSION: During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.

Structural improvement and analysis of a novel endoscopic succession closing device / 医用生物力学

Objective By developing a novel endoscopic succession closing device to overcome the shortcomings of existing devices that cannot deploy several clips at one time,to perform structural analysis on different clamp structures and to validate their performances in tissue closure through finite element analysis.Metbods Comparative analyses of 3 clamp structures,namely,the aligning tooth structure (original,clamp A),the staggered tooth structure (clamp B),a combination structure with page break angle and staggered tooth (clamp C),were performed to analyze pressure and its distribution on tissues when clamping the stomach wall.Displacement of 7.5 mm was then applied on the clamps to simulate the effect from operating procedures of the device and tissue kick-back.Results The maximum stresses of the clamp A and B were located on the first pair of teeth which was closest to the rotating shaft,with the stress of 10.39 kPa and 10.11 kPa,respectively.The maximum stress (11.35 kPa) of the clamp C was located on the second pair of teeth.For clamp A and B,the longer the distance to shaft,the larger pressure on stomach tissues.While for clamp C,the pressure on device-tissue interface showed little change along the path.Under tensile displacement,clamp A and B slipped off from the tissue when displacements reached to 5.0 mm and 6.5 mm,respectively,while clamp C did not slip off.Conclusions Clamp with page break angle and staggered tooth can exert the uniform maximum pressure to tissues and provide a larger contact area away from the rotating shaft,thus improving the anti-slippage and performance of the novel endoscopic closing device.

Structural improvement and analysis of a novel endoscopic succession closing device / 医用生物力学

Objective By developing a novel endoscopic succession closing device to overcome the shortcomings of existing devices that cannot deploy several clips at one time,to perform structural analysis on different clamp structures and to validate their performances in tissue closure through finite element analysis.Metbods Comparative analyses of 3 clamp structures,namely,the aligning tooth structure (original,clamp A),the staggered tooth structure (clamp B),a combination structure with page break angle and staggered tooth (clamp C),were performed to analyze pressure and its distribution on tissues when clamping the stomach wall.Displacement of 7.5 mm was then applied on the clamps to simulate the effect from operating procedures of the device and tissue kick-back.Results The maximum stresses of the clamp A and B were located on the first pair of teeth which was closest to the rotating shaft,with the stress of 10.39 kPa and 10.11 kPa,respectively.The maximum stress (11.35 kPa) of the clamp C was located on the second pair of teeth.For clamp A and B,the longer the distance to shaft,the larger pressure on stomach tissues.While for clamp C,the pressure on device-tissue interface showed little change along the path.Under tensile displacement,clamp A and B slipped off from the tissue when displacements reached to 5.0 mm and 6.5 mm,respectively,while clamp C did not slip off.Conclusions Clamp with page break angle and staggered tooth can exert the uniform maximum pressure to tissues and provide a larger contact area away from the rotating shaft,thus improving the anti-slippage and performance of the novel endoscopic closing device.

Structural improvement and analysis of a novel endoscopic succession closing device / 医用生物力学

Objective By developing a novel endoscopic succession closing device to overcome the shortcomings of existing devices that cannot deploy several clips at one time,to perform structural analysis on different clamp structures and to validate their performances in tissue closure through finite element analysis.Metbods Comparative analyses of 3 clamp structures,namely,the aligning tooth structure (original,clamp A),the staggered tooth structure (clamp B),a combination structure with page break angle and staggered tooth (clamp C),were performed to analyze pressure and its distribution on tissues when clamping the stomach wall.Displacement of 7.5 mm was then applied on the clamps to simulate the effect from operating procedures of the device and tissue kick-back.Results The maximum stresses of the clamp A and B were located on the first pair of teeth which was closest to the rotating shaft,with the stress of 10.39 kPa and 10.11 kPa,respectively.The maximum stress (11.35 kPa) of the clamp C was located on the second pair of teeth.For clamp A and B,the longer the distance to shaft,the larger pressure on stomach tissues.While for clamp C,the pressure on device-tissue interface showed little change along the path.Under tensile displacement,clamp A and B slipped off from the tissue when displacements reached to 5.0 mm and 6.5 mm,respectively,while clamp C did not slip off.Conclusions Clamp with page break angle and staggered tooth can exert the uniform maximum pressure to tissues and provide a larger contact area away from the rotating shaft,thus improving the anti-slippage and performance of the novel endoscopic closing device.

Structural improvement and analysis of a novel endoscopic succession closing device / 医用生物力学

By developing a novel endoscopic succession closing device to overcome the shortcomings of existing devices that cannot deploy several clips at a time, to perform structural analysis on different clamp structures and to validate their performances in tissue closure through finite element analysis. Methods Comparative analyses of three clamp structures, namely, the aligning tooth structure (original, clamp A), the staggered tooth structure (clamp B), a combination structure with page break angle and staggered tooth (clamp C), were performed to analyze pressure and its distribution on tissues when clamping the stomach wall. Displacement of 7.5 mm was then applied on the clamps to simulate the effect of the operating procedures of the device and tissue kick-back. Results The maximum stresses of the clamp A and B were located on the first pair of teeth which was closest to the rotating shaft, with the stress being 10.39 kPa and 10.11 kPa, respectively. The maximum stress (11.35 kPa) of the clamp C was located on the second pair of teeth. For clamp A and B, the longer the distance to shaft, the larger pressure on stomach tissues. While for clamp C, the pressure on device-tissue interface showed little change along the path. Under tensile displacement, clamp A and B slipped off from the tissue when displacements reached to 5 mm and 6.5 mm, respectively, while clamp C did not. Conclusions　Clamp with page break angle and staggered tooth can exert the uniform max pressure to tissues and provide a larger contact area away from the rotating shaft, thus improving anti-slippage and performance of the novel endoscopic closing device.

Three-Year Experience of Pouch Dilatation and Slippage Management after Laparoscopic Adjustable Gastric Banding

PURPOSE: Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications. MATERIALS AND METHODS: The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications. RESULTS: From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period. CONCLUSION: The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.

Tractor perfomance as a function of speed and seeder’s tire inflation pressure / Desempenho de trator em função da velocidade e da pressão de inflação dos pneus da semeadora

The performance of agricultural tractors under field conditions results from the interaction between tire and wheel affected by displacement speed. This work was developed to assess the performance of an agricultural tractor under different seeder's tire inflation pressure (518; 483 and 414kPa) and in two different gears providing speeds of 3.0 and 6.0km h-1. The experiment was performed at Jaboticabal Campus of São Paulo State University (UNESP). The experimental design used was entirely randomized in a 2-factor factorial design (3x2) with four replications. The draft force was influenced by the gear as well as by the required power; however, tire inflation pressure in the seeder did not change these parameters. Also, fuel consumption was influenced only by the tractor gear. Energy consumption was greater as speed increased, caused by gear shifting. The displacement speed was greater for the 518kPa pressure due to a lesser slippage in the seeder under this pressure. Tractor slippage did not change.

O desempenho de tratores agrícolas em condições de campo resulta da interação entre pneu e rodado, influenciado pela velocidade de deslocamento. O objetivo deste trabalho foi avaliar o desempenho de um trator agrícola sob diferentes pressões de inflação dos pneus da semeadora (518, 483, and 414kPa) e em duas marchas que proporcionaram velocidades de 3,0 e 6,0km h-1. O experimento foi realizado no campus de Jaboticabal da Universidade Estadual Paulista (UNESP). O delineamento experimental utilizado foi fatorial inteiramente casualizado (3x2), com quatro repetições. A força de tração foi influenciada pela marcha e pela potência exigida; no entanto, a pressão de inflação do pneu da semeadora não alterou esses parâmetros. Além disso, o consumo de combustível foi influenciado apenas pela marcha do trator. O consumo de energia foi maior com o aumento da velocidade, ocasionada pela mudança de marcha. A velocidade de deslocamento foi maior para a pressão de 518kPa, em razão da menor patinagem da semeadora promovida por essa pressão. A patinagem do trator não foi alterada pelos fatores testados.

Band Slippage after Laparoscopic Adjustable Gastric Banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) has proved to be safe and effective, worldwide. The perigastric technique was once the most frequent method of band placement, but posterior prolapse was a problem. The introduction of the pars flaccida technique has considerably reduced the incidence of this complication, and, currently, this technique is the most utilized method and recommended by most bariatric surgeons. However, LAGB with pars flaccida technique has rare complications such as band slippage and gastric pouch dilatation in 2~5% of patients. We have experienced 2 band replacement cases for band slippage and pouch dilatation each happening about 1 and 2 years after LAGB.

Analysis of slipped sequences in EST projects

Slippage is an important sequencing problem that can occur in EST projects. However, very few studies have addressed this. We propose three new methods to detect slippage artifacts: arithmetic mean method, geometric mean method, and echo coverage method. Each method is simple and has two different strategies for processing sequences: suffix and subsequence. Using the 291,689 EST sequences produced in the SUCEST project, we performed comparative tests between our proposed methods and the SUCEST method. The subsequence strategy is better than the suffix strategy, because it is not anchored at the end of the sequence, so it is more flexible to find slippage at the beginning of the EST. In a comparison with the SUCEST method, the advantage of our methods is that they do not discard the majority of the sequences marked as slippage, but instead only remove the slipped artifact from the sequence. Based on our tests the echo coverage method with subsequence strategy shows the best compromise between slippage detection and ease of calibration.

Reoperation due to Slippage of Titanium Aneurysm Clip: Case Report

Aneurysm surgery using titanium clips has been popularized, although confronted by some minor drawbacks and the paucity of long-term clinical results about the safety of these implants. The authors recently experienced an unusual case of postoperative titanium clip slippage in surgery for anterior communicating artery aneurysm in a 38-year-old man. Aneurysm reoperation with implanting of two cobalt alloy clips was followed. We reviewed the mechanical characteristics of the titanium clips and technical considerations in clipping, and then tried to search for solutions to prevent this kind of complication.