Implications of routine cholangiography during laparoscopic cholecystectomy on postoperative testing: Review of more than 2,300 cases in a community-based practice.

BACKGROUND: We hypothesized that routine cholangiography during laparoscopic cholecystectomy may increase use of postoperative imaging and invasive testing. METHODS: A retrospective review was performed of laparoscopic cholecystectomy cases at 6 community hospitals from 2017 through 2020. For surgeons performing routine vs selective cholangiography, we compared primary outcomes of operative time, 30-day complications, and postoperative imaging or procedures. RESULTS: In total, 2359 laparoscopic cholecystectomy procedures were performed. Eighteen surgeons performed routine cholangiography (1125 cases), and 13 performed selective (1234 cases). Mean operative time was longer in the routine group (125.3 vs 98.7 min, P < .001). Between groups, 30-day complications were similar. Two common bile duct injuries were identified in the routine group. Postoperatively, the routine group underwent 2.5 times more imaging and invasive testing (P < .001). CONCLUSIONS: In community hospitals, laparoscopic cholecystectomy can be performed safely by surgeons using cholangiography routinely or selectively. Routine cholangiography resulted in more postoperative imaging and invasive testing.

Direct Observation of the Xenon Physisorption Process in Mesopores by Combining In Situ Anomalous Small-Angle X-ray Scattering and X-ray Absorption Spectroscopy.

The morphology and structural changes of confined matter are still far from being understood. This report deals with the development of a novel in situ method based on the combination of anomalous small-angle X-ray scattering (ASAXS) and X-ray absorption near edge structure (XANES) spectroscopy to directly probe the evolution of the xenon adsorbate phase in mesoporous silicon during gas adsorption at 165 K. The interface area and size evolution of the confined xenon phase were determined via ASAXS demonstrating that filling and emptying the pores follow two distinct mechanisms. The mass density of the confined xenon was found to decrease prior to pore emptying. XANES analyses showed that Xe exists in two different states when confined in mesopores. This combination of methods provides a smart new tool for the study of nanoconfined matter for catalysis, gas, and energy storage applications.

Quantification of Nanoscale Density Fluctuations in Hydrogenated Amorphous Silicon.

The nanostructure of hydrogenated amorphous silicon (a-Si∶H) is studied by a combination of small-angle x-ray scattering (SAXS) and small-angle neutron scattering (SANS) with a spatial resolution of 0.8 nm. The a-Si∶H materials were deposited using a range of widely varied conditions and are representative for this class of materials. We identify two different phases that are embedded in the a-Si∶H matrix and quantified both according to their scattering cross sections. First, 1.2 nm sized voids (multivacancies with more than 10 missing atoms) which form a superlattice with 1.6 nm void-to-void distance are detected. The voids are found in concentrations as high as 6×10^{19} cm^{-3} in a-Si∶H material that is deposited at a high rate. Second, dense ordered domains (DOD) that are depleted of hydrogen with 1 nm average diameter are found. The DOD tend to form 10-15 nm sized aggregates and are largely found in all a-Si∶H materials considered here. These quantitative findings make it possible to understand the complex correlation between structure and electronic properties of a-Si∶H and directly link them to the light-induced formation of defects. Finally, a structural model is derived, which verifies theoretical predictions about the nanostructure of a-Si∶H.

Conditional repair by locally switching the thermal healing capability of dynamic covalent polymers with light.

Healable materials could play an important role in reducing the environmental footprint of our modern technological society through extending the life cycles of consumer products and constructions. However, as most healing processes are carried out by heat alone, the ability to heal damage generally kills the parent material's thermal and mechanical properties. Here we present a dynamic covalent polymer network whose thermal healing ability can be switched 'on' and 'off' on demand by light, thereby providing local control over repair while retaining the advantageous macroscopic properties of static polymer networks. We employ a photoswitchable furan-based crosslinker, which reacts with short and mobile maleimide-substituted poly(lauryl methacrylate) chains forming strong covalent bonds while simultaneously allowing the reversible, spatiotemporally resolved control over thermally induced de- and re-crosslinking. We reason that our system can be adapted to more complex materials and has the potential to impact applications in responsive coatings, photolithography and microfabrication.