The Role of the Transjugular Intrahepatic Porto-Systemic Shunt in an Emergency Setting.

Transjugular intrahepatic porto-systemic shunt (TIPSS) is an interventional radiology procedure whose aim is to create artificial communication between the portal and the hepatic blood flow in order to reduce the pressure gradient in portal hypertension. The indications to perform a TIPSS procedure can be framed in an elective or emergency setting: refractory ascites to diuretic therapy and secondary prophylaxis of variceal hemorrhage are the most frequent reasons for executing a TIPSS in an election context, while acute uncontrolled variceal bleeding is the principal indication that a TIPSS needs to be performed in an emergency setting. In recent years, the role of the TIPSS has been redefined for several conditions, such as ectopic varices, portal vein thrombosis, Budd-Chiari syndrome, hepatic veno-occlusive disease, and many others. This review aims to perform a deep analysis of when and why a TIPSS procedure should be carried out in an emergency, pointing out the related most common technical difficulties and complications.

Yoga instructors' reported benefits and disadvantages associated with functioning online: A convenience sampling survey.

BACKGROUND: Among numerous changes in response to the COVID-19 pandemic, most yoga classes have repositioned online. However benefits, difficulties and satisfaction of teaching yoga online remain to be studied. With this background the present survey aimed to determine: (i) benefits, disadvantages and satisfaction of teaching yoga online and (ii) their association with characteristics related to (a) socio-demographic, (b) online yoga teaching experience and (c) yoga practice. METHODS: Three hundred and five yoga instructors were invited to take part in the online survey. Of these, 181 (m:f = 98:83) responded to the survey satisfactorily and were included. RESULTS: The three most common benefits of teaching yoga online were: (i) a sense of safety from risk of COVID-19 (93.92%), (ii) cost saving (82.87%) and (iii) wider access to trainees within India (77.90%). The three most common disadvantages were: (i) technical difficulties (74.03%), (ii) missing in-person contact (63.90%) and (iii) concern that online instructions can lead to injury (59.16%). Around 66.30% respondents were satisfied with the monitoring of trainees during online yoga classes while 70.16% respondents were satisfied with the level of attention they could pay to the topic they were teaching during online yoga class. The benefits and disadvantages of teaching yoga online varied with the characteristics of yoga instructors (p < 0.05, χ2 test). CONCLUSIONS: The benefits and disadvantages of teaching yoga online are of relevance during and beyond the pandemic. Characteristics related to (i) socio-demographics, (ii) online yoga teaching and (iii) yoga practice influence reported benefits and disadvantages of teaching yoga online.

The role of transesophageal echocardiography in predicting technical problems and complications of transvenous lead extractions procedures.

BACKGROUND: Transesophageal echocardiography (TEE) is a useful tool in preoperative evaluation of patients undergoing transvenous lead extraction (TLE). HYPOTHESIS: Echocardiographic phenomena may determine the difficulty and safety of the procedure. METHODS: Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. RESULTS: TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead-to-lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%) and lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivariate analysis were: fibrous tissue binding the lead to atrial wall (OR = 1.738; p < 0.05), to right ventricular wall (OR = 2.167; p < 0.001), lead-to-lead binding sites (OR = 1.628; p < 0.01) and excess lead loops (OR = 1.488; p < 0.05). Lead-to-lead binding sites increased probability of major complications (OR = 3.034; p < 0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR = 0.296; p < 0.05), right atrial wall (OR = 323; p < 0.05) and right ventricular wall (OR = 0.297; p < 0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR = 0.307; p < 0.05). CONCLUSIONS: Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.

Review of the Technical, Toxicological, and PKPD Considerations for Conducting Inhalation Toxicity Studies on Biologic Pharmaceuticals-The Outcome of a Cross-Industry Working Group Survey.

The inhaled route is still a relatively novel route for delivering biologics and poses additional challenges to those encountered with inhaled small molecules, further complicating the design and interpretation of toxicology studies. A working group formed to summarize the current knowledge of inhaled biologics across industry and to analyze data collated from an anonymized cross-industry survey comprising 12 inhaled biologic case studies (18 individual inhalation toxicity studies on monoclonal antibodies, fragment antibodies, domain antibodies, oligonucleotides, and proteins/peptides). The output of this working group provides valuable insights into the issues faced when conducting toxicology studies with inhaled biologics, including common technical considerations on aerosol generation, use of young and sexually mature nonhuman primates, pharmacokinetic/pharmacodynamic modeling, exposure and immunogenicity assessment, maximum dose setting, and no observed adverse effect levels determination. Although the current data set is too small to allow firm conclusions, testing of novel biologics remains an active area and is likely to remain so for molecules where delivery via the inhaled route is beneficial. In the future, it is hoped others will continue to share their experiences and build on the conclusions of this review to further improve our understanding of these complex issues and, ultimately, facilitate the safe introduction of inhaled biologics into clinical use.

Infección por Dengue, un problema de salud pública en México / Dengue infection, a public health problem in México

Objetivo: Describir la infección por dengue, así como las dificultades técnicas y de participación ciudadana para la erradicación de este problema de Salud Pública en México. Metodología: Se realizó una revisión sistemática de literatura de los aspectos generales de la infección por dengue y las dificultades técnicas y de participación comunitaria que se presentan para su erradicación. Se eligieron artículos científicos desde 1995 hasta 2016, los cuales se identificaron en las bases de datos Medline, Pubmed, Scielo y Redalyc por medio de los buscadores web y Google Académico. Las palabras clave, utilizadas para la búsqueda bibliográfica en resumen o en palabras de texto completo, fueron las siguientes: dengue, infección, dificultades técnicas y participación ciudadana. La búsqueda se realizó en español e inglés. Resultados: La búsqueda en las bases de datos resultó en un total de veintidós artículos. En la totalidad de ellos se presenta información que describe la infección por dengue, el cincuenta y cuatro por ciento señalan las dificultades técnicas para la erradicación del dengue y solo el treinta y tres por ciento hacen referencia a la no participación de la población civil en la erradicación del dengue. Conclusiones: La infección por dengue es una patología que se ha descrito anteriormente y que a pesar de ello no se ha logrado su erradicación por diversas dificultades técnicas, siendo la principal: la complejidad de disminuir la presencia del mosquito Aedes aegypti, y por ciertas dificultades de participación ciudadana en dicho problema, siendo la principal: que las actividades de control y erradicación del dengue no contemplan el conocimiento previo que las personas tiene sobre el tema, ni la actitud de la población hacía dicho problema, esto ultimo podría significar resultados negativos.(AU)

Aim: To describe the dengue infection, as well as the technical difficulties and citizen participation for the eradication of this Public Health problem in Mexico. Methodology: A systematic literature review of the general aspects of dengue infection and the technical difficulties and community participation that are presented for its eradication was carried out. Scientific articles were chosen from 1995 to 2016, which were identified in the Medline, Pubmed, Scielo and Redalyc databases through web search engines and Google Scholar. The key words used for the bibliographic search in summary or in full-text words were the following: dengue, infection, technical difficulties and citizen participation. The search was conducted in Spanish and English. Results: The search in the databases resulted in a total of twenty-two articles. In all of them, information describing dengue infection is presented, fifty-four percent point out the technical difficulties for dengue eradication and only thirty-three percent refer to the non-participation of the civilian population in the dengue eradication. Conclusions: Dengue infection is a pathology that has been described previously and that despite this, its eradication has not been achieved due to various technical difficulties, the main one being: the complexity of reducing the presence of the Aedes aegypti mosquito, and certain difficulties. of citizen participation in said problem, the main one being that the dengue control and eradication activities do not contemplate the prior knowledge that people have on the subject, nor the attitude of the population towards said problema, The latter could mean negative results.(AU)

An Overview of Fiber-Shaped Batteries with a Focus on Multifunctionality, Scalability, and Technical Difficulties.

Flexible and wearable energy storage devices are receiving increasing attention with the ever-growing market of wearable electronics. Fiber-shaped batteries display a unique 1D architecture with the merits of superior flexibility, miniaturization potential, adaptability to deformation, and compatibility with the traditional textile industry, which are especially advantageous for wearable applications. In the recent research frontier in the field of fiber-shaped batteries, in addition to higher performance, advances in multifunctional, scalable, and integrable systems are also the main themes. However, many difficulties exist, including difficult encapsulation and installation of separators, high internal resistance, and poor durability. Herein, the design principles (e.g., electrode preparation and battery assembly) and device performance (e.g., electrochemical and mechanical properties) of fiber-shaped batteries, including lithium-based batteries, zinc-based batteries, and some other representative systems, are summarized, with a focus on multifunctional devices with environmental adaptability, stimuli-responsive properties, and scalability up to energy textiles, with the hope of enlightening future research directions. Finally, technical challenges in the realistic wearable application of these batteries are also discussed with the aim of providing possible solutions and new insights for further improvement.

What Makes Bariatric Operations Difficult-Results of a National Survey.

Background and objective: The most commonly performed bariatric procedures include laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB). A study comparing the degree of difficulty among those procedures could serve as a guide for decision making in bariatric surgery and further improve training programs for general surgery trainees. The aim of this study was to compare the subjective level of technical difficulty of LSG, LRYGB, and OAGB-MGB as perceived by surgeons and surgical residents. Materials and Methods: An anonymous internet-based survey was designed to evaluate the subjective opinions of surgeons and surgical residents in training in Poland. It covered baseline characteristics of the participants, difficulty of LSG, OAGB-MGB, LRYGB and particular stages of each operation assessed on a 1-5 scale. Results: Overall, 70 surgeons and residents participated in our survey. The mean difficulty degree of LSG was 2.34 ± 0.89. The reinforcing staple line with sutures was considered most difficult stage of this operation (3.17 ± 1.19). The LRYGB operation had an average difficulty level of 3.87 ± 1.04. Creation of the gastrojejunostomy was considered the most difficult stage of LRYGB with a mean difficulty level (3.68 ± 1.16). Responders to our survey assessed the mean degree of difficulty of OAGB-MGB as 2.34 ± 0.97. According to participating surgeons, creating the gastrojejunostomy is the most difficult phase of this operation (3.68 ± 1.16). Conclusion: The LSG is perceived by surgeons as a relatively easy operation. The LRYGB was considered to be the most technically challenging procedure in our survey. Operative stages, which require intra-abdominal suturing with laparoscopic instruments, seem to be the most difficult phases of each operation.

Analysis of technical difficulties of single-port and reduced port laparoscopic radical gastrectomy for gastric cancer / 中华消化外科杂志

Single-port and reduced-port laparoscopic radical gastrectomy as the innovative surgery for gastric cancer are gradually accepted nowadays,and more attentions are also paid to single-port and reduced-port laparoscopic radical gastrectomy due to its better cosmetic effect,less pain,lower incidence rate of surgical site infection and more advantages in enhanced recovery after surgery.However,in the early stage,the development of single-port and reduced-port laparoscopic radical gastrectomy were facing challenges and obstacles on account of limited surgical skills,the lack of special laparoscopic instruments,laparoscope and multi-port Trocar.In recent years,the dilemma and difficult situations were gradually resolved following by surgical techniques innovation,laparoscopic instruments and facilities improvement.It is believed that single-port and reduced-port laparoscopic radical gastrectomy will have a good prospect and breakthrough in the field of gastric cancer treatment in the future.

The impact of age on the art of mammography and how to adapt accordingly.

INTRODUCTION: Breast cancer is increasingly a disease of the elderly, and combined with the NHS Breast Screening Extension means that more elderly patients are having mammography. Increasing age can make mammography more technically difficult. This is a technical note detailing the results of a local audit which may be of interest due to potential service implications. METHOD: A retrospective audit of the first year of screening extension of The Shropshire Breast Screening Programme. Aims to collect data on patient demographics and describe the technical adaptations developed in Shropshire. RESULTS: Breast screening extension has increased by 2.5 times the number of women aged 70-74 screened, and doubled the overall numbers of women over 70 screened. Significantly more older patients are being screened to present technical challenges to a screening programme. Data was obtained from a month of screening showed that 29% of patients over 70 needed extra time for positioning. Reasons included 22% difficulty in obtaining adequate positioning and 15% needed a relative to aid with consent. DISCUSSION: In the Shropshire screening programme different technical adaptations have been developed and are key to ensuring adequate images. These include double appointments, two radiographers, thorough assessment, steeper angles, seated examinations, from-below imaging and pre-planning for subsequent screen. CONCLUSION: Significantly more older women are having breast screening due to the increasing incidence of breast cancer and the Breast Screening Programme extension. Increasing age can significantly increase time taken for adequate imaging and present technical challenges. Development of technical adaptations to art of mammography is key to achieve adequate images.

Exploration on technical difficulties of multipath system in tissue cross-reactivity studies / 药物评价研究

Tissue cross-reactivity (TCR) studies play an important role in the preclinical safety evaluation of monoclonal antibody (mAb) drugs.The objective of TCR studies is to find out off-target binding sites of mAbs,and provide valuable predictions for the toxicological evaluation and safety medication in vivo.According to the new drug application requirements of FDA,EMA and CFDA,TCR studies need to be carried out before Phase I clinic trails.As the origin of mAb drugs was transferred from murine antibodies to fully humanized antibodies in current years,immunohistochemical methods used in TCR studies were confronted with some new problems and challenges.Taking our own experiences and recent progress on TCR studies at home and abroad together,the authors summarized the recent exploration on technical difficulties of multipath system in TCR studies.This may provide valuable insight for further improving the quality of TCR studies and increase the predictive value of TCR studies for in vivo toxicological evaluation in China.

Technical aspects of revision and functional outcome after revision of the Oxford unicompartmental knee arthroplasty.

BACKGROUND: This study analysed the technical aspects of revision of the Oxford unicompartmental knee arthroplasty (OUKA) and functional results after revision. METHODS: In a historic cohort study we analysed all revised OUKAs that were primarily implanted at our clinic over a 10-year period (1998-2009). The primary aim was to investigate surgical difficulties encountered during revision surgery of the OUKA. Outcomes were the knee society score (KSS), WOMAC (Western Ontario and McMaster Universities), SF-36, VAS pain and VAS satisfaction after revision. RESULTS: During the study period, 331 OUKAs were inserted. With an average follow-up of six years and five months (range one month to nine years and eight months), there were 44 (13.3%) OUKAs that needed one or more revision surgery procedures. The average time to revision was three years and eight months (range one month to nine years and five months). The main reasons for revision surgery were bearing dislocation, malpositioning or loosening of a component and progression of osteoarthritis. Most revisions, mainly conversion to primary total knee arthroplasty (TKA), gave few surgical problems. Minor bone loss that needed no augmentation was seen most frequently. The functional outcomes after revision surgery were moderate. CONCLUSION: A limited amount of surgical difficulty during revision of OUKA was found; in all total revision cases a primary TKA was implanted. However, in most patients there were moderate functional results as well as disappointing pain and satisfaction scores after revision.

Percutaneous closure of atrial septal defect with situs solitus and dextrocardia.

Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.