No drains in reduction mammaplasty - a systematic review.

Breast reduction mammaplasty is the only effective therapeutic intervention for patients with symptomatic breast hypertrophy. In this procedure, closed suction drains have become a standard of care, while the literature supporting use of drains is lacking. In fact, with emerging data we found out that drains might not be so necessary. This review aimed to systematically compare the number of complications in drained and undrained breasts and to evaluate the safety of omitting drains in reduction mammaplasty in clinical practice. A systematic review of literature was conducted identifying all studies on drainage in reduction mammaplasty. The analysed databases revealed 13 eligible studies to be included in this review. There were 308 drained breasts and 859 undrained breasts in total in patients from 16 to 73 years of age. The resected tissue weight per side fluctuated from 108 to 1,296 grams. In total, there was only 2.4% incidence of haematoma complications in undrained breasts and 3.9% in drained breasts. Closed suction drains are still being routinely used in reduction mammaplasty, although aborting drain use is proven to be not only safe, but advantageous. The clear benefit is increased patient comfort, shortened hospital stay, decreased cost of the procedure and nurse care, and decreased rate of complications.

[Surgical technique for aspiration of soft lens nucleus with preoperative femtosecond laser-assisted fragmentation]. / Khirurgicheskaya tekhnika aspiratsii myagkogo yadra khrustalika s predvaritel'noi femtolazernoi fragmentatsiei.

Fragmentation and aspiration of soft cataracts require different surgical techniques and approaches compared to the removal of dense nuclei, including when using a femtosecond laser. PURPOSE: This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. MATERIAL AND METHODS: The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. RESULTS: The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. CONCLUSIONS: Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.

Japanese Wooden Plate Denture as Origin of Suction Retention.

The modern theory of complete denture retention using suction was applied to wooden plate dentures in Japan from the first half of the 16th century, which is an astonishing achievement since it was clinically applied in North America and Europe in the latter half of the 19th century nearly 300 years later. Wooden dentures are unique to Japan resulting from skilled Japanese craftsmanship and are not found in other countries. We comprehensively reviewed reports on wooden plate dentures, analyzed 145 complete and partial dentures, and discussed their history. Japanese wooden plate dentures are mainly made of box wood, and artificial teeth are made of pagodite, ivory, and natural teeth. Small nails were driven into the molar region. Many existing dentures revealed attrition on the occlusal faces, thereby indicating that the wearers were able to masticate sufficiently. Wooden plate dentures have been used for 400 years in the early 20th century. Although Japanese wooden dentures have not been mentioned in the history of dentistry in Western literature, they comprise an important part of the history of denture development.

[Suctioning in intubated and tracheotomized patients : A narrative review]. / Absaugung bei intubierten und tracheotomierten Patient*innen : Eine narrative Übersichtsarbeit.

BACKGROUND: Endotracheal suctioning in intubated or tracheotomized critically ill patients is a daily task of various professional groups in intensive and emergency medicine; however, a German language summary of current evidence is lacking. OBJECTIVE: The aim is to develop a narrative overview of current evidence on endotracheal suctioning of intubated or tracheotomized patients in the clinical setting. MATERIAL AND METHODS: A literature search was conducted in the databases Cinahl, Cochrane Library, Livivo, and Medline via PubMed by nurses with an academic degree. In addition, a hand search and applying the snowball principle were performed. Following a successful critical appraisal, all English and German language publications addressing endotracheal suctioning in the context of hospital care were included. RESULTS: A total of 23 full texts were included. After developing 6 main topics on endotracheal suction 19 articles were considered in the reporting. The results showed, among others, that routine deep suctioning once per shift is contraindicated and that the catheter should be advanced no more than 0.5-1 cm beyond the distal end of the tube or tracheal cannula. Closed suction catheters offer advantages, especially for staff protection, although studies are heterogeneous. Further training of staff is obligatory. CONCLUSION: Few conclusive studies on endotracheal suction could be found; however, with the available evidence initial conclusions can be drawn which should be considered in, for example, internal standard operating procedures. Further research is needed.

Bioinspired multiscale adaptive suction on complex dry surfaces enhanced by regulated water secretion.

Suction is a highly evolved biological adhesion strategy for soft-body organisms to achieve strong grasping on various objects. Biological suckers can adaptively attach to dry complex surfaces such as rocks and shells, which are extremely challenging for current artificial suction cups. Although the adaptive suction of biological suckers is believed to be the result of their soft body's mechanical deformation, some studies imply that in-sucker mucus secretion may be another critical factor in helping attach to complex surfaces, thanks to its high viscosity. Inspired by the combined action of biological suckers' soft bodies and mucus secretion, we propose a multiscale suction mechanism which successfully achieves strong adaptive suction on dry complex surfaces which are both highly curved and rough, such as a stone. The proposed multiscale suction mechanism is an organic combination of mechanical conformation and regulated water seal. Multilayer soft materials first generate a rough mechanical conformation to the substrate, reducing leaking apertures to micrometres (~10 µm). The remaining micron-sized apertures are then sealed by regulated water secretion from an artificial fluidic system based on the physical model, thereby the suction cup achieves long suction longevity on complex surfaces but minimal overflow. We discuss its physical principles and demonstrate its practical application as a robotic gripper on a wide range of complex dry surfaces. We believe the presented multiscale adaptive suction mechanism is a powerful unique adaptive suction strategy which may be instrumental in the development of versatile soft adhesion.

Treatment Options and the Management of Complications in Hydatid Cysts of the Liver in Endemic Regions.

BACKGROUND: Hydatid cyst of the liver induced by Echinococcus granulosus is a pervasive zoonotic disease in our region. Its incidence varies across age groups, contingent on community lifespans and hygiene standards. Therapeutic modalities include Puncture, Aspiration, Injection, Re-aspiration (PAIR), and surgery. Due the limited feasability of PAIR, we suggest that surgery represents the optimal treatment in all stages, especially in endemic regions, depending on patient-specific variables. METHOD: Patients with hydatid cyst of the liver treated with PAIR and surgery in our center between January 2016 and January 2022 were analyzed retrospectively. PAIR or cystectomy were applied in treatment. These were then compared in terms of efficacy, feasibility, and complications. RESULTS: A single hydatid cyst of the liver was detected in 184 of the 225 cases, two cysts in 33, and three or more cysts in eight. The largest cyst diameter was 233 × 124 mm in the surgery group and 100 × 90 mm in the PAIR group. One hundred thirty-three of the 225 patients underwent open surgery, and no recurrence was encountered in these. However, recurrence was observed 19 patients treated with PAIR. Allergic reaction developed in one case during surgery, postoperative abscess in two cases, biliary fistula in five, and pneumonia in one. CONCLUSION: Surgical treatment should represent the standard procedure since it is safe and effective, ensures complete elimination of the parasite, involves no intraoperative shedding, preserves healthy tissues, and minimizes the risk of long-term recurrence and cavity-related complications.

Research and application of bag filter system for railway ballast bed coal suction vehicles: An optimization and application study.

The current bag filter system used by railway ballast bed coal suction vehicles for cleaning coal dust from railway tunnels has low operational efficiency and generates significant volumes of dust. This paper describes a simulation test unit designed to enhance the dust removal performance in railway tunnels. The flow field inside the simulation test unit is investigated under different operating conditions through numerical simulations, and the variations in air volume and working resistance, total dust collection efficiency, and optimal operating parameters of a pulse cleaning system are identified through a series of experiments. The numerical results show that the pulse cleaning system does not significantly affect the uniformity of the flow field distribution at the bottom of the filter cartridge during the process of operation. The experimental research indicates that the simulation test unit satisfies the design requirements, achieving an average total dust removal efficiency of 99.93%. A field application shows that the total dust mass concentration at the operator position can be reduced from 335.8 mg∙m-3 to 4.2 mg∙m-3, effectively improving the operating environment within the tunnel.

Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm-3 cm: a randomized controlled study from a university teaching hospital.

PURPOSE: To assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24-30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm. METHODS: From February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups. RESULTS: Mean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98% vs 94%, p = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant. CONCLUSION: Super-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.

Stickiness in shear: stiffness, shape, and sealing in bioinspired suction cups affect shear performance on diverse surfaces.

Aquatic organisms utilizing attachment often contend with unpredictable environments that can dislodge them from substrates. To counter these forces, many organisms (e.g. fish, cephalopods) have evolved suction-based organs for adhesion. Morphology is diverse, with some disc shapes deviating from a circle to more ovate designs. Inspired by the diversity of multiple aquatic species, we investigated how bioinspired cups with different disc shapes performed in shear loading conditions. These experiments highlighted pertinent physical characteristics found in biological discs (regions of stiffness, flattened margins, a sealing rim), as well as ecologically relevant shearing conditions. Disc shapes of fabricated cups included a standard circle, ellipses, and other bioinspired designs. To consider the effects of sealing, these stiff silicone cups were produced with and without a soft rim. Cups were tested using a force-sensing robotic arm, which directionally sheared them across surfaces of varying roughness and compliance in wet conditions while measuring force. In multiple surface and shearing conditions, elliptical and teardrop shapes outperformed the circle, which suggests that disc shape and distribution of stiffness may play an important role in resisting shear. Additionally, incorporating a soft rim increased cup performance on rougher substrates, highlighting interactions between the cup materials and surfaces asperities. To better understand how these cup designs may resist shear, we also utilized a visualization technique (frustrated total internal reflection; FTIR) to quantify how contact area evolves as the cup is sheared.

Develop of endocavitary suction device for MiECC on minimally invasive mitral valve surgery.

The minimally invasive extracorporeal circulation (MiECC) system was developed to minimize the contact of blood with air and foreign surfaces during conventional cardiopulmonary bypass (CPB). It is also aimed to reduce the inflammatory response by further increasing the biocompatibility of the components that make up the MiECC circuits. The Minithoracotomy (MTH) approach for mitral valve disease remains associated with prolonged operative times, but it is beneficial in terms of reduced postoperative complications (renal failure, atrial fibrillation, blood transfusion, wound infection), length of stay in intensive care unit (ICU) and in hospitalization, with finally a reduction in global cost. Combining the use of the MiECC technique with minimally invasive mitral valve surgery (MIMVS) could open up new research scenarios. Although considerable progress has been made in the standardization of the surgical technique, limitations remain to be filled in the setting of Endo-cavitary aspiration for the association of MiECC with MIMVS. In this paper we introduce invention refers to a device and an air-closed endocavitary aspiration system for cardiac chamber surgery, as well as a method aimed at eliminating gaseous micro-embolic activity, hemolysis and CO2 aspiration and alteration of carbon dioxide production (VCO2) the parameters for goal directed perfusion. The system allows the surgery of the cardiac chambers to be associated with a minimally invasive extra-corporeal circulation circuit.

Inducing cavitation within hollow cylindrical radially polarized transducers for intravascular applications.

Thrombotic occlusions of large blood vessels are increasingly treated with catheter based mechanical approaches, one of the most prominent being to employ aspiration to extract clots through a hollow catheter lumen. A central technical challenge for aspiration catheters is to achieve sufficient suction force to overcome the resistance of clot material entering into the distal tip. In this study, we examine the feasibility of inducing cavitation within hollow cylindrical transducers with a view to ultimately using them to degrade the mechanical integrity of thrombus within the tip of an aspiration catheter. Hollow cylindrical radially polarized PZT transducers with 3.3/2.5 mm outer/inner diameters were assessed. Finite element simulations and hydrophone experiments were used to investigate the pressure field distribution as a function of element length and resonant mode (thickness, length). Operating in thickness mode (∼5 MHz) was found to be associated with the highest internal pressures, estimated to exceed 23 MPa. Cavitation was demonstrated to be achievable within the transducer under degassed water (10 %) conditions using hydrophone detection and high-frequency ultrasound imaging (40 MHz). Cavitation clouds occupied a substantial portion of the transducer lumen, in a manner that was dependent on the pulsing scheme employed (10 and 100 µs pulse lengths; 1.1, 11, and 110 ms pulse intervals). Collectively the results support the feasibility of achieving cavitation within a transducer compatible with mounting in the tip of an aspiration format catheter.

Routine closed-suction drainage reduces seromas following totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis.

BACKGROUND: The value of prophylactic closed-suction drainage in totally extraperitoneal inguinal hernia repair (TEP) is still a matter of controversy. We conducted a meta-analysis of studies examining postoperative seroma rates in patients with or without routine placement of closed-suction drainage tubes. METHODS: A systematic literature search was conducted for trials comparing the outcome of TEP with or without routine drainage placement. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The odds ratio and standardized mean differences with 95% confidence intervals were calculated. RESULTS: Four studies were identified, involving a total of 1626 cases (Drain: n = 1251, no Drain: n = 375). There was a statistically significant difference noted between the 2 groups regarding postoperative seroma formation favoring the Drain group (odds ratio = 0.12; 95% confidence intervals [0.05, 0.29]; P < .001; 4 studies; I2 = 72%). For the remaining secondary endpoints postoperative urinary retention, recurrence, mesh infection and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. CONCLUSION: Current evidence suggests that patients who underwent TEP with routine closed-suction drain placement developed significantly fewer seromas without any additional morbidity or prolongation of in-hospital stay.

Supplemental Oxygen Concentrations and the Use of Suction to Mitigate Risk of Oral Surgical Fires Using a Laboratory Model.

Purpose: Intraoral oxygen pooling during dental sedation, especially using supplemental oxygen, is associated with an increased risk of spontaneous perioperative fire. The purpose of this in vitro study was to examine the effectiveness of intraoral suctioning for reducing oxygen pooling to safe levels during a simulated dental procedure. Methods: Phase one: Twenty trials were completed for each of the three suctioning devices: high-volume evacuation (HVE), fixed tip saliva ejector (SE), and Yankauer suction (YS). Phase two: Twenty trials were completed for each of three suctioning scenarios: no suctioning and continuous suctioning for the HVE and SE. Results: In phase one, the slope for change (decrease) in oxygen during suction was significantly larger for SE than HVE (P<0.001) and YS (P<0.001), but for HVE and YS were not significantly different. Mean oxygen levels during suction were significantly higher for SE than HVE (P<0.001) and YS (P<0.001). In phase two, oxygen increased faster for no suction than for SE and HVE (P<0.001) and increased faster for SE than HVE (P<0.001). Mean oxygen levels were significantly lower for HVE than for SE (P<0.001) and no suction (P<0.001), and significantly lower for SE than no suction (P<0.001). Conclusion: All three devices were effective for reducing intraoral oxygen concentration to acceptable levels during the procedure. The HVE was the most effective suction device for rapidly evacuating pooled intraoral oxygen.

Experimental study of a new technique for minimally invasive percutaneous nephrolithotomy: intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy.

BACKGROUND: To test the reliability and safety of a newly invented technique for minimally invasive percutaneous nephrolithotomy, intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy (IPC-MPCNL). METHODS: Eighteen kidneys of nine female pigs were randomly divided into three groups. Those in Groups A and B underwent IPC-MPCNL through the new system composed of a pressure-measuring MPCNL suctioning sheath and an irrigation and suctioning platform with pressure feedback control. The infusion flow rate was 500 ml/min in Group A and 750 ml/min in Group B. Those in Group C underwent MPCNL at an infusion flow rate of 500 ml/min. The renal pelvic pressure (RPP) monitored by a ureteral catheter and that monitored by the pressure-measuring sheath in Groups A and B were compared. The RPP in Group C was monitored by a ureteral catheter. RESULTS: The RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group A was - 5.59 ± 1.95 mmHg and 4.46 ± 2.08 mmHg, respectively. The RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group B was - 4.00 ± 2.01 mmHg and 5.92 ± 2.05 mmHg, respectively. Hence, the RPPs measured by the pressure-measuring sheath in Groups A and B were consistent with those measured by the ureteral catheter. The RPP in Group C was 27.75 ± 5.98 mmHg (large fluctuations). CONCLUSIONS: IPC-MPCNL can be used to accurately monitor the RPP and maintain it within a preset safe range via suction. The new technique and the new system are safe and reliable.

Comparative analytical study of suction drum foundation penetration characteristics of guide frame platforms with real measurements.

A suction bucket foundation is a new type offering high construction efficiency, precise positioning, cost-effectiveness, and environmental friendliness. It has been extensively employed in marine resource development, particularly in offshore wind power and oil and gas extraction. It usually involves multiple suction bucket conduit rack platforms during offshore construction projects. Accurately predicting the sinking penetration resistance and determining the suction value is crucial during the construction of the suction bucket foundation, as it ensures the safe sinking of the platform foundation to the designated depth. This paper examines the feasibility of the suction bucket foundation's sinking, sinking penetration resistance, suction value, and self-weight penetration depth, using the offshore wind farm guiding frame platform foundation project in Yangjiang, Guangdong Province, as a basis of analysis. The measured data is analyzed using the API specification static equilibrium analysis method, ABAQUS finite element analysis, and data mining techniques. The suction drum base platform's sinking process was monitored for negative pressure and penetration resistance. These observed values were compared to theoretical and finite element calculations. Results demonstrated that the API specification's theoretical calculations and finite element analyses effectively predict sinking penetration resistance, the suction force value, and the penetration depth for self-gravitational penetration. On-site engineering data fit these theoretical calculations, and finite element analyses well. The findings from this study have enriched the engineering application database of the suction drum foundation, providing a valuable reference for the design and construction of similar projects and establishing the groundwork for further promotion and application.